Early Markers of Cardiovascular Dysfunction in Young Girls Affected by Cushing's Syndrome before and after Successful Cure

BACKGROUND: even after successful surgical cure, Cushing's Syndrome (CS) may induce cardiovascular (CV) diseases including hypertension, or elicit onset of CV risk factors, such as obesity. OBJECTIVES: to evaluate some early markers of CV dysfunction in adolescent girls before and after successful surgical cure of CS; to compare after surgery data with those of a control group (C) of healthy young girls. METHODS: 23 girls affected by CS were enrolled (range: 11-17 years; mean: 14.3 +/- 1.7 years). Epicardial fat thickness (EFT), intima-media thickness (IMT), N-terminal pro B-type natriuretic peptide (NT-proBNP) were assessed; transthoracic echocardiogram coupled with Tissue Doppler imaging (TDI) was performed. RESULTS (CS before surgery vs. CS after surgery): EFT (p < 0.05). (CS after surgery vs. C): EFT (p = 0.0001); IMT (p = 0.0001); NT-proBNP (p = 0.0001). TDI: isovolumetric relaxation time (p = 0.001); isovolumetric contraction time (p = 0.001); myocardial performance index (p = 0.001). Significant correlations: NT-proBNP with IRT (r = 0.45, p = 0.026 ), ICT (r = 0.47, p = 0.028), and myocardial performance index (r = 0.51, p = 0.0032). CONCLUSIONS: important structural and functional modifications of heart and vessels are present in young female CS despite successful surgical cure, even in paediatric age. It underlines their significantly higher cardiovascular risk. Our findings confirm that EFT, IMT, NT-proBNP and TDI diastolic parameters, not previously tested in paediatric CS, are early markers of cardiovascular dysfunction. Because of its relationship with TDI, the assessment of NT-proBNP proves to be the best marker in detecting a cardiovascular dysfunction in this specific population.