Endocrine Abstracts

Introduction: Cushing’s disease (CD) is associated with persistent risk of cardiovascular complications, which were found to be four times higher than in age- and sex-matched population. The main cause is cardiovascular disease with thrombotic complications due to the activation of changes in haemostatic and fibrinolytic system with high level of cortisol secretion.

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

Materials and methods: We studied 78 patients with active CD (Group 1), 41 patients during 1 year CD remission after successful surgical treatment (Group 2) and 20 patients were the control (Group 3). Prothrombin index (PTI), thrombin time (TT), activated partial thromboplastine time (APTT), fibrinogen, tissue plasminogen activator (tPA) and inhibitor (PAI-1), endotelin, thrombomodulin were investigated. Statistical analysis was performed using Kruskal–Wallis 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: 366 (329;421), 339 (283;376), 283 (239;339) (P=0.01, P1,2=0.015, P1,3=0.002, P2,3=0.019); PTI, %: 92 (86;100), 88 (80;92), 87.5 (78;95) (P=0.004, P1,2=0.003, P1,3=0.032, P2,3=0.93); TT, sec: 17.3 (16.4;18.8), 16.6 (15.7;17.9), 17.8 (16.9;18.5) (P=0.05); APTT, sec: 29.1 (27.2;32), 33.1 (32.2;34.2), 33.85 (32.9;35.7) (P=0.0001, P1,2=0.001, P1,3=0,0009, P2,3=0,276); tPA, ng/dl: 1.90 (1.29;3.7), 1.82 (1.51;2.29), 1.45 (1.01;1.62) (P=0.02, P1,2=0.04, P1,3=0.001, P2,3=0.001); PAI-1, ng/ml: 67.5 (46.07;89.2), 63.99 (21.12;90.09), 39.76 (27.39;42.79) (P=0.0012, P1,2=0.036, P1,3=0.0007, P2,3=0.039); endotelin, fmol/l: 1.34 (0.97;1.83), 1.75 (1.13;2.67), 1.51 (0.87;1.94) (P=0.31); thrombomodulin, ng/ml: 1.13 (0.78;1.61), 1.59 (1.26;2.08), 1.10 (0.76;1.51) (P=0.04, P1,2=0.02, P1,3=0.76, P2,3=0.04). Patients of Group 1 had significantly higher fibrinogen level and PTI and lower APTT than patients of Groups 2 and 3. tPA, PAI-1 levels were significantly increased before and during 1 year after surgical treatment than in patients of control group.

Conclusion: Our results suggest, hypercoagulation found in patients with CD is predominantly associated with alterations of fibrinolytic system and persisted after treatment.