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CUSHING'S SYNDROME, A RISK FACTOR FOR VENOUS THROMBOEMBOLISM IS A CANDIDATE FOR GUIDELINES
G Koraćević1,2, M Stojanović3, S Petrović4,2
1Clinical Centre Niš - Department for Cardiovascular Diseases, Novi Sad Serbia.
Insights
Patients with Cushing's syndrome (CS) face a significantly higher risk of venous thromboembolism (VTE), with endogenous CS patients showing an 18-fold increased risk. This elevated VTE risk, particularly in the first year post-diagnosis, is often overlooked in clinical guidelines.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Oncology
Background:
- Cushing's syndrome (CS) is associated with significant morbidity, but its link to venous thromboembolism (VTE) remains under-recognized.
- A discrepancy exists between meta-analyses confirming increased VTE risk in CS and its absence in current VTE guidelines.
Purpose of the Study:
- To review contemporary information on VTE risk in endogenous and exogenous CS.
- To highlight the discrepancy between established VTE risk in CS and its omission from clinical guidelines.
Main Methods:
- Extensive literature search of PubMed, Google Scholar, and Scopus.
- Keywords included Cushing's syndrome, venous thromboembolism, deep vein thrombosis, and pulmonary embolism.
Main Results:
- Patients with CS exhibit approximately a tenfold increased risk for VTE, especially within the first year of diagnosis.
- Oral glucocorticoid use (iatrogenic CS) confers a threefold VTE risk increase.
- A 2019 meta-analysis revealed an 18-fold higher risk of unprovoked VTE in patients with endogenous CS compared to the general population.
Conclusions:
- Substantial evidence accumulated over 50 years confirms elevated VTE risk in both endogenous and exogenous CS.
- Official guidelines fail to acknowledge CS as a VTE risk factor, necessitating increased physician awareness.
- Physicians treating CS and VTE should be cognizant of this significant risk.
Objectives:
The present paper aims to review important contemporary information about VTE risk in endogenous and exogenous CS, as a substantial discrepancy exists between the results of a recent meta-analysis confirming the increased risk for VTE and the absence of CS in VTE guidelines.
Methods:
An extensive search of relevant databases (e.g. PubMed, Google Scholar, and Scopus) was performed in order to establish the interconnectedness of the following terms: Cushing's syndrome, venous thromboembolism, deep vein thrombosis, pulmonary embolism.
Results:
The analysis demonstrated that patients with CS have about ten times the risk for VTE, particularly during the first year following the diagnosis of CS. Oral glucocorticoid users (with iatrogenic CS) have a 3-fold increase in risk of VTE in comparison with non-users. The most recent 2019 meta-analysis encompassed 7142 patients with endogenous CS (including Cushing's disease) undergoing transsphenoidal surgery or adrenalectomy, and their risk of unprovoked VTE was almost 18 times higher in comparison with a healthy population.
Conclusion:
Over the past 50 years considerable evidence of increased VTE risk in CS has been accumulated. It pertains to both endogenous and exogenous type of CS and has been confirmed in the vast majority, if not all the available studies, including meta-analyses. Nevertheless, official CS guidelines make no mention of CS as a VTE risk factor, even though it is important that not only physicians who treat CS, but also physicians who manage patients with suspected VTE be aware of increased VTE risk.
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