People with Cushing’s syndrome often experience a rise in blood pressure that puts them at a significant risk of cardiovascular ills, but most improve within 10 days after surgery to treat their hypercortisolism, a study found.
Nonetheless, fewer than half see their blood pressure normalized within one year of surgical cure, suggesting that blood pressure should be monitored in the immediate post-surgical period, and anti‐hypertensive medications adjusted to avoid cardiovascular problems.
The study, “Remission of hypertension after surgical cure of Cushing’s Syndrome,” was published in the journal Clinical Endocrinology.
Cushing’s syndrome develops when the body makes too much of the hormone cortisol, often due to tumors in the pituitary or adrenal glands. Surgical removal of the tumor is a standard treatment for the disease.
High blood pressure (hypertension) is a Cushing’s syndrome hallmark, and a major risk factor for cardiovascular injury, but usually returns to normal or near normal within one year of surgery. However, the exact timing and predictors of blood pressure improvement in these patients are not known.
A group of researchers at the National Institutes of Health examined data from 75 Cushing’s syndrome patients — 72 with ACTH-producing tumors, and three with an adrenal tumor — who had high blood pressure and whose cortisol levels returned to normal after surgery to remove their tumors.
Their main goal was to determine the proportion of patients whose high blood pressure also dropped to healthy levels (below 130/80 mmHg), either without the use of anti-hypertensive medications or with continued medication — or whose hypertension eased enough to allow a decline in doses of anti-hypertensive medications used.
Another goal was to assess the time it took for their blood pressure to drop, which these researchers thought for most would be within 10 days of surgery. They also speculated that younger age, a shorter duration of excess cortisol and high blood pressure, a milder severity of hypertension and obesity, and greater post-surgical weight loss would be predictors (most likely factors in) hypertension remission.
At the time of their hospital discharge — 10 days after surgery — 23% of the patients showed no evidence of hypertension, and 68% showed some easing in it. In total, with or without medication, blood pressure was normal in 50% of these patients, and those on medications were using a median of one fewer blood pressure medication than they were before surgery.
Patients were then followed for another three, six, and 12 months. Overall, 44% achieved remission within one year after surgery — which was not sustained in 3% of them — and an additional 48% showed improvement. Hypertension remained a problem for six patients (8%), which researchers suggested may be attributable to hypertension that is not related to Cushing’s or a genetic tendency to be hypertensive.
Younger age and a lower preoperative body mass index (BMI) — a measure of body fat — were seen as significant factors associated with a return to normal blood pressure after Cushing’s-induced hypertension.
But the duration of hypertension, severity of excess cortisol, magnitude of post-surgical weight loss, or race were not relevant factors, the study reported.
“Our data show that approximately 80% patients with co-existing hypertension and [excess cortisol] experience remission or improvement of hypertension within 10-days of surgical cure, and a further 10% achieve remission or improvement by one year,” the researchers concluded.
“Additionally, the prompt normalization of blood pressure after normalization of cortisol underscores the utility of blood pressure as a marker of possible CS [Cushing’s syndrome], especially in young individuals who are unlikely to develop essential hypertension,” they noted.