Endocrine Abstracts

Cushing Syndrome (CS) is associated with a 18-fold higher risk of venous thromboembolism (VTE) when compared to the general population with the similar demographic characteristics. Despite numerous studies on hypercoagulability in CS, the unequivocal recommendations regarding timing and dosing of thromboprophylaxis in hypercortisolism are still lacking. We present a case series of patients with CS and VTE, hospitalized in the Endocrinology Department of University Hospital in Krakow. Among 135 patients with CS, we found 7 cases of VTE (5.19%), aged 35–65 years, mostly females (n=6). The etiology of CS was pituitary (n=3), adrenal (n=2), ectopic(n=1) and adrenal carcinoma (n=1). Pulmonary embolism (PE) was found in 3 patients, deep venous thrombosis (DVT) in 2 patients, while 2 patients suffered from concomitant DVT and PE. We found that 5 patients had VTE at the moment of active hypercortisolemia, while 2 patients within the 30 days after inducing the biochemical remission by either a transsphenoidal surgery in one, or metyrapone treatment in 2nd case. In 3 patients VTE was the first manifestation of CS. Among patients, 2 PE episodes were associated with other predisposing factors, such as postpartum period in a 36-year-old woman and combined oral contraceptive in a 35-year-old woman. Of note, at the time of VTE episode, 1 patient was treated with warfarin, another one took apixaban. One fatal PE occurred on the thromboprophylaxis with low molecular weight heparin, in the hypocortisolemia following metyrapone implementation.

To summarizeVTE may be the first, life threatening presentation of CS.VTE may occur after treatment of hypercortisolism. VTE may happen in patients on thromboprophylaxis or anticoagulant treatment.VTE should be included in the differential diagnosis of a thrombotic event despite coexisting transient factor. Multicenter studies are essential to create the recommendations on thromboprophylaxis in CS.