Nailfold Capillaroscopy Evaluation in Cushing Syndrome Patients

Study Overview
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Brief Summary
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This cross-sectional, single-center study will assess the microvascular function using a nailfold video-capillaroscopy in patients with endogenous Cushing syndrome.

Detailed Description
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Endogenous Cushing's syndrome (CS) is associated with increased macrovascular diseases and impaired endothelial function. There is no clear data about the effects of hypercortisolism on microcirculation. The primary aim of this study is to evaluate the peripheric microvascular area in patients with Cushing's syndrome. The association of microvascular changes with present comorbidities (diabetes, hypertension, etc.) and disease activation will be evaluated. Method: Cushing syndrome patients admitted to our clinic will be included in this study for the next six months after given informed consent. The following clinical laboratory parameters will be evaluated as cross-sectionally. Previous medical history, available laboratory parameters (fasting plasma glucose, HbA1c, total cholesterol, triglyceride, HDL, LDL, creatine, AST, ALT, complete blood count, ACTH, dexamethasone suppression tests (1 mg- 2mg), urine free cortisol, FSH, LH, total testosterone, estradiol, IGF-1, TSH, free T3, free T4, prolactin), radiologic images (Cranial MRI and Adrenal MRI) will be recorded from medical charts. Nailfold microcirculation will be evaluated with video-capillaroscopy: it is a non-invasive atraumatic assessment of the morphology and some functional aspects of cutaneous capillaries.

Official Title
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Skin Microcirculation Evaluation With Nailfold Capillaroscopy in Cushing's Syndrome Patients

Conditions
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Cushing Syndrome, Hypercortisolism

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female patients diagnosed as Cushing syndrome (CS) caused by ACTH-producing pituitary adenoma or cortisol producing adrenal adenoma Age between 18 and 70 years Exclusion Criteria: Chronic glucocorticoid use CS caused by ectopic ACTH producing tumors CS caused by adrenocortical carcinoma Pseudo CS Patients with Raynaud phenomenon Patients with collagen tissue disease Patients who use drugs that affect the metabolism of fibrinolysis (such as oral contraceptives) Employees at work at risk of microtrauma (such as gardeners, farmers) Skin diseases with nail fold involvement (such as dermatitis, psoriasis)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cushing syndrome<br>Male and female patients diagnosed as Cushing syndrome caused by ACTH-producing pituitary adenoma or cortisol producing adrenal adenoma | |
| Controls<br>Healthy controls matched for age, gender, and body mass index | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nailfold capillary number of tortuous loops | Nailfold capillary area changes | 6 months | 
| Nailfold capillary area number of meandering capillaries | Nailfold capillary area changes | 6 months | 
| Nailfold capillary avascular areas | Nailfold capillary area changes | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between nailfold capillary number of tortuous loops and presence of diabetes | Independent risk factors that affected nailfold capillaroscopy images | 6 months | 
| Correlation between nailfold capillary number of tortuous loop with urine free cortisol levels | Presence and severity of hypercortisolism as an independent risk factor | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cushing's syndrome, Capillaroscopy, Cushing's disease, Adrenal adenoma, Nailfold capillary, Microvascular circulation