Glucocorticoid excess syndromes causing hypertension.

The adrenal glucocorticoid secretions undoubtedly perform necessary physiologic functions in maintaining normal blood pressure when secreted at their ordinary rate or in response to short term stress. Sustained glucocorticoid excess, in Cushing's syndrome or during prolonged therapy with synthetic steroids, leads to arterial hypertension and arteriosclerotic cardiovascular disease through a plentiful variety of pathogenetic mechanisms. Naturally occurring Cushing's syndrome should be readily detected, treated, and reversed unless due to metastatic malignancy. The benefits of glucocorticoid treatment as immunosuppressive and anti-inflammatory therapy are genuine, but the price includes cardiovascular disease. It is likely that the past role of glucocorticoid therapy will be supplanted by new strategies that minimize steroid dose, employ nonsteroid regimens, and perhaps lead to the development of specific steroids that possess only beneficial actions without potential for cardiovascular toxicity.