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Hypercoagulability in Cushing Syndrome, Prevalence of Thrombotic Events: A Large, Single-Center, Retrospective Study

  • Suarez, Maria Gabriela1, 2
  • Stack, Madeleine2
  • Hinojosa-Amaya, Jose Miguel2, 3, 4
  • Mitchell, Michael D5
  • Varlamov, Elena V1, 2, 3
  • Yedinak, Chris G2, 3
  • Cetas, Justin S2, 3, 6
  • Sheppard, Brett7
  • Fleseriu, Maria1, 2, 3
  • 1 Department of Medicine (Endocrinology), Oregon Health & Science University, USA , (United States)
  • 2 Department of Neurological Surgery, Oregon Health & Science University, USA , (United States)
  • 3 Northwest Pituitary Center, Oregon Health & Science University, USA , (United States)
  • 4 Endocrinology Division, Department of Medicine, Hospital Universitario “Dr. Jose E. Gonzalez”, Universidad Autonoma de Nuevo Leon, Mexico , (Mexico)
  • 5 University of Iowa
  • 6 Operative Care Division, Portland Veterans Administration Hospital, USA , (United States)
  • 7 Department of General Surgery, Oregon Health & Science University, USA , (United States)
Published Article
Journal of the Endocrine Society
The Endocrine Society
Publication Date
Dec 15, 2019
DOI: 10.1210/jendso/bvz033
PMID: 32064411
PMCID: PMC7009121
PubMed Central


Background The risk of Cushing syndrome (CS) patients experiencing a thrombotic event (TE) is significantly higher (odds ratio; OR 18%) than that of the general population. However, there are currently no anticoagulation guidelines. Methods A retrospective, single-center, longitudinal study of patients undergoing all types of treatment—surgical (pituitary, unilateral, and bilateral adrenalectomy) and medical treatment—was undertaken. TEs were recorded at any point up until last patient follow-up; myocardial infarction (MI), deep venous thrombosis (DVT), and pulmonary embolism (PE) or stroke. Patients’ doses and complications of anticoagulation were recorded. Results Included were 208 patients; a total of 165 (79.3%) were women, and mean age at presentation was 44 ± 14.7 years. Thirty-nine (18.2%) patients had a TE; extremity DVT (38%), cerebrovascular accident (27%), MI (21%), and PE (14%). Of 56 TEs, 27 (48%) were arterial and 29 (52%) were venous. Patients who underwent bilateral adrenalectomy (BLA) had an odds ratio of 3.74 (95% CI 1.69-8.27) of developing a TE. Of patients with TEs, 40.5% experienced the event within the first 60 days after surgery. Baseline 24-hour urinary free cortisol levels did not differ in patients with or without TE after BLA. Of 197 patients who underwent surgery, 50 (25.38%) received anticoagulation after surgery, with 2% having bleeding complications. Conclusions The risk of TEs in patients with CS was approximately 20%. Many patients had more than 1 event, with higher risk 30 to 60 days postoperatively. The optimal prophylactic anticoagulation duration is unknown, but most likely needs to continue up to 60 days postoperatively, particularly after BLA.

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