The heart in rare endocrine diseases: cardiometabolic studies in Cushing’s syndrome and acromegaly

Introduction: Cushing’s syndrome (CS) and acromegaly are two rare endocrine diseases associated to increased morbidity and mortality, mainly for cardiovascular events. Cardiac magnetic resonance (CMR) is the established non-invasive gold standard method for measuring (left ventricle) LV volume, cardiac function and LV mass (LVM) due to its higher accuracy and reproducibility and lower variability in comparison with echocardiography. Aim: The aim of the current study was to evaluate the metabolic profile and to perform a cardiological study through CMR in patients with CS and acromegaly. Materials and methods: This was a prospective multicentric case-control study. Consecutive patients with CS and acromegaly, both cured and with active disease, entered the study. The control group included patients with non-functioning adrenal incidentaloma matched with patients for sex, age and BMI. Metabolic and clinical parameters and CMR parameters have been compared between patients and controls. Results: Sixteen patients with CS, 20 patients with acromegaly and 18 controls entered the study. Fasting glucose levels were significantly lower in CS patients than controls (p=0.003), whereas they were significantly higher in acromegaly patients than controls (p=0.033). No significant differences were found neither in lipid levels nor in systolic and diastolic blood pressure levels between patients and controls. No significant differences in the prevalence of cardiometabolic complications were found between patients and controls. LV end-systolic volume (LV-ESV) and LV-ESV indexed with respect to the body surface (LV-ESVi) were significantly higher in CS patients than controls (p=0.041; p=0.030). Right ventricle enddiastolic volume (RV-EDV), RV-EDVi, RV-ESV and RV-ESVi were significantly higher in CS patients than controls (p=0.025; p=0.033; p=0.004; p=0.008). LV-EDV, LV-EDVi, LV-ESV and LV-ESV were significantly and markedly higher in acromegaly patients than controls (p=0.001; p=0.003; p=0.001; p=0.001). LVM was significantly higher in acromegaly patients 3 than controls (p=0.002). RV-EDV, RV-EDVi, RV-ESV and RV-ESVi were significantly and markedly higher in acromegaly patients than controls (p=0.000; p=0.001; p=0.000; p=0.000). Consequently, acromegaly patients had a significantly lower RV-EF than controls (p=0.002). Moreover, a significant correlation was found between IGF-1 levels and cardiac parameters at CMR in acromegaly patients. Conclusions: CS and acromegaly have been demonstrated to have biventricular cardiac structural and functional impairment at CMR, which seem to have a multifactorial pathogenesis: the presence of disease-related cardiovascular risk factors and a direct effect of hormone excess. The results of the current studies suggest that CMR may have a place in the cardiac work-up of selected patients with rare endocrine diseases, such as CS and acromegaly.