How Do Glucocorticoids Cause Hypertension: Role of Nitric Oxide Deficiency, Oxidative Stress, and Eicosanoids

The discovery of the anti-inflammatory effects of corticosteroid hormones by Philip Hench and colleagues in 1929 revolutionized the treatments of various inflammatory conditions. Today, glucocorticoids are widely used in inflammatory conditions and in chemotherapeutic and immunosuppressive regimens for the treatment of both cancer and solid organ transplantation. Unfortunately, chronic usage of systemic glucocorticoids at supraphysiological doses, sometimes inevitable for certain medical conditions, often leads to iatrogenic Cushing syndrome, which is more common than its endogenous counterpart. Cushing syndrome, both endogenous and iatrogenic, is associated with several cardiovascular and metabolic side effects. Approximately 80% of patients with Cushing syndrome have hypertension. 1 Around 20% of patients receiving exogenous glucocorticoids have been reported to have hypertension, which can be severe in some cases. 2,3 Adrenocorticotropic hormone (ACTH) is another cause of Cushing syndrome. Endogenous ACTH excess due to pituitary ACTH overproduction (Cushing disease), such as in pituitary adenoma or ectopic ACTH release, can be associated with hypertension. The use of synthetic ACTH is currently limited to some neurologic conditions such as infantile spasms and diagnosis of certain endocrine conditions