Arterial and venous thrombotic events in Cushing's syndrome
Catalina Poiana1,2, Corina Chirita2, Mara Carsote1, Cristina Ene2, Ramona Samoila2, Raluca Trifanescu1,2, Monica Gheorghiu1,2 & Mihail Coculescu1,2
Background: Cushings syndrome (CS) is associated with a hypercoagulable state and an increased risk for acute coronary syndromes, stroke, and deep vein thrombosis (DVT).
Aim: To assess the prevalence of thrombotic events in a series of patients with CS.
Patients and methods: Notes of 113 patients with CS were retrospectively reviewed.
Results: Instable angina was diagnosed in ten women, aged 52.1±12.2 years. Three cases had Cushings disease (CD), four adrenal Cushings (AC), one had independent ACTH bilateral adrenal hyperplasia, two iatrogenic CS.
Acute myocardial infarction was diagnosed in one woman, aged 41 years, with CS due to ACTH independent bilateral macronodular hyperplasia. Several risk factors for thrombosis were associated: obesity, diabetes mellitus, hypertension. Bilateral adrenalectomy was performed.
A 48 years old woman with android phenotype, hirsutism, secondary amenorrhea had a history of two strokes. AC was diagnosed and left adrenalectomy performed.
DVT occurred in four patients. One woman with CD, aged 31, developed DVT of the calf. Estroprogestin pillss use was an additional risk factor. Pituitary radiotherapy and bilateral adrenalectomy were performed. The second women, aged 41, with CS due to ACTH independent bilateral macro nodular adrenal hyperplasia, associating a parathyroid carcinoma, was diagnosed with extensive DVT of ilio-femuro-popliteal axis. Bilateral adrenalectomy was performed. The third case, a 60 years old diabetic, hypertensive woman with CD, showed an extensive thrombosis of the left inferior cave vein 3 months after left adrenalectomy. The fourth case was a 46 years female with right adrenalectomy for adrenal carcinoma with hepatic metastasis, secondary hypertension and diabetes mellitus. After surgery, inferior cave vein thrombosis occurred. Anticoagulation was initiated in all cases.
Conclusions: Arterial or venous thrombotic events are an important clue in CS diagnosis or a complication in cases already diagnosed.