Hypercoagulability in Cushing syndrome, prevalence of thrombotic events: A large, single-center, retrospective study

Maria Gabriela Suarez, Madeleine Stack, Jose Miguel Hinojosa-Amaya, Michael D. Mitchell, Elena V. Varlamov, Chris G. Yedinak, Justin S. Cetas, Brett Sheppard, Maria Fleseriu

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: The risk of Cushing syndrome (CS) patients experiencing a thrombotic event (TE) is significantly higher (odds ratio; OR 18%) than that of the general population. However, there are currently no anticoagulation guidelines. Methods: A retrospective, single-center, longitudinal study of patients undergoing all types of treatment—surgical (pituitary, unilateral, and bilateral adrenalectomy) and medical treatment—was undertaken. TEs were recorded at any point up until last patient follow-up; myocardial infarction (MI), deep venous thrombosis (DVT), and pulmonary embolism (PE) or stroke. Patients’ doses and complications of anticoagulation were recorded. Results: Included were 208 patients; a total of 165 (79.3%) were women, and mean age at presentation was 44 ± 14.7 years. Thirty-nine (18.2%) patients had a TE; extremity DVT (38%), cerebrovascular accident (27%), MI (21%), and PE (14%). Of 56 TEs, 27 (48%) were arterial and 29 (52%) were venous. Patients who underwent bilateral adrenalectomy (BLA) had an odds ratio of 3.74 (95% CI 1.69-8.27) of developing a TE. Of patients with TEs, 40.5% experienced the event within the first 60 days after surgery. Baseline 24-hour urinary free cortisol levels did not differ in patients with or without TE after BLA. Of 197 patients who underwent surgery, 50 (25.38%) received anticoagulation after surgery, with 2% having bleeding complications. Conclusions: The risk of TEs in patients with CS was approximately 20%. Many patients had more than 1 event, with higher risk 30 to 60 days postoperatively. The optimal prophylactic anticoagulation duration is unknown, but most likely needs to continue up to 60 days postoperatively, particularly after BLA.

Original languageEnglish (US)
JournalJournal of the Endocrine Society
Volume4
Issue number2
DOIs
StatePublished - Feb 1 2020

Keywords

  • Anticoagulation
  • Bilateral adrenalectomy
  • Cushing disease
  • Cushing syndrome
  • Hypercoagulability
  • Thrombotic events
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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