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Venous thromboembolism in patients with Cushing’s syndrome: need of a careful investigation of the prothrombotic risk profile

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Abstract

A high incidence of venous thromboembolic (VTE) complications has been reported in Cushing’s syndrome (CS), mostly post-operatively and attributable to hypercoagulability. The prevalence of symptomatic VTE was investigated retrospectively in 58 consecutive CS patients in relation to acquired and genetic thrombotic risk factors. Eight CS patients (14 %) developed VTE (group A), 3 of them related and 5 unrelated to surgery. These patients had higher urinary free cortisol (p = 0.01) and VWF levels (p = 0.02) than the 50 patients without VTE (group B), as well an increase in the hemostatically more efficient, high-molecular-weight VWF multimers (p = 0.002). Factor V Leiden and the prothrombin gene 20210A variants (the most common inherited thrombophilic defects) were more represented in group A than in group B, as was the genotype GCAG/GCAG of the VWF gene promoter, known to hyperinduce VWF upregulation under cortisol excess. All but one of the patients with VTE unrelated to surgery had at least four acquired and at least one inherited risk factor. Severe hypercortisolism and VWF levels with increased haemostatic activity are strongly associated with VTE in CS. VTE episodes unrelated to surgery are attributable to the synergistic action of acquired and inherited thrombotic risk factors. Based on these observations, we believe that severely affected CS patients should be screened for coagulation disorders and receive antithrombotic prophylaxis whenever they have concomitant prothrombotic risk factors.

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Conflict of interest

The authors declare that they have no conflict of interest. This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale 105, 35128, Padua, Italy

    S. Koutroumpi, N. M. Albiger, G. Occhi, S. Ferasin, F. Mantero & C. Scaroni

  2. Department of Cardiological, Thoracic and Vascular Sciences, Second Chair of Internal Medicine, University of Padua Medical School, Padua, Italy

    V. Daidone, M. T. Sartori, M. G. Cattini & A. Casonato

  3. Department of Environmental Medicine and Public Health, University of Padua Medical School, Padua, Italy

    A. Frigo

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  1. S. Koutroumpi
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  2. V. Daidone
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  3. M. T. Sartori
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  4. M. G. Cattini
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  9. F. Mantero
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Correspondence to S. Koutroumpi.

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Koutroumpi, S., Daidone, V., Sartori, M.T. et al. Venous thromboembolism in patients with Cushing’s syndrome: need of a careful investigation of the prothrombotic risk profile. Pituitary 16, 175–181 (2013). https://doi.org/10.1007/s11102-012-0398-4

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