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Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease

OBJECTIVE: Patients with Cushing’s syndrome (CS) are at high risk of venous thromboembolism related to a hypercoagulability due to procoagulant imbalance. However, whether these alterations are reversible after disease remission is still unclear. The endogenous thrombin potential (ETP) measured with...

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Autores principales: Ferrante, E., Serban, A. L., Clerici, M., Indirli, R., Scalambrino, E., Carosi, G., Padovan, L., Locatelli, M., Arosio, M., Peyvandi, F., Mantovani, G., Tripodi, A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8741706/
https://www.ncbi.nlm.nih.gov/pubmed/34115342
http://dx.doi.org/10.1007/s40618-021-01605-5
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author Ferrante, E.
Serban, A. L.
Clerici, M.
Indirli, R.
Scalambrino, E.
Carosi, G.
Padovan, L.
Locatelli, M.
Arosio, M.
Peyvandi, F.
Mantovani, G.
Tripodi, A.
author_facet Ferrante, E.
Serban, A. L.
Clerici, M.
Indirli, R.
Scalambrino, E.
Carosi, G.
Padovan, L.
Locatelli, M.
Arosio, M.
Peyvandi, F.
Mantovani, G.
Tripodi, A.
author_sort Ferrante, E.
collection PubMed
description OBJECTIVE: Patients with Cushing’s syndrome (CS) are at high risk of venous thromboembolism related to a hypercoagulability due to procoagulant imbalance. However, whether these alterations are reversible after disease remission is still unclear. The endogenous thrombin potential (ETP) measured with and without the addition of thrombomodulin provides a global representation of coagulation and previous data confirmed hypercoagulable profile in patients with active hypercortisolism. Aim of this study was to assess the short- and long-term modification of ETP in patients with CS after disease remission. DESIGN AND METHODS: Nineteen patients with CS for whom surgical remission was achieved, were prospectively evaluated for clinical characteristics, cortisol secretion profile and ETP at different time points: (i) before surgical intervention; (ii) after 6 months and (iii) 5 years from the time of persistent remission. Nineteen healthy subjects matched for age and gender were also evaluated as control group. RESULTS: Before surgery, patients showed higher ETP-ratio (with/without thrombomodulin) than controls (0.62 ± 0.09-vs-0.56 ± 0.09, p = 0.034). No significant correlation between ETP-ratio and cortisol secretion was found. 6 months after remission, ETP-ratio was still significantly increased compared to controls (0.64 ± 0.09-vs-0.56 ± 0.09, p = 0.01), but was similar to baseline (0.64 ± 0.09-vs-0.62 ± 0.09, p = 0.87). At 5 years, ETP-ratio showed a significant decrease (0.55 ± 0.14-vs-0.62 ± 0.09, p = 0.02) and was comparable to controls (0.55 ± 0.14-vs-0.56 ± 0.09, p = 0.7). CONCLUSIONS: Plasma hypercoagulability detected in patients with active hypercortisolism persists at short-term evaluation and seems to be completely reversible after long-term remission of disease. These data, as part of a whole evaluation of thrombotic risk, can contribute to make appropriate therapeutic choice in these patients.
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spelling pubmed-87417062022-01-20 Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease Ferrante, E. Serban, A. L. Clerici, M. Indirli, R. Scalambrino, E. Carosi, G. Padovan, L. Locatelli, M. Arosio, M. Peyvandi, F. Mantovani, G. Tripodi, A. J Endocrinol Invest Original Article OBJECTIVE: Patients with Cushing’s syndrome (CS) are at high risk of venous thromboembolism related to a hypercoagulability due to procoagulant imbalance. However, whether these alterations are reversible after disease remission is still unclear. The endogenous thrombin potential (ETP) measured with and without the addition of thrombomodulin provides a global representation of coagulation and previous data confirmed hypercoagulable profile in patients with active hypercortisolism. Aim of this study was to assess the short- and long-term modification of ETP in patients with CS after disease remission. DESIGN AND METHODS: Nineteen patients with CS for whom surgical remission was achieved, were prospectively evaluated for clinical characteristics, cortisol secretion profile and ETP at different time points: (i) before surgical intervention; (ii) after 6 months and (iii) 5 years from the time of persistent remission. Nineteen healthy subjects matched for age and gender were also evaluated as control group. RESULTS: Before surgery, patients showed higher ETP-ratio (with/without thrombomodulin) than controls (0.62 ± 0.09-vs-0.56 ± 0.09, p = 0.034). No significant correlation between ETP-ratio and cortisol secretion was found. 6 months after remission, ETP-ratio was still significantly increased compared to controls (0.64 ± 0.09-vs-0.56 ± 0.09, p = 0.01), but was similar to baseline (0.64 ± 0.09-vs-0.62 ± 0.09, p = 0.87). At 5 years, ETP-ratio showed a significant decrease (0.55 ± 0.14-vs-0.62 ± 0.09, p = 0.02) and was comparable to controls (0.55 ± 0.14-vs-0.56 ± 0.09, p = 0.7). CONCLUSIONS: Plasma hypercoagulability detected in patients with active hypercortisolism persists at short-term evaluation and seems to be completely reversible after long-term remission of disease. These data, as part of a whole evaluation of thrombotic risk, can contribute to make appropriate therapeutic choice in these patients. Springer International Publishing 2021-06-11 2022 /pmc/articles/PMC8741706/ /pubmed/34115342 http://dx.doi.org/10.1007/s40618-021-01605-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Ferrante, E.
Serban, A. L.
Clerici, M.
Indirli, R.
Scalambrino, E.
Carosi, G.
Padovan, L.
Locatelli, M.
Arosio, M.
Peyvandi, F.
Mantovani, G.
Tripodi, A.
Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease
title Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease
title_full Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease
title_fullStr Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease
title_full_unstemmed Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease
title_short Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease
title_sort evaluation of procoagulant imbalance in cushing’s syndrome after short- and long-term remission of disease
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8741706/
https://www.ncbi.nlm.nih.gov/pubmed/34115342
http://dx.doi.org/10.1007/s40618-021-01605-5
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