Cardiovascular Manifestations
Three-quarters [6] of patients with Cushing’s syndrome may have systemic arterial hypertension (SAH), which will be added to other cardiovascular risk factors that may also be present, such as dyslipidemia and insulin resistance.
SAH occurs due to different mechanisms; first, there will be an increase in plasma volume due to increased renal retention of sodium and, consequently, of water. This is due to the effect of cortisol in the kidney tubules.
It should be noted that this same effect can lead to hypokalemia with metabolic alkalosis. Water retention can also, in cases of more severe hypercortisolism, cause the formation of peripheral edema. Endothelial dysfunction will also occur, due to the increased production of vasoconstrictors and the inhibition of the release of several vasodilating factors, promoted by cortisol. Such condition, added to the increased pressure physiological response by the body, will increase peripheral vascular resistance and cardiac output.