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Comparative Study
. 2009 Jun;94(6):2002-8.
doi: 10.1210/jc.2008-2694. Epub 2009 Mar 17.

Blood pressure in pediatric patients with Cushing syndrome

Maya B Lodish  1 , Ninet Sinaii, Nicholas Patronas, Dalia L Batista, Meg Keil, Jonelle Samuel, Jason Moran, Somya Verma, Jadranka Popovic, Constantine A Stratakis
Affiliations
Comparative Study

Blood pressure in pediatric patients with Cushing syndrome

Maya B Lodish et al. J Clin Endocrinol Metab. 2009 Jun.

Abstract

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.

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Figures

Figure 1
Figure 1
Distributional scatterplots of preoperative, postoperative, and 1-yr systolic BP and diastolic BP z-scores for patients with CD (A) and AICS (B). The figures depict the extent of hypertensive subjects at each interval per patient group. Dashed line corresponds to the 95th percentile z-score, at or above which hypertensive status was defined.
Figure 2
Figure 2
A, Correlation between midnight cortisol and preoperative systolic (rp = 0.22, P < 0.05) and diastolic (rp = 0.33, P = 0.0027) BP in patients with CD. B, Correlation between midnight cortisol and diastolic BP z-score (rp = 0.31, P = 0.0059) in patients with CD. C, Correlation between UFC and systolic (rp = 0.35, P = 0.0016) and diastolic (rp=0.38, P = 0.0005) BP z-score in patients with CD. D, Correlation between midnight cortisol and systolic (rp=0.55, P = 0.0027) and diastolic (rp = 0.56, P = 0.0026) BP z-score in patients with AICS. E, Correlation between UFC and systolic (rp = 0.54, P = 0.0045) and diastolic (rp = 0.53, P = 0.0050) BP z-score in patients with AICS.
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References

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