FRI110 Prevalence Of Thromboembolic Events In 51 Patients Treated For Cushing’s Disease With Pituitary Surgery At University Hospital Of Wales Over A 15-year Period

Abstract

Abstract Disclosure: R. Suresh John: None. J. Witczak: None. A. Rees: None. C. Hayhurst: None. A. Lansdown: None. Background: Hypercortisolism is associated with a hypercoagulable state and both arterial and venous thromboembolic events (TE). Aim: To determine the prevalence of TE in our cohort of patients with Cushing’s Disease (CD) undergoing pituitary surgery. Methods: Patients with a clinical & biochemical diagnosis of Cushing’s Disease who had undergone pituitary surgery at University Hospital of Wales between 2007-2022 were identified from a database. Clinical, biochemical and radiological data were studied from the time of diagnosis to the period of 6 months following pituitary surgery. Results: 51 patients were identified: 15 Male, 36 Female, median age 46 (11-77)y. Total group: 5/51 (9.8%) patients had a TE. Pre-surgery: 2/51 (3.9%) had a TE (Deep vein thrombosis (DVT) = 1; Aortic thrombus = 1), both at time of diagnosis. Mean 24-h Urinary Free Cortisol (UFC) was 1126nmol in TE group vs 662nmol in non-TE group (p=0.64) and mean cortisol after overnight dexamethasone suppression test (ODST) was 251nmol/L in the TE group vs 327nmol/L in the non-TE group (p=0.64). Post-surgery: All patients received standard thrombo-prophylaxis with low-molecular weight heparin peri-operatively. 3/51 (5.9%) had TE within 6-months post-surgery (DVT=1, pulmonary embolism (PE)=1, cavernous sinus thrombosis=1), all occurred within 21 days of surgery and none had other risk factors for VTE. Mean time from diagnosis to surgery was 187 days in TE group vs 127 in non-TE group (p=0.43). At diagnosis, mean 24-h UFC was 560nmol in TE group vs 699nmol in non-TE group (p=0.82), mean cortisol after ODST was 420nmol/L in TE group vs 321nmol/L in non-TE group (p=0.46). Mean post-op cortisol was 221nmol/L in TE group vs 257nmol/L in no TE group (p=0.85). No TE events occurred between 22 days-6 months post-surgery. Conclusion: In our cohort, 9.8% patients had a TE event. 3.9% occurred pre-surgery and 5.9% in the early post-operative period, which concurs with data from other studies. There was no correlation with level of hypercortisolism and TE events in our group. Timing, dose & duration of prophylactic anticoagulation in CD patients needs careful consideration. Presentation: Friday, June 16, 2023