ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
Coagulation parameters in patients with adrenal incidentalomas and mild cortisol secretion: sex difference matters
Ilaria Bonaventura 1 , Marianna Minnetti 1 , Dario De Alcubierre 1 , Alessandra Tomaselli 1 , Davide Ferrari 1 , Valentina Sada 1 , Francesco Angelini 1 , Valeria Hasenmajer 1 , Alessia Cozzolino 1 , Emilia Sbardella 1 , Riccardo Pofi 2 , Andrea Lenzi 1 & Andrea M. Isidori 1
1Sapienza University of Rome, Department of Experimental Medicine, Rome, Italy; 2Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Department of
Endocrinology, Oxford, United Kingdom
Background: Patients with Cushing’s syndrome (CS) typically show an alteration in the intrinsic coagulation pathway, leading to an increased risk of venous thromboembolism. Cortisol autonomy has been variably associated with higher risk of cardiovascular events and mortality compared to patients with non-functioning adrenal adenomas (NFA), particularly in women younger than 65 years. However, dedicated studies describing coagulation status in patients with adrenal incidentaloma are lacking.
Aim: To describe the effects of cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone-suppression testing, DST) on coagulation parameters in patients with adrenal incidentaloma enrolled in the ITACA study (NCT04127552) and to investigate sex differences.
Methods: A prospective study on 90 asymptomatic patients with adrenal incidentaloma was performed (62% female, mean age 62 ± 10). Patients with clinically apparent hormonal excess, active malignancy, history of thrombosis or taking hormone replacement therapy and anticoagulants were excluded. According to DST, three groups were defined: 41 NFA (<50 nmol/l), 39 possible autonomous cortisol secretion (PACS, 50 to 138 nmol/l) and 10 ACS (>138 nmol/l). Coagulation markers (fVIII, fVII, fV, fibrinogen, PT, aPTT, platelets) and coagulation inhibitors (Antithrombin III, Protein C, Protein S) were evaluated.
Results: A weak positive correlation was found between DST and platelets (r=0.217; P=0.042). Nevertheless, no differences in coagulation markers and inhibitors were observed among the three groups. A sub-group analysis by sex was performed in PACS and NFA groups. In PACS group, females compared with males had significantly decreased levels of aPTT (aPTTFemale 28.7 sec ± 2.7 vs aPTTMale 32.1 sec ± 4.7, P<0.01) and increased levels of fVIII (fVIIIFemale 155% [125-163] vs fVIIIMale 117% [95-121], P=0.037), fibrinogen (fibrinogenFemale 3.67 g/l [2.62-4.60] vs fibrinogenMale 2.98 g/l [2.42-3.39] P=0.018), ATIII (ATIIIFemale 106.5% ± 12.5 vs ATIIIMale 91.8% ± 5.5, P<0.01) and Protein C (Protein CFemale 138% [117-149] vs Protein CMale 109% [87-129], P=0.039). Moreover, the frequency to have altered fVIII levels was greater in females than in males (81.2% vs 18.8%; OR 4.33, 95%CI 0.94 to 20.03, P=0.05). No sex differences were found in NFA group.
Conclusion: Overall, asymptomatic patients with adrenal incidentaloma, seem not to show alterations in coagulation parameters, in contrast to patients with overt CS. However, considering the presence of sex differences in coagulation markers and inhibitors, females with adrenal adenoma show alterations in coagulation pathways, especially those with a DST >50 nmol/l who therefore might benefit, in selected cases, from anticoagulation prophylaxis before and after adrenal surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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