Abstract
ObjectivePatients with Cushing’s syndrome (CS) are at high risk of venous thromboembolism related to a hypercoagulability due to procoagulant imbalance. However, whether these alterations are reversible after disease remission is still unclear. The endogenous thrombin potential (ETP) measured with and without the addition of thrombomodulin provides a global representation of coagulation and previous data confirmed hypercoagulable profile in patients with active hypercortisolism. Aim of this study was to assess the short- and long-term modification of ETP in patients with CS after disease remission.Design and methodsNineteen patients with CS for whom surgical remission was achieved, were prospectively evaluated for clinical characteristics, cortisol secretion profile and ETP at different time points: (i) before surgical intervention; (ii) after 6 months and (iii) 5 years from the time of persistent remission. Nineteen healthy subjects matched for age and gender were also evaluated as control group.ResultsBefore surgery, patients showed higher ETP-ratio (with/without thrombomodulin) than controls (0.62 ± 0.09-vs-0.56 ± 0.09, p = 0.034). No significant correlation between ETP-ratio and cortisol secretion was found. 6 months after remission, ETP-ratio was still significantly increased compared to controls (0.64 ± 0.09-vs-0.56 ± 0.09, p = 0.01), but was similar to baseline (0.64 ± 0.09-vs-0.62 ± 0.09, p = 0.87). At 5 years, ETP-ratio showed a significant decrease (0.55 ± 0.14-vs-0.62 ± 0.09, p = 0.02) and was comparable to controls (0.55 ± 0.14-vs-0.56 ± 0.09, p = 0.7).ConclusionsPlasma hypercoagulability detected in patients with active hypercortisolism persists at short-term evaluation and seems to be completely reversible after long-term remission of disease. These data, as part of a whole evaluation of thrombotic risk, can contribute to make appropriate therapeutic choice in these patients.
Highlights
Cushing syndrome (CS) is associated with a high venous thromboembolic (VTE) risk with an odds ratio of 17.8 when compared to general population [1]
Lag time and time to peak were shorter in patients than controls (p < 0.001); endogenous thrombin potential (ETP) and peak were higher in patients than controls (< 0.05); ETP-ratio was higher in patients than controls (< 0.05) (Table 2, Figs. 1 and 2)
Chronic hypercortisolism determines dramatic biochemical and clinical alterations leading to several comorbidities and to a significantly higher mortality risk than those observed in the general population [26, 27]
Summary
Cushing syndrome (CS) is associated with a high venous thromboembolic (VTE) risk with an odds ratio of 17.8 (95% CI 15.24–20.85) when compared to general population [1]. The incidence of VTE events increases during the first months after surgery and progressively decreases throughout follow-up, it is likely to remain higher than in general population even in case of surgery [2, 3].
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