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Abstract: Cushing''s syndrome is associated with increased cardiovascular morbidity and mortality. It''s also associated with other cardiac risk factors like hypertension, diabetes mellitus and obesity. Cardiovascular autonomic function impairment could predict cardiovascular morbidity and mortality. Twenty five patients with Cushing''s syndrome without diabetes and twenty five age matched healthy controls underwent a battery of cardiovascular autonomic function tests including deep breath test, Valsalva test, hand grip test, cold pressor test and response to standing from lying position. The rise in diastolic blood pressure on hand grip test and diastolic BP response to cold pressor test in Cushing''s patients were significantly less compared to healthy controls (9.83±3.90 vs 20.64±9.55, p <0.001 and 10.09±4.07 vs 15.33±6.26, p <0.01 respectively). The E:I ratio on deep breathing test was also less in the patients in comparison to controls (1.36±0.21 vs 1.53±0.19, p <0.01). Seven patients underwent the same battery of tests 6months after a curative surgery showing a trend towards normalization with significant improvement in expiratory to inspiratory ratio and sinus arrhythmia delta heart rate. To conclude, this study showed that chronic endogenous hypercortisolism in Cushing''s is associated with an impaired sympathetic cardiovascular autonomic functioning. After a curative surgery, some of the parameters tend to improve. [Copyright &y& Elsevier]

Abstract: Cardiac autonomic functions were assessed in 145 consecutive recently detected type 2 diabetics. Ninety-nine healthy persons served as controls. Criteria for normalcy were, heart rate variation during deep breathing ≥15beats/min, deep breathing expiratory to inspiratory R–R ratio ≥1.21, Valsalva ratio ≥1.21, sustained handgrip test ≥16mm of mercury, cold pressor test ≥10, BP response to standing ≤10mm of mercury and 30:15 R–R ratio on standing ≥1.04. An abnormal test was defined as the above parameters being <10beats/min, <1.21, <1.21, ≤10mm of mercury, <10, ≥30mm of mercury and ≤1.0, respectively. A borderline test was defined as, heart rate variation during deep breathing 11–14, sustained handgrip test 11–15mm of mercury, BP response to standing 11–29mm of mercury and 30:15 R–R ratio on standing 1.01–1.03. Parasympathetic dysfunction was found in 44.2% and sympathetic dysfunction in 51.9% diabetics. Among healthy controls, these figures were 11.9% and 22.1%, respectively. Cardiac autonomic function was normal in 7.8% patients and 32.5% healthy controls. [Copyright &y& Elsevier]