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Thrombin generation in Cushing's Syndrome: do the conventional clotting indices tell the whole truth?

S Koutroumpi1, L Spiezia, N Albiger

  • 1Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale, 105, 35128, Padua, Italy.

Pituitary
|February 15, 2013
PubMed

Insights

Cushing's Syndrome (CS) and Metabolic Syndrome (MetS) patients exhibit a prothrombotic state, with altered thrombin generation parameters. While CS patients show increased endogenous anticoagulants, suggesting a potential protective mechanism, their hypercoagulability is less pronounced than in MetS.

Area of Science:

  • Endocrinology
  • Hematology
  • Thrombosis Research

Background:

  • Cushing's Syndrome (CS) is linked to increased mortality, with hypercoagulability playing a key role in thrombosis.
  • Understanding the hemostatic balance in CS is crucial for managing associated risks.

Purpose of the Study:

  • To evaluate in vitro thrombin generation (TG) and clotting markers in CS patients.
  • To compare these markers with those in Metabolic Syndrome (MetS) patients and healthy controls.
  • To investigate correlations between TG parameters, cortisol levels, and clinical factors like BMI and comorbidities.

Main Methods:

  • Assessed TG parameters (lag time, peak thrombin, ETP) and clotting markers (PT, PTT).
  • Included 33 CS patients, 28 MetS patients, and 31 healthy individuals.
  • Analyzed correlations with night salivary cortisol, urinary free cortisol, BMI, obesity, diabetes, and hypertension.

Main Results:

  • CS and MetS patients showed shorter lag time and higher peak thrombin/ETP than controls; CS lag time was less shortened than MetS.
  • PT was prolonged in both CS and MetS; PTT was shorter in CS.
  • Elevated Factor VIII (FVIII), Antithrombin (AT), protein C, and S were observed exclusively in CS patients.
  • Cortisol levels, BMI, obesity, diabetes, and hypertension correlated significantly with TG parameters and clotting markers.

Conclusions:

  • CS and MetS patients present a prothrombotic state, with distinct patterns in thrombin generation.
  • Elevated endogenous anticoagulants in CS may offer a partial protective effect against hypercoagulability.
  • These findings highlight the complex hemostatic alterations in CS and their relationship with endocrine and metabolic factors.

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