Coagulopathy in Cushing's syndrome.
A hypercoagulable state and its consequent increased incidence of thromboembolic complications are reported in patients with Cushing's syndrome (CS). These alterations are related to cortisol excess that induces prothrombotic changes in blood by several and complex mechanisms including increased levels of clotting factors, mainly factor VIII and von Willebrand factor (VWF) and impaired fibrinolytic capacity. However, it has recently been observed that the increase in VWF levels is not a constant feature of CS and that VWF response to glucocorticoids is genetically determined and depends on the presence of particular polymorphisms in the VWF gene promoter. The risk of venous thromboembolism is moreover enhanced in patients with CS by additional endogenous and exogenous risk factors such as obesity, bed rest, surgery and invasive diagnostic procedures like inferior petrosal sinus (IPS) sampling. In line with all these data, patients with active CS should be treated as having a prothrombotic disorder and undergo antithrombotic prophylaxis during IPS sampling. Special care should be taken in the immediate perioperative period in order to avoid thromboembolic events. In the absence of prospective randomized trials, preventive antithrombotic treatment (best with heparin) during IPS sampling and low-dose heparin treatment early after surgery should be suggested.
Trementino
Laura
L
Division of Endocrinology, Department of Internal Medicine, Polytechnic University of Marche Region, Ancona, Italy.
Arnaldi
Giorgio
G
Appolloni
Gloria
G
Daidone
Viviana
V
Scaroni
Carla
C
Casonato
Alessandra
A
Boscaro
Marco
M
D003480:Cushing Syndrome / Q000097:blood / Q000150:complications*; D005169:Factor VIII / Q000378:metabolism*; D006801:Humans; D012307:Risk Factors; D019851:Thrombophilia / Q000097:blood / Q000209:etiology*; D014841:von Willebrand Factor / Q000378:metabolism*
D014841:von Willebrand Factor; D005169:Factor VIII