It is well known that hypercortisolism is associated with increased morbidity and mortality caused predominantly by vascular and atherosclerotic complications. The effect of hypercortisolism on microvasculature is less known. The aim of this study was to evaluate skin microvascular reactivity (MVR) in relation to arterial hypertension, diabetes mellitus and other possible influencing factors (fibrinolysis, oxidative stress and endothelial function) in patients with Cushings syndrome (CS).
Twenty-nine patients with active CS, 10 patients at least 6 months after successful operation and a group of 16 control subjects were studied. Skin MVR was measured by laser Doppler flowmetry during post-occlusive (PORH) and thermal hyperemia (TH). Selected parameters of fibrinolysis, oxidative stress and endothelial activity were determined as well.
We found an impaired microvascular reactivity in patients with CS. Maximal perfusion during PORH and TH was significantly lower in patients with arterial hypertension (P<0.01, P<0.05, respectively) as was the velocity of perfusion increase during PORH and TH (P<0.05). The most expressed impairment of microvascular reactivity was present in patients with combination of arterial hypertension and diabetes mellitus. Impaired fibrinolysis, increased oxidative stress and endothelial dysfunction were present in patients with hypercortisolemia, however, increased concentration of ICAM-1 was found also in patients after operation as compared to controls (P<0.05). It documents the presence of persistent endothelial dysfunction also in cured patients.
Based on the obtained results, we conclude that the impairment of microvascular reactivity in hypercortisolism can be modulated by many factors but the most important is the presence of arterial hypertension. The combination of arterial hypertension and diabetes mellitus led to the most decreased microvascular reactivity in patients with Cushings syndrome.
Study was supported by the grant IGA Ministry of Health Czech Republic No. NR/9438-3 and approved by local Ethical Committee.
03 - 07 May 2008
European Society of Endocrinology