Metabolic alterations and cardiovascular outcomes of cortisol excess

Cushing's syndrome (CS) is a severe chronic and systemic condition caused by endogenous or exogenous excess of glucocorticoids, associated with increased morbidity and mortality. Patients with active CS suffer from many metabolic alterations, including visceral obesity, systemic arterial hypertension, impairment of glucose metabolism and dyslipidemia. Additionally, in these patients several cardiovascular abnormalities, i.e. atherosclerosis, clotting disorders, left ventricular hypertrophy, concentric remodeling and diastolic dysfunction have been documented. These alterations, which persist even long after hypercortisolism remission, account for the increased cardiovascular risk and greatly contribute to the increased mortality observed in patients with CS. The current review aims to discuss the main adverse effects of CS on metabolism and cardiovascular risk, focusing on the active and remission phases of disease, and underlining the importance of long-term monitoring and treatment of these complications during active disease, as well as in the long-term follow-up after CS remission.