ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)
Thromboprophylaxis of venous thromboembolism in endogenous cushing’s syndrome: recommendations from a delphi panel consensus position statement
Kristina Isand 1,2 , Hiroshi Arima 3 , Olaf Dekkers 4,5 , Richard Feelders 6,7 , Maria Fleseriu 8,9 , Monica R. Gadelha 10 , Jose Miguel Hinojosa-Amaya 11 , Niki Karavitaki 12,13,14 , Frederikus Klok 15 , Anneli McCormack 16 , John Newell-Price 17 , Sue Pavord 18 , Martin Reincke 19 , Saurabh Sinha 20 , Elena Valassi 21,22,23 , John Wass 24 & Alberto Pereira 25
1Institute of Biomedicine and Translational Medicine, Tartu, Estonia; 2North Estonia Medical Centre, Tallinn, Estonia; 3Nagoya University Graduate School of Medicine Faculty of Medicine, Department of Endocrinology and Diabetes, Nagoya, Japan; 4Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology, Leiden, Netherlands; 5Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, Netherlands; 6Erasmus Medical Center, Department of Internal Medicine, Division of Endocrinology, Rotterdam, Netherlands; 7New York University Langone Medical Center, Division of Endocrinology, Diabetes and Metabolism, New York, United States; 8Pituitary Center, Oregon Health & Science University, Department of Medicine, Oregon, United States; 9Pituitary Center, Oregon Health & Science University, Department of Neurological Surgery, Portland, United States; 10Universidade Federal do Rio de Janeiro, Medical School and Hospital Universita´rio Clementino Fraga Filho, Rio de Janeiro, Brazil; 11Hospital Universitario "Dr. Jose´ E. Gonza´lez" Universidad Autónoma de Nuevo León, Pituitary Clinic, Endocrinology Division, Department of Medicine, Nuevo Leon, Mexico; 12College of Medicine and Health, University of Birmingham, Department of Metabolism and Systems Science, Birmingham, United Kingdom; 13Birmingham Health Partners, Centre for Endocrinology, Diabetes and Metabolism, Birmingham, United Kingdom; 14Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Department of Endocrinology, Birmingham, United Kingdom; 15Leiden University Medical Center, Department of Medicine – Thrombosis and Hemostasis, Leiden, Netherlands; 16University of New South Wales, St Vincent’s Hospital and Clinical School, Sydney, Australia; 17The University of Sheffield, School of Medicine and Population Health, Sheffield, United Kingdom; 18Oxford University Hospitals NHS Foundation Trust, Department of Haematology, Oxford, United Kingdom; 19LMU University Hospital, LMU Munich, Department of Medicine IV, Munich, Germany; 20Sheffield Teaching Hospitals, Department of Neurosurgery, Sheffield, United Kingdom; 21Germans Trias i Pujol Hospital and Research Institute, Endocrinology and Nutrition Department, Barcelona, Spain; 22Universitat Internacional de Catalunya (UIC), Barcelona, Spain; 23Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Pituitary Diseases Unit 747, Madrid, Spain; 24Oxford University Hospitals NHS FT, OCDEM, Oxford, United Kingdom; 25Amsterdam University Medical Center, University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, Netherlands
JOINT574
Background: Patients with Cushing’s syndrome (CS) are at markedly increased risk of thromboembolic events. However, despite recognised risk, no guidance on thromboprophylaxis for CS has been established, and practices remain variable across clinical settings.
Aim: To provide recommendations for thromboprophylaxis, perioperative management, and treatment of VTE in patients with endogenous CS. To unify care practices and improve patient outcomes by mitigating the risk of venous thromboembolic events (VTE ) in this population.
Methods: This was a Delphi method involving four iterative rounds of voting and subsequent discussions. The expert panel comprised 18 international specialists from 11 countries across 4 continents. Consensus was achieved with a threshold of ≥75% agreement. The recommendations were categorised into thromboprophylaxis, perioperative management, and treatment of VTE.
Results: Consensus was achieved on 14 recommendations. Thromboprophylaxis should be initiated at time of diagnosis and continued for at least three months after biochemical remission, provided there are no contraindications. Hospitalised patients with active CS should routinely receive thromboprophylaxis unless contraindicated. Patients with CS who are biochemically controlled on medical therapy and do not have additional risk factors may not require thromboprophylaxis. Low-molecular-weight heparin (LMWH), at standard weight-based prophylactic doses, is the preferred agent due to its known safety and efficacy. For perioperative management, LMWH should be administered until 24 hours before surgery and resumed 24 hours postoperatively, continuing for at least three months after achievement of biochemical remission. For patients undergoing inferior petrosal sinus sampling (IPSS), thromboprophylaxis should be reconsidered if it has not already been initiated. Prophylactic LMWH should be continued. Patients on direct oral anticoagulants (DOACs) should discontinue them 24–72 hours prior to IPSS and resume 48 hours after the procedure with interim prophylactic LMWH. The panel did not find sufficient evidence to recommend routine pre- or postoperative haemostatic testing to guide clinical decisions. Antiembolic stockings are not recommended due to limited efficacy and potential complications. Future research priorities include evaluating the use of DOACs in CS and determining the optimal duration of thromboprophylaxis post-remission.
Conclusion: These Delphi consensus recommendations aim to unify care practices and improve outcomes in CS by offering clear guidance on thromboprophylaxis, including its initiation, duration across different disease stages, and preferred treatment options. Key gaps for future research include the role of DOACs in CS, the optimal duration of thromboprophylaxis after remission, and refining criteria for thromboprophylaxis in patients with mild CS and mild autonomous cortisol secretion (MACS).
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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