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Overview rationale and to suggest enlisting cushing’s syndrome

OVERVIEW OF THE MEDICALLITERATURE ON THE TOPICThe intention of the paper is to give rationale and to suggest enlistingCushing’s syndrome (CS) amongst high cardiovascular (CV) risk conditions. A considerableamount of data refers to several-fold amplified mortality in CS. The causes arebased on high occurrence of many CV risk factors in persons with CS (e.

g., adiposity, arterial hypertension, dyslipidemia, as well as diabetes mellitus /DM/). Therefore, practically all individuals with CS have correspondingly the metabolic syndrome(MetSy), which is known as laden with high CV risk. Characteristically, in spite of the young average age, numerous of CS individuals dysplaya ‘ high’ or a ‘ very high’ CV risk, with the risk of a major CV event of over20% in the following ten years. Although DM is listed as a conditionwith high cardiovascular risk CSis not, despite the fact that the greater part of CS populationhave either diabetes mellitus or diagnosed impaired glucose tolerance. CS is stated as a risk factor for aortic dissectionin current guidelines, and it should be named as a disease with high CV risk (alikeDM and chronic kidney disease) in the relevant guidelines, as well.

Key-Words: Cushing’ssyndrome, diabetes mellitus, arterial hypertension, metabolic syndrome, cardiovascularrisk factors. Chroniccorticosteroid administration (i. e. CS) is enlistedin 2010 Guidelines as a risk factor (RF) for aortic dissection with lack ofdetailed elucidation (1). Accordingly, what is evident both from commonmedical sense, as well as from everyday practice (that CS should be consideredas a kind of high cardiovascular /CV/ risk) is not in Guidelines; nevertheless, what is neither noticeable, nor common (that CS persons are predisposed toaortic dissection) is a part of current Guidelines (1).

The intention of the paper isto give rationale (from published medical literature) and to suggest enlistingCS amongst high cardiovascular risk conditions. OVERVIEW OF THE MEDICAL LITERATURE ON THE TOPICExogenous (mostly iatrogenic) CS isthe repercussion of the applying of glucocorticoids or adrenocorticothropichormone (ACTH). Iatrogenic CS is nowadays definitely the most frequent form of allforms of CS. In other words, as many as one percent of the populace is receiving corticosteroidsper os (even 3% of individuals over 70 years old ), plus individuals whouse other administration routes (e. g., inhalation, transdermal, intravenous, intramuscular, intraarticular, rectal, etc) (2). Whileendogenous form of CS is practically rare, a markedly high percentage (0.

8-2%)of the overall population has long-term/high-dose glucocorticoid therapy (3). Wei et al. examined exactly 68, 781 persons who were on glucocorticoid therapy, as well as 82, 202controls with lack of earlier hospitalization for CV illness (more than 150, 000 individuals in whole). Independently of known covariates, estimatedrelative risk (adjusted rate ratio) for  CV events, was  2. 56 (CI, 2. 18-2.

99) in individuals whohave received glucocorticoids in high doses (4). This population-based research demonstrates that individualswho were treated with daily doses of glucocorticoids larger than 7. 5 mg ofprednisolone (or dose equivalents of other glucocorticoids) during one to five yearsof follow-up period, had significantly higher prevalence of all CV diseases, e. g.

, myocardial infarction, cardiac insufficiency, as well as cerebrovascular illness(4).  Sincemany individuals were administered corticosteroid therapy, it has a considerableclinical relevance (5)

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