Wednesday, April 28, 2010

Cushing's Syndrome Associated With a Thrombophilic State, Changes in the Fibrinolytic System: Presented at ECE

By Karen Dente

PRAGUE, Czech Republic -- April 27, 2010 -- Patients with Cushing's syndrome have an increased tendency for coagulation and thrombosis, especially since high concentrations of glucocorticoids result in reduced fibrinolytic capacity and increases in the plasma clotting factors, in particular of von Willebrand factor (vWf).

A longitudinal study following 40 patients was presented here during a poster presentation on April 26 at the 12th European Congress of Endocrinology (ECE).

"The aim of our study was to evaluate the haemostatic and fibrinolytic markers in patients with active Cushing's syndrome during the activity and after the remission or the persistency of the disease," said Valentina Raffaelli, MD, Department of Endocrinology, University of Pisa, Pisa, Italy.

Of the 40 patients, all with active Cushing's syndrome, 31 were women and 9 were men. A total of 36 were affected by adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and 4 by adrenal adenomas. Haemostatic and fibrinolytic markers were evaluated in all patients during the activity of the disease and after surgery.

None of the patients received any kind of medication that affected coagulation tests.

A year or two after surgery all patients were re-evaluated. At this point 27 patients presented with remission (group 1), and 13 patients demonstrated persistent hypercortisolism (group 2).

Compared with patients in the active group, patients in the remission group had different levels of von Willebrand factor (P < .0001), plasminogen activator inhibitor (PAI-1; P = .003), antithrombin III (P = .0002), and plasmin-antiplasmin complex (P = .006).

In terms of other markers including fibrinogen, prothrombin fragment 1 and 2, factor V, factor VII, factor IX, factor XII, activated partial thromboplastin time, thrombin-antithrombin complex, plasminogen, and D-dimer, no differences were observed between the active and remission patients.

"The study confirms that Cushing's syndrome is associated with a thrombophilic state and changes in the fibrinolytic system," said Dr. Raffaelli. Recent studies provide further evidence that genetic polymorphisms in the vWf and PAI-1 can influence the corticosteroid-mediated transcriptional regulation of these factors.

Further studies are required to better delineate the exact changes in the coagulation cascade in hypercortisolism, says Dr. Raffaelli.

[Presentation title: Evaluation of Haemostatic and Fibrinolytic Marker in Patients With Cushing's Syndrome: A Longitudinal Study. Abstract 5]


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