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Cushing`s disease: Fibrinogen and D-dimer levels fail to normalize despite early postoperative remission - a
Przemysław Witek, Grzegorz Zieliński1, Katarzyna Szamotulska
1Department of Neurosurgery, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland.. gzielinski@wim.mil.pl.
Insights
Even after successful transsphenoidal surgery (TSS) for Cushing's disease (CD), elevated fibrinogen and D-dimer levels persist, indicating a continued risk for thrombotic events and cardiovascular complications in patients with early remission.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Hematology
Background:
- Transsphenoidal surgery (TSS) is effective for Cushing's disease (CD), normalizing cortisol and reducing hypercortisolism complications.
- However, cardiovascular morbidity remains a concern even after successful CD treatment.
Purpose of the Study:
- To prospectively investigate the dynamics of fibrinogen and D-dimer levels for six months post-effective TSS in CD patients.
- To compare these levels with healthy controls.
Main Methods:
- A prospective, controlled study involving 40 CD patients and 40 healthy controls.
- Assessment of ACTH, cortisol, fibrinogen, and D-dimer levels before TSS and during a six-month follow-up.
Main Results:
- CD patients exhibited higher baseline BMI, fibrinogen, and D-dimer levels compared to controls.
- Elevated fibrinogen was independent of BMI and associated with hsCRP and hypertension.
- Sustained differences in fibrinogen and D-dimer levels were observed between the CD remission group and controls at six months.
Conclusions:
- Fibrinogen and D-dimer levels did not decrease despite early biochemical remission of CD.
- These persistent elevations suggest a high risk for thrombotic events.
- Close follow-up for thromboembolic and cardiovascular complications is crucial for CD patients in early remission.
Introduction:
Effective transsphenoidal surgery (TSS) for Cushing`s disease (CD) normalizes cortisol levels and reduces complications of hypercortisolism. However, there is evidence of increased cardiovascular morbidity even after successful surgery.
Objective:
A prospective, controlled study on the dynamics of fibrinogen and D-dimer levels with a six-month follow-up after an effective TSS for CD.
Material And Methods:
Forty patients with CD and forty healthy age- and sex-matched subjects were included. We assessed ACTH, urinary and serum cortisol, and fibrinogen and D-dimer levels before TSS and during follow-up.
Results:
Baseline BMI (P < 0.001), fibrinogen (P = 0.002), and D-dimer (P = 0.001) levels in CD patients were significantly higher than those in healthy controls. High fibrinogen levels in the CD group were independent of BMI, and were positively associated with hsCRP (rS = 0.61, P < 0.001) and arterial hypertension (P = 0.029). After the six-month follow-up we confirmed a sustained difference between the remission group and controls in fibrinogen and D-dimer levels (P = 0.001 and P = 0.017, respectively).
Conclusions:
Despite early biochemical remission of CD the levels of fibrinogen and D-dimer failed to decrease. This probably contributes to the high risk of thrombotic events and indicates the need for a close follow-up for signs of thromboembolic and cardiovascular complications in patients with early CD remission. (Endokrynol Pol 2016; 67 (3): 283-291).
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