Thromboembolic disease in hypercortisolism

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Hematology

Background:

• Endogenous Cushing's syndrome (CS) significantly increases patient morbidity, including cardiovascular issues and impaired quality of life.
• CS is strongly linked to arterial and venous thromboembolic events (TE), exacerbated by surgical procedures.
• Increased mortality in untreated CS is primarily driven by cardiovascular events and infections.

Purpose of the Study:

• To review the heightened risk of thromboembolic episodes in patients with Cushing's syndrome.
• To discuss the prothrombotic mechanisms and cardiovascular consequences in CS.
• To highlight the need for thromboprophylaxis strategies in CS patients.

Main Methods:

• Review of existing literature on Cushing's syndrome, thromboembolism, and hemostasis.
• Analysis of the prothrombotic state in CS, including coagulation and fibrinolysis.
• Evaluation of the impact of CS remission on thromboembolic risk.

Main Results:

• Patients with CS exhibit a markedly increased risk of TE compared to the general population.
• The prothrombotic state in CS involves elevated procoagulant factors and impaired fibrinolysis.
• While some abnormalities improve post-CS remission, normalization may take over a year.

Conclusions:

• Anticoagulation prophylaxis should be considered in CS patients undergoing procedures, balancing thrombotic and bleeding risks.
• There is a lack of clear protocols for thromboprophylaxis in CS, necessitating increased risk awareness.
• Prospective trials are required to identify high-risk CS patients and optimize prevention strategies.