title: Coagulation Profile Dynamics in Pediatric Patients with Cushing Syndrome: A Prospective, Observational Comparative Study.
abstract: To evaluate the association between Cushing syndrome and hypercoagulability in children.
  
  
  
  A prospective, observational study was performed of 54 patients with Cushing syndrome, 15.1 ± 3.9 years, treated at the National Institutes of Health Clinical Center. Coagulation profiles were taken before and 6-12 months after surgery and compared with18 normocortisolemic children, 13.7 ± 3.6 years.
  
  
  
  At baseline, patients with Cushing syndrome had greater levels of the procoagulant factor VIII (FVIII) vs controls (145 IU/dL ± 84 vs 99 ± 47, P = .04); 6-12 months after surgery, FVIII levels decreased to 111 ± 47, P = .05. Patients with Cushing syndrome had greater levels of the antifibrinolytic α2-antiplasmin, 96 ± 17% vs 82 ± 26%, P = .015. After surgery, antifibrinolytic α2-antiplasmin levels decreased to 82 ± 24%, P < .001. Anticoagulants were greater in patients with Cushing syndrome vs controls at baseline, including protein C (138 ± 41% vs 84 ± 25%, P < .001), protein S (94 ± 19% vs 74 ± 19%, P = .001), and antithrombin III (96 ± 18% vs 77 ± 13%, P < .0001). The 24-hour urinary free cortisol levels correlated positively with FVIII levels, r = 0.43, P = .004.
  
  
  
  Children with Cushing syndrome had elevated procoagulants, antifibrinolytics, and anticoagulants at baseline compared with controls; normalization of coagulation measures was seen after surgical cure. Despite the increase in anticoagulants, hypercortisolemia is associated with a hypercoagulable state in children, as is the case in adults. This finding has potential implications for prevention of venous thromboembolism in children with Cushing syndrome.
  
  
  
  ClinicalTrials.gov:NCT00001595.
authors: University of Maryland, College Park, MD; Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors: Leah
authors: L
authors: Birdwell
authors: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Electronic address: lodishma@mail.nih.gov.
authors: Maya
authors: M
authors: Lodish
authors: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors: Amit
authors: A
authors: Tirosh
authors: National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD.
authors: Prashant
authors: P
authors: Chittiboina
authors: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors: Meg
authors: M
authors: Keil
authors: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors: Charlampos
authors: C
authors: Lyssikatos
authors: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors: Elena
authors: E
authors: Belyavskaya
authors: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Richard A
authors: RA
authors: Feelders
authors: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors: Constantine A
authors: CA
authors: Stratakis
mesh_terms: D000293:Adolescent; D003480:Cushing Syndrome / Q000097:blood* / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D019851:Thrombophilia / Q000209:etiology*
keywords: blood clot; hypercoagulable state; thromboembolic event