Influence of Hypercortisolism on the Origin and Development of Arteriosclerotic
Vascular Changes
Ježková J.1, Marek J.1, Prázný M.1, Kršek M.1, Malíčková K.2, Rosická M.1,Jarkovská Z.1, Pecen L.
1III. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. Š. Svačina, DrSc. 2Ústav imunologie 1. lékařské fakulty UK a VFN, Praha, přednosta doc. MUDr. I. Štercl, CSc.3Ústav informatiky Akademie věd České republiky, Praha, ředitel doc. RNDr. J.Wiedermann, DrSc. |
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Summary:
Hypercortisolism is associated with a high risk of sickness rate and death rate particularly in
view of facilitated arteriosclerotic processes. It is most frequently induced by drug therapy, but
endogenous hypercortisolism (Cushing's syndrome) may serve as a suitable model of the effect of
hypercortisolism on vascular wall. Our cohort included the following groups of patients and
control individuals: 1. a group of patients with florid so far untreated Cushing's syndrome - 14
patients, 2. a control group to these patients - 16 individuals, 3. a group recently operated on and
healed-up patients with Cushing's syndrome - 8 patients, 4. a group of previous of previous cured-
up patients with Cushing's syndrome - 27 subjects, 5. a control group to those patients of
group 4 - 17 persons. The following differences were found between the respective groups: 1. the
ultrasonographic examination of carotid arteries demonstrated sclerotic plates or carotid stenosis
in 21.3 % of patients with florid Cushing's syndrome and 41.4 % in patients with corticolism
having been cured-up against 11.7 % in the relevant control group; 2. the examination of skin
microcirculation by the laser-doppler method revealed a lower velocity of perfusion increase
during examination of postocclusion hyperemia in patients with florid Cushing's syndrome and
hypercortisolism having been cured-up against a control group (CUSH., P < 0.04; previous curedup,
P < 0.02) as well as thermally-induced hyperemia (CUSH., P < 0.03; formerly cured-up, P <
0.04); 3. the laboratory examination of patients with florid Cushing's syndrome revealed higher
values of LDL-cholesterol (P < 0.05) and total cholesterol (P < 0.001), malonyldialdehyde as an
indicator of increased formation of oxygen radicals (P < 0.05) and oromucoid, the protein of acute
phase, signaling a chronic inflammation (P < 0.05); 4. in patients who previously suffered from
hypercortisolism increased levels of fibrinogen (P < 0.03) and the cytoadhesive molecule ICAM-1
(P < 0.05) were accompanied by decreased levels of the growth factor of vascular endothelia
(VEGF) (P < 0.05) against patients with florid Cushing's syndrome. Conclusion: The findings of the
examinations performed indicate that increased incidence of arteriosclerotic processes is present
in patients with the florid Cushing's syndrome as well as in those who have suffered from
Cushing's syndrome before.
Key words:
Hypercortisolism - Arteriosclerosis -
Cytoadhesive molecules - Microcirculation
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