Coagulopathy in Cushing's syndrome

Area of Science:

• Endocrinology
• Hematology
• Vascular Medicine

Background:

• Cushing's syndrome (CS) is associated with a hypercoagulable state and increased thromboembolic complications.
• Cortisol excess in CS induces prothrombotic changes via complex mechanisms, including elevated clotting factors (Factor VIII, von Willebrand factor) and impaired fibrinolysis.
• The increase in von Willebrand factor (VWF) is not constant in CS and is influenced by genetic polymorphisms in the VWF gene promoter.

Purpose of the Study:

• To review the prothrombotic state in Cushing's syndrome.
• To highlight the role of cortisol excess in increasing thromboembolic risk.
• To recommend prophylactic antithrombotic strategies for patients with active CS.

Main Methods:

• Review of existing literature on hypercoagulability in Cushing's syndrome.
• Analysis of mechanisms linking cortisol excess to prothrombotic changes.
• Evaluation of additional risk factors for venous thromboembolism in CS patients.
• Assessment of current recommendations for antithrombotic prophylaxis.

Main Results:

• Cortisol excess in CS leads to increased clotting factor levels and reduced fibrinolytic capacity.
• Venous thromboembolism risk is amplified by factors like obesity, surgery, and invasive procedures (e.g., inferior petrosal sinus sampling).
• VWF response to glucocorticoids is variable and genetically determined.

Conclusions:

• Active Cushing's syndrome patients should be considered to have a prothrombotic disorder.
• Antithrombotic prophylaxis is advised during inferior petrosal sinus sampling.
• Perioperative management requires special attention to prevent thromboembolic events, with heparin suggested for prophylaxis.