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Cited by 219Venous Thromboembolism Diagnosis and ManagementPituitary Gland Disorders and TreatmentsBlood Coagulation and Thrombosis Mechanisms

Hypercoagulable State in Cushing’s Syndrome: A Systematic Review

Van Zaane, Bregje, Nur, Erfan, Squizzato, Alessandro, Dekkers, Olaf M., Twickler, Marcel (Th) B., Fliers, Eric, Gerdes, Victor E. A., Büller, Harry R. +1 more·2009·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2009-0290
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Abstract

CONTEXT: It has been debated whether an increased risk of venous thromboembolism (VTE) exists in patients with Cushing's syndrome. OBJECTIVE: We aimed to summarize published literature on the effects of endogenous hypercortisolism on coagulation and fibrinolysis, as well as on the clinical outcome of VTE. DATA SOURCES: We searched the MEDLINE and EMBASE databases up to July 2008. Review of reference lists further identified candidate studies. STUDY SELECTION: Two investigators independently performed study selection and data extraction. Eligible studies had to include Cushing's syndrome patients and either evaluate hemostatic parameters in comparison with control persons or posttreatment levels or describe the occurrence of VTE. DATA EXTRACTION: The Newcastle-Ottawa Scale was used to assess study quality. A scoring system divided studies into categories of low, medium and high quality. DATA SYNTHESIS: Of 441 identified publications, 15 reports were included. They contained information on eight cross-sectionals, two intervention, and eight cohort studies. No high-quality studies were identified. Hypercoagulability was suggested by high levels of factor VIII, factor IX, and von Willebrand factor and by evidence of enhanced thrombin generation. A risk of 1.9 and 2.5% was reported for VTE not provoked by surgery, whereas risk of postoperative VTE varied between 0 and 5.6%, with one outlier of 20%. VTE was reported as the cause of death in 0-1.9% of Cushing's syndrome patients. CONCLUSIONS: Available studies suggest a high risk of venous thrombosis in patients with Cushing's syndrome. Glucocorticoid-induced hypercoagulability as well as surgery and obesity almost certainly contribute to this thrombotic tendency.

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  • Patients with active Cushing syndrome have a high risk of venous thromboembolism in comparison to the general population.

    “Finally, patients with active CS have a high risk of venous thromboembolism (VTE) in comparison to the general population (8, 45, 46).”

    From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [45]

  • Cushing syndrome is associated with a high risk of venous thromboembolic events which can be a presenting symptom.

    “Cushing syndrome is associated with a high risk of venous thromboembolic events which can be a presenting symptom”

    From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [45]

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Authors
Van Zaane, B., Nur, E., Squizzato, A., Dekkers, O. M., Twickler, M. (. B., Fliers, E., Gerdes, V. E. A., Büller, H. R., & Brandjes, D. P. M.
Affiliations
  • Department of Internal Medicine (B.V.Z., E.N., V.E.A.G., D.P.M.B.), Slotervaart Hospital, 1066 EC Amsterdam, The Netherlands
  • Slotervaartziekenhuis (NL)
  • University of Insubria (IT)
  • Leiden University Medical Center (NL)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Department of Vascular Medicine (B.V.Z., A.S., M.B.T., V.E.A.G., H.R.B.), Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2009-08-01
Volume
94
Issue
8
Pages
2743-2750
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2009-0290
OpenAlex
W2116856478
Cited by
216
References
68
Citations by year
2026: 6 · 2025: 12 · 2024: 13 · 2023: 17 · 2022: 15 · 2021: 13 · 2020: 12 · 2019: 10 · 2018: 7 · 2017: 11 · 2016: 11 · 2015: 19 · 2014: 15 · 2013: 12 · 2012: 21
FWCI
2.57
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • IrInSubria (University of Insubria) (submittedVersion)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords
Cushing's syndrome, hypercoagulability, venous thromboembolism, hypercortisolism, coagulation, fibrinolysis, factor VIII, factor IX, von Willebrand factor, thrombin generation, postoperative thrombosis, obesity, mortality
MeSH terms
Blood Coagulation, Cushing Syndrome, Fibrinolysis, Humans, Thrombophilia, Venous Thromboembolism

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