Cardiovascular morbidity in patients with suspected Cushing's syndrome. A prospective evaluation of the German Cushing's registry

Cushing's syndrome is associated with increased cardiovascular morbidity and mortality. Aim of our study was to evaluate patients with suspected Cushing's syndrome regarding cardiovascular risk factors and comorbidities.

The prospective phase of the German Cushing's Registry started in 2012. All patients referred to our hospital since October 2012 with the clinical suspicion of Cushing's syndrome were included in this study. Patients were characterized clinically and biochemically in a standardized fashion. Final diagnosis was based on evidence of tumor histology or adrenal insufficiency following surgery (in case of Cushing's syndrome) or longitudinal follow up (rule-out Cushing's syndrome). Cardiovascular risk factors were assessed clinically and biochemically.

Of 55 patients, 34 patients were rule-out cases of Cushing's syndrome. 21 patients had confirmed Cushing's syndrome (38%). Of them, 11 had Cushing's disease, 7 had adrenal Cushing's syndrome (including 2 patients with subclinical hypercortisolism) and 3 had ectopic Cushing's syndrome.

Regarding the cardiovascular risk profile, patients with confirmed Cushing's syndrome were more often affected by arterial hypertension (100% vs. 67.6%, p = 0.004), hyperlipidemia (66.7% vs. 29.4%, p = 0.007) or diabetes mellitus (47.6% vs. 8.8%, p = 0.001) compared to rule-out Cushing's syndrome cases. Moreover, waist-to-hip ratio was significantly elevated in patients with Cushing's syndrome compared to rule-out Cushing's syndrome cases (median 1.06 (IQR 0.16) vs. median 0.90 (IQR 0.16), p = 0.000).

In conclusion, patients with confirmed Cushing's syndrome have a higher cardiovascular risk profile compared to patients with excluded Cushing's syndrome.