ACTA ENDOCRINOLOGICA (BUC)

Background The cardiovascular risk in obese patients is very high and is the main cause of mortality and morbidity. While many studies have focused on obese patients who already developed cardiovascular pathologies few tried to address the prevention of atherosclerosis in healthy young adults. Objectives In the present study we assessed the effect of weight loss on atherosclerosis risk factors and on vascular stiffness. While no important clinical events were expected our goal was to show that weight loss in obese patients will lower the vascular risk. Subjects and methods 159 obese patients with no cardiovascular pathology were assigned, for 6 months, to either weight loss program or a weight maintenance recommendation. The intensive care group subjects participated to weekly visits consisting of counseling on hypocaloric diets and physical exercise programs. We have measured BMI, lipid profile, adipokines levels, glycemia as well as markers of arterial stiffness (CAVI, BP, ABI). Results At the study endpoint, we found a clinically and statistically significant (p<0.001) difference between the lipid and the adipokines profiles, and, in univariate analysis, this difference correlates with weight loss: for total cholesterolemia decrease r= 0.63, LDL decrease r= 0.65, HDL increase r= -0.48, adiponectin increase r= -0.59, leptin decrease r=0.6 and also with abdominal circumference decrease. We also found correlation between vascular stiffness parameters (CAVI, diastolic blood pressure) and the adipose tissue loss (r = 0,71; p < 0,001 for CAVI and r = 0,4; p = 0,001 for DBP). Conclusions : We found that using a moderate hypocaloric diet and encouraging physical exercise, even after a short period of time, subjects can lose weight, mainly by losing fat mass. The weight loss improved the lipid and adipokines levels and had reduced vascular stiffness

Endogenous Cushing’s syndrome is rare, with an incidence of 0.7–2.4 per a million people a year. Clinical presentation of Cushing syndrome can be pleomorphic, and establishing diagnosis can be difficult. Early recognition and rapid control of hypercortisolaemia are necessary to decrease morbidity and mortality in these patients. We report a series of 6 endogenous Cushing’s syndromes of different etiologies (4 Cushing’s disease and 2 adrenal Cushing’s syndrome) assessed in our endocrine department over a decade (2009-2019). In order to highlight the diversity of clinical forms, diagnostic tools and specific management of this condition we labelled each case suggestively: the typical Cushing’s disease, the Pseudo Cushing’s, the elusive Cushing’s disease, the mild autonomous cortisol hypersecretion, Cushing’s syndrome in pregnancy and Cushing’s disease with thromboembolism. We discussed their particularities which were revelatory for the diagnosis, such as dermatologic, cardiovascular, musculoskeletal, neuropsychiatric, or reproductive signs, reviewing literature for each manifestation. We also discuss the commonalities and differences in laboratory and imagistic findings. Therapeutic approach can also differ with respect to the particular condition of each patient and the multiple choices of therapy will be reviewed.