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Prevalence and Associated Risk Factors for Venous Thromboembolism in a Large Cohort of Patients With Cushing Disease

Ana Julia Garcia Pereira1, Rafael Loch Batista1, Malebranche Berardo Carneiro Cunha-Neto1

  • 1Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|October 17, 2025
PubMed

Insights

Patients with Cushing disease (CD) have a high risk of venous thromboembolism (VTE), with obesity and hypercortisolism being key risk factors. Thromboprophylaxis should be considered for these patients.

Area of Science:

  • Endocrinology
  • Vascular Medicine
  • Oncology

Background:

  • Endogenous Cushing syndrome presents an intrinsic hypercoagulable state, elevating venous thromboembolism (VTE) risk.
  • Cushing disease (CD), a common cause of endogenous Cushing syndrome, requires thorough VTE risk assessment.

Purpose of the Study:

  • To determine the prevalence and identify risk factors for VTE in a large cohort of patients diagnosed with Cushing disease (CD).

Main Methods:

  • Retrospective analysis of 408 patients with CD at a tertiary care center.
  • Comparison with 323 patients with nonfunctioning pituitary adenomas.
  • Analysis of clinical, laboratory, hormonal, imaging, and outcome data, including VTE events.

Main Results:

  • A significantly higher prevalence of VTE (8.6%) was observed in CD patients compared to controls (0.3%).
  • VTE events predominantly occurred preoperatively (54%).
  • Obesity, mood disorders, elevated cortisol levels, leukopenia/leukocytosis, and postoperative complications were identified as significant VTE risk factors.

Conclusions:

  • The study confirms a high incidence of VTE in Cushing disease patients, independent of the surgical period.
  • Obesity, hypercortisolism severity, and postoperative complications are associated with increased VTE risk.
  • Consideration of thromboprophylaxis is recommended for patients with Cushing disease.
Abstract

Keywords:
ACTH-secreting pituitary adenomaCushing syndromehypercortisolismsevere Cushing syndromevenous thromboembolism

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