Endocrine Abstracts

Introduction: Chronic endogenous hypercortisolism is characterized by abdominal obesity, systemic arterial hypertension, glucose and lipid abnormalities, insulin resistance, osteoporosis. This syndrome also has features of hypercoagulation. The mortality rate in patients with active Cushing’s disease (CD) is four times higher than in age- and sex- matched population. The main cause is cardiovascular disease with thrombotic complications.

Objective: To study hemostatic and fibrinolytic state in patients with CD.

Materials and methods: We studied 31 patients with active CD (group 1), 21 patients during one year CD remission after successful surgical treatment (group 2) and 16 patients were the control (group 3). Prothrombin time (PT), thrombin time (TT), activated partial thromboplastine time (APTT), fibrinogen, plasminogen, tissue plasminogen activator (tPA) and inhibitor (PAI-1) were investigated. Statistical analysis was performed using Crasckell-Walles criteria. Results are presented as median and 25; 75 percentiles.

Results: Results are given for the groups 1, 2 and 3, respectively. Fibrinogen level, mg/dl: 341 (306; 370), 329 (316; 391), 285 (226; 339) (P=0.0333); PTI, %: 96 (89.5; 101), 85 (78; 93), 85 (75; 93) (P=0.0074, P1.2=0.0055, P1.3=0.0351, P2.3=0.683); TT, s: 18.1 (16.9; 19.7), 17.1 (16.6; 22.3), 17.2 (16.7; 18.5) (P=0.6770); APTT, s: 29.2 (36; 27.45), 33.6 (32.9; 35.4), 34.8 (33; 39) (P=0.0001, P1.2=0.001, P1.3=0.0009, P2.3=0.276); plasminogen, %: 96 (87; 102), 86 (73; 92), 79.5 (70; 85) (P=0.0002, P1.2=0.001, P1.3=0.001, P2.3=0.331); tPA, ng/dl: 3.24 (1.90; 5.51), 2.026 (1.67; 2.67), 1.61 (1.49; 2.06) (P=0.002, P1.2=0.021, P1.3=0.001, P2.3=0.09); PAI-1, ng/ml: 69.63 (39.33; 90.46), 41.80 (16.85; 86.80), 37.92 (28.16; 42.35) (P=0.0163, P1.2=0.02, P1.3=0.007). Thus, patients of group 1 had significantly higher fibrinogen level and lower APTT than patients of groups 2 and 3. tPA, PAI-1 levels were significantly increased before treatment and decreased slowly after treatment to become normal in 6–12 month. The haemostatic parameters of patients in group 2 and group 3 did not differ significantly.

Conclusion: Our results suggest that hypercoagulation found in patients with active CD is predominantly associated with fibrinolytic system alterations.