Hypercoagulability in Cushing's syndrome: From arterial to venous disease

Area of Science:

• Endocrinology
• Hematology
• Vascular Medicine

Background:

• Cushing's syndrome (CS) presents with multisystemic complications, significantly impacting the hematological system.
• Hypercoagulability in CS is characterized by altered hemostatic parameters and in vivo endothelial dysfunction.
• Thrombotic events, both arterial and venous, are a major cause of morbidity and mortality in CS patients.

Purpose of the Study:

• To review current data on the epidemiology, pathophysiology, and management of hypercoagulability in Cushing's syndrome.
• To highlight the increased risk of thrombotic events in CS patients, including cardiovascular and pulmonary embolism.
• To emphasize the importance of risk stratification and balancing anticoagulation benefits against risks in CS.

Main Methods:

• This review synthesizes up-to-date data from existing literature.
• Focuses on epidemiological findings related to hypercoagulability in CS.
• Examines the pathophysiological mechanisms linking CS to thrombosis.
• Discusses current management strategies for hypercoagulability in CS patients.

Main Results:

• Cushing's syndrome significantly increases the risk of arterial and venous thrombotic events.
• Cardiovascular events and pulmonary embolism account for over 50% of mortality in CS.
• Approximately 50% of thrombotic events occur within 1-2 months following surgical intervention for CS.

Conclusions:

• Effective evaluation and risk stratification are essential for preventing thrombotic events in CS.
• Management strategies must carefully balance the risks and benefits of anticoagulation.
• Understanding and addressing hypercoagulability is critical for improving outcomes in Cushing's syndrome.