Risk of Blood Clots Highest Within 6 Months of Cushing Syndrome Surgery

For patients with Cushing syndrome, transsphenoidal surgery can be a beneficial option for addressing pituitary growths or tumors. But according to Cushing’s Disease News, this same surgery also increases the risk of blood clots during the following 6 months. Since patients with Cushing syndrome are already more likely to develop blood clots than those without, it is important to understand how preventative treatment could be used to address this potential complication. However, after 6 months, the risk of blood clots is reduced to match the general population. Check out the full study findings published in the Journal of Endocrinological Investigation.

The Research

According to past studies, researchers estimated that the risk of venous thromboembolism, characterized by blood clot formation in deep veins, is up to 17.8x higher in patients with Cushing syndrome. These clots can form as a result of imbalanced cortisol levels. Ultimately, heightened cortisol also causes procoagulant and anticoagulant factors to become imbalanced. Normally, these factors play a role in blood clotting.

In this study, Italian researchers wanted to understand whether or not coagulant factors returned to a normal (balanced) state after Cushing disease surgery. For example, if patients achieved remission, did their imbalances also resolve? Altogether, 38 participants joined the study. Of these, 19 people had Cushing syndrome and had achieved remission following surgical intervention. The remaining 19 people made up the control group.

To begin, researchers performed a thrombin generation assay (TGA) to evaluate the levels of both procoagulant and anticoagulant factors. Follow-up periods included 6 months and 5 years following surgery. Findings included:

  • Patients with high endogenous thrombin potential (ETP) were more likely to develop blood clots. Additionally, patients with a higher ETP ratio were more likely to develop blood clots.
  • Prior to surgery, patients with Cushing syndrome had a higher ETP ratio than the control group. However, researchers found no connection between cortisol levels and ETP ratio.
  • Within 6 months of surgery, patients with Cushing syndrome had significantly higher ETP and an ETP ratio. However, there was an immense decrease in ETP and ETP ratio within 5 years, showcasing some sort of normalization. In fact, by the end of the 5 year follow-up period, there was no significant difference between the control group and the patients.

Cushing Syndrome

Also known as hypercortisolism, Cushing syndrome is an endocrine disorder in which patients develop excessive blood cortisol levels. Typically, Cushing syndrome results from either oral corticosteroid use or overproduction of cortisol, often caused by an adrenal gland or pituitary gland tumor. Normally, cortisol plays a role in helping the body cope with stress by modulating blood pressure and inflammation. However, when cortisol levels are already too high, it results in a number of symptoms.

Symptoms include:

  • High blood pressure
  • Fatty hump between the shoulders
  • Rounded face
  • Pink/purple stretch marks
  • Fatigue
  • Muscle weakness
  • Easy bruising
  • Hirsutism (excessive hair growth)
  • Weight gain, often around the face or trunk
  • Osteoporosis (fragile bones)
  • Erectile dysfunction (for males)
  • Menstrual irregularities (for females)
  • Lowered libido
  • Poor memory or concentration

Learn more about Cushing syndrome.


Jessica Lynn

Jessica Lynn

Jessica Lynn has an educational background in writing and marketing. She firmly believes in the power of writing in amplifying voices, and looks forward to doing so for the rare disease community.

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