Blood Pressure in Pediatric Patients with Cushing Syndrome

• Published in: The journal of clinical endocrinology and metabolism 2009-06, Vol.94 (6), p.2002-2008
• Main Authors: Lodish, Maya B., Sinaii, Ninet, Patronas, Nicholas, Batista, Dalia L., Keil, Meg, Samuel, Jonelle, Moran, Jason, Verma, Somya, Popovic, Jadranka, Stratakis, Constantine A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adrenocorticotropic Hormone - physiology; Biological and medical sciences; Blood Pressure - physiology; Child; Child, Preschool; Cohort Studies; Cushing Syndrome - complications; Cushing Syndrome - physiopathology; Cushing Syndrome - rehabilitation; Cushing Syndrome - surgery; Endocrinopathies; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Hypertension - etiology; Hypertension - surgery; Male; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Original; Retrospective Studies; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2008-2694

Context: Hypertension (HTN) has been reported in up to 60% of children with Cushing syndrome (CS), but its course, side effects, and potential differences among various causes of CS have not been adequately studied. Objective: The objective of the study was to measure blood pressure in pediatric patients with CS before and after transphenoidal surgery or adrenalectomy and identify side effects and rates of residual HTN. Design: Data from 86 children with corticotropinomas [Cushing disease (CD)] and 27 children with ACTH-independent CS (AICS) were analyzed. Results: Patients with CD and AICS had significant HTN before surgery; more patients with AICS had systolic HTN (SHTN) than with CD (74 vs. 44%, P = 0.0077), but the rate of diastolic HTN (DHTN) was similar. Both groups experienced significant decreases in SHTN immediately after transphenoidal surgery and adrenalectomy. One year postoperatively, both SHTN and DHTN were lower than the preoperative values in all patients, but as many as 16 and 4% of the patients with CD and 21 and 5% of the patients with AICS still had SHTN and DHTN, respectively. Higher blood pressure preoperatively correlated with cortisol levels. Two patients suffered serious side effects: one with multiple infarcts and another with hypertensive encephalopathy. Conclusions: Children with CS are at risk for residual HTN despite a significant improvement after surgical cure. HTN appears to correlate with the degree of hypercortisolemia. Serious HTN-related side effects, although rare, may occur during the perioperative period. Children with Cushing’s syndrome are at risk for residual hypertension despite a significant improvement after surgical cure.