Comparison Of Clinical Characteristics Of Different Types Of Cushing's Syndrome And Analysis Of Influencing Factors Of Cardiovascular And Cerebrovascular Diseases

PurposeThe aim of this study was to compare the clinical features of patients with different types of Cushing's syndrome(CS)and to explore the risk factors for cardiovascular and cerebrovascular disease in CS patients.Method102 patients with CS diagnosed in our hospital were enrolled.The clinical data of the patients were collected.The demographics,clinical manifestations,hortmone levels,laboratory indexes and complications of different etiology were compared and analyzed.CS patients were divided into two groups according to whether they had cardiovascular and cerebrovascular diseases.Logistic regression analysis was used to analyze the related factors.Result(1)Patients characteristics:The number of women in Cushing's syndrome was significantly higher than that of men(6.8:1).The average age of patients with CS was 42.7±14.2 years,and the median duration was 12(6-48)months.The etiology was 30.4%for Cushing's disease(CD),54.9%for adrenal adenoma,7.8%for ACTH independent bilateral macronodular adrenal hyperplasi(AIMAH),3.9%for adrenal carcinoma,and 2.9%for ectopic ACTH syndrome.Compared with adrenal adenoma and AIMAH,CD group had the highest proportion of women,the youngest age and shorter course of disease;the AIMAH group is equal in proportion to men and women,and is older and has a longer course;the adrenal adenoma group accounted for a large proportion of women,and the course of disease was longer than the CD group.(2)Clinical manifestations:There are differences in clinical manifestations between different types and genders.The most common symptoms of female are full moon face,centripetal obesity,hypertension and edema.In men,hypertension,hypokalemia and weakness are more common.The typical Cushing symptoms are more common in patients with CD,while hypertension in the adrenal adenoma and AIMAH patients is more commen.In the CD group,the typical Cushing face and pigmentation were significantly higher than those in the adrenal adenoma group and AIMAH group;the AIMAH group had significantly fatigue symptoms than the CD and adrenal adenoma group.(3)Cortisol levels:There were significant differences in blood cortisol levels between three groups at 8 am and 0 midnight.Patients with CD had the highest cortisol level,while those with adrenal adenoma and AIMAH were lower and AIMAH was the lowest.(4)Laboratory indicators:There were no significant differences in blood cells,coagulation function,glucose,insulin resistance,serum uric acid and liver function in the three groups.The levels of triglyceride and ferritin in the AIMAH group were significantly higher than those in others.And estimated glomerular filtration rate of adrenal adenoma and AIMAH groups was significantly lower than that of CD group.(5)Pituitary axis hormones:There were no significant differences in thyroid hormone and growth hormone levels between three groups.Among female patients,CD group had the lowest follicle stimulating hormone(FSH),Luteinizing hormone(LH)and the highest testosterone level.The higher the cortisol level,the lower the TSH,FT3 and growth hormone,and in female patients,the higher the cortisol level,the lower the FSH and' LH and the higher the testosterone level.(6)Complications:Diabetes,kidney stones,and hypokalemia complications were not significantly different among the three groups.The incidence of osteoporosis was higher in patients with adrenal adenoma.And the higher the cortisol level,the lower the serum calcium,phosphorus,bone formation markers(PICP,N-MID),while the bone resorption marker(?-CTx)did not change.The AIMAH group had the highest proportion of hypertension,and the highest proportion of fatty liver and cardiovascular disease.(7)Multivariate logistic regression showed that age increasing,elevated serum uric acid level and neutrophil/lymphocyte ratio(NLR)were independent risk factors for cardiovascular and cerebrovascular disease in CS patients.ConclusionThe clinical characteristics of patients with different types of Cushing's syndrome are significantly different.Age increasing,elevated serum uric acid level and NLR are independent risk factors for cardiovascular and cerebrovascular disease in CS patients.