Exploration of Endocrine and Metabolic Diseases

Table 3. Pathophysiologic mechanisms linking hormonal excess to cardiac injury.

Mechanistic pathway	PA	PPGL	CS	Common outcome	Ref. No.
Mineralocorticoid receptor activation	+++	–	++	Fibrosis, hypertrophy	[3, 4, 11, 12, 41]
β-Adrenergic overstimulation	–	+++	+/–	Myocyte necrosis, arrhythmia	[23–28, 47]
Oxidative stress	++	+++	++	Mitochondrial damage	[11, 12, 24, 30, 44]
Endothelial dysfunction	++	++	+++	Arterial stiffness	[17, 23, 48, 50]
Inflammation and cytokine activation	++	++	+++	Fibrosis, remodeling	[11, 12, 24, 43, 46]

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In CS, β-adrenergic overstimulation is primarily indirect, resulting from cortisol-induced upregulation of adrenergic receptors and enhanced sympathetic sensitivity. –: denotes absence or negligible contribution; +/–: denotes weak or indirect involvement; +: denotes mild involvement; ++: denotes moderate involvement; +++: denotes strong and well-established involvement. PA: primary aldosteronism; PPGL: pheochromocytoma and paraganglioma; CS: Cushing syndrome.

Declarations

Author contributions

MMŞ: Conceptualization, Investigation, Writing—original draft. MK: Conceptualization, Writing—review & editing. MY: Writing—review & editing. MCÇ: Conceptualization, Investigation, Writing—original draft. LB: Supervision, Validation. YK: Supervision, Validation. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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No financial funding was received for this study.

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