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Thromboembolic disease in hypercortisolism.

Cristina Capatina1, Maria Fleseriu2

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Patients with Cushing's syndrome (CS) face a high risk of dangerous blood clots due to a prothrombotic state. Anticoagulation may be needed, but clear guidelines are lacking.

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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.