Hypertension and kidney dysfunction despite long-term remission of Cushing's syndrome

Abstract

Purpose: Hypertension is the most frequent co-morbidity in active Cushing's syndrome (CS) and regarded as a major cardio-vascular risk factor. It is unknown whether blood pressure and related parameters, such as kidney function, recover in the long-term following remission of CS.

Methods: Blood pressure and related co-morbidities were analyzed in a cohort of 81 patients with CS (Cushing's disease: 52, ectopic CS: 8, adrenal CS: 21) from a single tertiary care center. Patients were longitudinally evaluated at baseline, at 7.1 years (6.3-7.4) and at 14 years (13.5-14.4) after biochemical remission. Data were compared to a control group matched for BMI, age and sex (n = 243) from the "Cooperative Health Research in the Region of Augsburg" study (KORA) in a 1:3 fashion.

Results: Patients with CS showed a higher median blood pressure and lower median glomerular filtration rate (GFR) compared to the matched controls, at baseline, 7 and 14 years after biochemical remission. Although the prevalence of hypertension and chronic kidney disease increased over time in the KORA cohort, patients treated for CS had a significantly higher prevalence of both comorbidities. Notably, the number of patients on antihypertensive medication declined in the Cushing's cohort, resulting in significantly higher rates of uncontrolled hypertension at follow-up.

Conclusion: The prevalence of hypertension and impaired kidney function remained elevated in patients with CS years after biochemical remission, potentially contributing to an unfavorable long-term clinical outcome. This highlights the critical need for increased monitoring and treatment of co-morbidities in patients with CS following surgical remission.

Keywords: Blood pressure; Co-morbidities; Cushing’s syndrome; Hypertension; Kidney function; Remission.