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Hypercoagulable state in Cushing's syndrome: a systematic review
Bregje Van Zaane1, Erfan Nur, Alessandro Squizzato
1Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, Amsterdam, The Netherlands. b.vanzaane@amc.uva.nl
The Journal of Clinical Endocrinology and Metabolism
|May 21, 2009
Summary
Patients with Cushing's syndrome face a high risk of venous thromboembolism (VTE). Hypercoagulability, surgery, and obesity contribute to this increased thrombotic tendency, highlighting the need for awareness and management.
Area of Science:
- Endocrinology
- Hematology
- Thrombosis Research
Background:
- Cushing's syndrome is associated with endogenous hypercortisolism.
- The relationship between Cushing's syndrome and an increased risk of venous thromboembolism (VTE) remains debated.
Purpose of the Study:
- To review and synthesize existing literature on the impact of endogenous hypercortisolism on coagulation and fibrinolysis.
- To evaluate the clinical outcomes related to VTE in patients with Cushing's syndrome.
Main Methods:
- A systematic literature search was conducted in MEDLINE and EMBASE databases up to July 2008.
- Study selection and data extraction were performed by two independent investigators.
- Study quality was assessed using the Newcastle-Ottawa Scale.
Main Results:
- Fifteen reports from 441 identified publications were included, comprising various study designs (cross-sectional, intervention, cohort).
- Evidence suggests hypercoagulability in Cushing's syndrome, indicated by elevated levels of factor VIII, factor IX, and von Willebrand factor, and enhanced thrombin generation.
- Reported risks for non-postoperative VTE were 1.9-2.5%, while postoperative VTE risk varied from 0-5.6% (with one outlier at 20%). VTE was a cause of death in 0-1.9% of cases.
Conclusions:
- Available evidence indicates a significant risk of venous thrombosis in individuals with Cushing's syndrome.
- Glucocorticoid-induced hypercoagulability, surgical procedures, and obesity are likely contributing factors to the thrombotic tendency observed.
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