title: Cushing`s disease: Fibrinogen and D-dimer levels fail to normalize despite early postoperative remission - a prospective, controlled study.
abstract: BACKGROUND
  Effective transsphenoidal surgery (TSS) for Cushing`s disease (CD) normalizes cortisol levels and reduces complications of hypercortisolism. However, there is evidence of increased cardiovascular morbidity even after successful surgery.
  
  
  OBJECTIVE
  A prospective, controlled study on the dynamics of fibrinogen and D-dimer levels with a six-month follow-up after an effective TSS for CD.
  
  
  METHODS
  Forty patients with CD and forty healthy age- and sex-matched subjects were included. We assessed ACTH, urinary and serum cortisol, and fibrinogen and D-dimer levels before TSS and during follow-up.
  
  
  RESULTS
  Baseline BMI (P < 0.001), fibrinogen (P = 0.002), and D-dimer (P = 0.001) levels in CD patients were significantly higher than those in healthy controls. High fibrinogen levels in the CD group were independent of BMI, and were positively associated with hsCRP (rS = 0.61, P < 0.001) and arterial hypertension (P = 0.029). After the six-month follow-up we confirmed a sustained difference between the remission group and controls in fibrinogen and D-dimer levels (P = 0.001 and P = 0.017, respectively).
  
  
  CONCLUSIONS
  Despite early biochemical remission of CD the levels of fibrinogen and D-dimer failed to decrease. This probably contributes to the high risk of thrombotic events and indicates the need for a close follow-up for signs of thromboembolic and cardiovascular complications in patients with early CD remission. (Endokrynol Pol 2016; 67 (3): 283-291).
authors.forename: Przemysław
authors.initials: P
authors.lastname: Witek
authors.affiliation: Department of Neurosurgery, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland.. gzielinski@wim.mil.pl.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Zieliński
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Szamotulska
authors.forename: Joanna
authors.initials: J
authors.lastname: Witek
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Kamiński
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003480:Cushing Syndrome / Q000097:blood* / Q000473:pathology / Q000601:surgery; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: Cushing’s disease; D-dimer level; cortisol; fibrinogen; hipercortisolemia; thromboembolic complications; transsphenoidal surgery