A venous thromboembolism risk assessment model for patients with Cushing’s syndrome

Zilio, Marialuisa; Mazzai, Linda; Sartori, Maria Teresa; Barbot, Mattia; Ceccato, Filippo; Daidone, Viviana; Casonato, Alessandra; Saggiorato, Graziella; Noventa, Franco; Trementino, Laura; Prandoni, Paolo; Boscaro, Marco; Arnaldi, Giorgio; Scaroni, Carla

doi:10.1007/s12020-015-0665-z

Cited by 38 publications

(56 citation statements)

References 45 publications

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“…Recently, it has been observed that diabetes in patients with CS is not strictly dependent on UFC and serum cortisol levels, but related to other parameters such as familial history of diabetes, age, and likely duration of disease [42]. In another study conducted by Zilio et al, no correlation between UFC and onset of venous thromboembolic events were found [43].…”

Section: Discussionmentioning

confidence: 97%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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Cushing syndrome (CS) is characterized by increased morbidity and mortality compared to the general population. However, there are patients who have more clinical aggressive forms than others. Aim of the study is to evaluate whether the degree of hypercortisolism, defined by the number of times urinary free cortisol (UFC) levels exceed the upper limit of the normal range (ULN), is related to the worsening of phenotypic features, as well as metabolic and cardiovascular parameters, in a cohort of CS patients. A cross-sectional study was conducted on 192 patients with active CS, consecutively presenting at the outpatients' clinic of the University Hospitals of Ancona, Naples, and Palermo. Patients were grouped into mild (UFC not exceeding twice the ULN), moderate (2-5 times the ULN), and severe (more than 5 times the ULN) hypercortisolism. Thirty-seven patients (19.3 %) had mild, 115 (59.8 %) moderate, and 40 (20.9 %) severe hypercortisolism. A significant trend of increase among the three groups was demonstrated for 8-, 16-, and 24-h serum cortisol levels (p \ 0.001) and serum cortisol after low dose of dexamethasone suppression test (p = 0.001). No significant trend of increase was found regarding phenotype and comorbidities. The degree of hypercortisolism by itself does not appear to be a sufficient parameter to express the severity of CS. Therefore, estimating the severity of CS according to biochemical parameters remains a challenge, while the clinical phenotype and the associated comorbidities might be more useful to assessing the severity of the CS.

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Section: Discussionmentioning

confidence: 97%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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“…However, the risk stratification does not differ from that in individuals without Cushing's syndrome. There is also increased risk of thromboembolic events, both pre-and postoperatively (PO) (20)(21)(22)(23)(24)(25). Thus, the analysis of coagulation factors is very important, although there are no formal guidelines to define which factors should be analyzed in addition to those traditionally considered (i.e., thrombin time, prothrombin time, thromboplastin activated time, platelets) or which coagulation protocol should be recommended before and after surgery (26).…”

Section: Surgical Treatmentmentioning

confidence: 99%

A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism

Machado¹,

Fragoso²,

Moreira³

et al. 2018

Archives of Endocrinology and Metabolism

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The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure. Medical treatment, radiotherapy and adrenalectomy are the other options when transsphenoidal pituitary surgery fails. There are several options of medical treatment, although cabergoline and ketoconazole are the most commonly used alone or in combination. Novel treatments are also addressed in this review. Different therapeutic approaches are frequently needed on an individual basis, both before and, particularly, after surgery, and they should be individualized. The objective of the present review is to provide the necessary information to achieve a more effective treatment for CD. It is recommended that patients with CD be followed at tertiary care centers with experience in treating this condition.

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“…It is worth noting that the highest cortisol levels (>3000 nmol/mL) were observed in a patient with gram-negative sepsis arising from the biliary tract, in a patient with E. coli pneumonia complicated with venous thromboembolism (VTE), and in a patient with fulminant meningococcal sepsis who survived with severe sequelae (data not shown). Higher plasma cortisol levels have already been demonstrated in survivors of meningococcal sepsis in comparison to nonsurvivors, and in patients with Cushing's syndrome with increased risk of VTE; however, there have been no studies of cortisol levels in patients with biliary sepsis [ 26 , 27 ]. It seems probable that these findings represent the severity of those clinical situations.…”

Section: Discussionmentioning

confidence: 99%

Selected Biomarkers Correlate with the Origin and Severity of Sepsis

Holub

Džupová

Růžková

et al. 2018

Mediators of Inflammation

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The microbial etiology and source of sepsis influence the inflammatory response. Therefore, the plasma levels of cytokines (IL-6, IL-8, and IL-10), chemokines (CCL2/MCP-1, MIP-1β), heparin-binding protein (HBP), soluble CD14 (sCD14), and cortisol were analyzed in blood from septic patients obtained during the first 96 hours of intensive care unit hospitalization. The etiology was established in 56 out of a total of 62 patients enrolled in the study. Plasma concentrations of MCP-1, sCD14, IL-6, and IL-10 were significantly higher in patients with community-acquired pneumonia (CAP; n = 10) and infective endocarditis (IE; n = 11) compared to those with bacterial meningitis (BM; n = 18). Next, cortisol levels were higher in IE patients than in those with BM and CAP, and at one time point, cortisol was also higher in patients with gram-negative sepsis when compared to those with gram-positive infections. Furthermore, cortisol and MCP-1 levels correlated positively with the daily measured SOFA score. In addition, HBP levels were significantly higher in patients with IE than in those with BM. Our findings suggest that MCP-1, sCD14, IL-6, IL-10, cortisol, and HBP are modulated by the source of sepsis and that elevated MCP-1 and cortisol plasma levels are associated with sepsis-induced organ dysfunction.

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A venous thromboembolism risk assessment model for patients with Cushing’s syndrome

Cited by 38 publications

References 45 publications

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism

Selected Biomarkers Correlate with the Origin and Severity of Sepsis

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