Increased Factor VIII Associated Activities in Cushing's Syndrome: A Probable Hypercoagulable State

Zanon, R. Dal Bo; Fornasiero, L.; Boscaro, Marco; Cappellato, G; Fabris, Fabrizio; Girolami, A

doi:10.1055/s-0038-1657142

Cited by 73 publications

(8 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our opinion, cholecystectomy and, subsequently, the anterior approach are mandatory when gallstones are present prior to surgery in order to prevent postoperative acute cholecystitis, a complication under steroid replacement therapy. As others [25,26], we have observed thromboembolic complications due to increased factor VIII activity in Cushing's syndrome, responsible for an hypercoagulable state. We advocate perioperative prevention by low-molecularweight heparin, but this opinion is not shared by others [7].…”

Section: Discussionsupporting

confidence: 72%

Role and Operative Risk of Bilateral Adrenalectomy in Hypercortisolism

et al. 1996

View full text Add to dashboard Cite

Transsphenoidal pituitary surgery has radically modified the management of pituitary-dependent hypercortisolism (Cushing's disease). Bilateral adrenalectomy may, however, represent the ultimate treatment in some cases of hypercortisolism. In the present study we report our experience of bilateral adrenalectomy in 82 patients operated on during the last 15 years. The causes of hypercortisolism were Cushing's disease (n = 78), ectopic ACTH syndrome (n = 3), and primary adrenocortical nodular dysplasia (Carney-Meador syndrome) (n = 1). Before operation 37% of the patients had severe symptoms of hypercortisolism. A bilateral posterior approach was undertaken in 58 patients, whereas 18 patients had an anterior transabdominal approach and 6 patients a laparoscopic approach. There were two operative deaths (2.4%). Postoperative complications occurred mostly in cases of advanced disease and were observed in 14 patients (17%), among whom 4 had severe complications. At long-term follow-up, one recurrence of hypercortisolism and 12 Nelson syndromes (15%) were observed. In conclusion, bilateral adrenalectomy carries an acceptable operative risk, and we recommend bilateral adrenalectomy rather than long-term suppressive therapy in patients requiring prompt and definitive control of their hypercortisolism or after pituitary surgery failure.

show abstract

Section: Discussionsupporting

confidence: 72%

Role and Operative Risk of Bilateral Adrenalectomy in Hypercortisolism

et al. 1996

View full text Add to dashboard Cite

show abstract

“…The thrombogenic potential of steroids is well described in the literature (Isacson, 1970; Jorgenson et al , 1982; Zanon et al , 1982; van Giezen & Jansen, 1992; Patrassi et al , 1992; Ozturk et al , 1994; Patrassi et al , 1995; Nowak‐Gottl et al , 1999, 2001a; Sartori et al , 1999; Athale & Chan, 2003b). Several investigators have shown that steroid therapy leads to elevation of factors VIII, von Willebrand factor (VWF), prothrombin and antithrombin, and decreases the levels of fibrinogen and plasminogen (Ozsoylu et al , 1962; Isacson, 1970; Jorgenson et al , 1982; Zanon et al , 1982; van Giezen & Jansen, 1992; Halton et al , 1992; Ozturk et al , 1994; Patrassi et al , 1995; Sartori et al , 1999). Steroid therapy has been shown to alter the VWF function as well as to induce a hypofibrinolytic state, with elevation of plasminogen activator inhibitor 1 (PAI‐1) levels, reduction of α 2 ‐macroglobin and decrease in the content of venous wall plasminogen activator.…”

Section: Discussionmentioning

confidence: 94%

Thromboembolism in children with acute lymphoblastic leukaemia treated on Dana‐Farber Cancer Institute protocols: effect of age and risk stratification of disease

et al. 2005

View full text Add to dashboard Cite

SummaryChildren with acute lymphoblastic leukaemia (ALL) are at increased risk for thromboembolism (TE). Identification of a susceptible population is crucial for effective thromboprophylaxis. However, the risk factors for ALLassociated TE are unclear. Concomitant asparaginase (ASP) and steroid therapy has been shown to increase the incidence of TE. Dana-Farber Cancer Institute (DFCI)-ALL protocols use a combination of ASP and steroids during the postinduction intensification phase when high-risk (HR) patients receive thrice the steroid-dose given to standard-risk (SR) patients. We studied prospectively assembled cohorts of children treated on two consecutive DFCI-ALL protocols to define the risk factors for symptomatic TE. Ten (11%) of 91 patients developed symptomatic TE; eight (seven HR) during intensification. Seven (44%) of 16 older patients ( ‡10 years) compared with three of 75 (4%) younger patients developed TE (P < 0AE0001). Nine of 35 (26%) HR and one of 56 (2%) SR patients developed TE (P ¼ 0AE0006). Gender, ALL-immunophenotype, steroid-type or ASP dosing schedule did not alter the risk but older age and HR-disease were factors predisposing to TE associated with DFCI-ALL protocols. Agerelated risk may partly reflect the effect of ALL-risk stratification. Higher dose steroids combined with ASP may lead to an increased risk of TE in HR patients.

show abstract

“…The procoagulant factors that veterinary medical authors have investigated related to this procoagulant state include factors II, V, VII, IX, X, XII, and fibrinogen . In human HAC patients, the tendency toward hypercoagulability has been attributed to increases in factor activity for factor VIII alone, the combination of factors VIII, V, and prothrombin, factors XII, XI, IX, and VIII and increased factor VIII and von Willebrand factor (vWF) activity with abnormal vWF multimers and hyperresponsive platelet activity . Decreased function of the anticoagulant system has been attributed to a decrease in antithrombin concentrations .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of coagulation status in dogs with naturally occurring canine hyperadrenocorticism

Klose¹,

Creevy

Brainard³

2011

J Vet Emergen Crit Care

View full text Add to dashboard Cite

Objective -To determine whether or not there are differences in coagulation parameters (eg, thrombelastography [TEG], activated partial thromboplastin time [aPTT], prothrombin time [PT], and fibrinogen) among dogs with naturally occurring hyperadrenocorticism (HAC), dogs with HAC undergoing medical management, and dogs without HAC. Design -Prospective, observational study. Setting -Veterinary teaching hospital. Animals -Forty-six client-owned dogs undergoing adrenal function testing. Interventions -None. Measurements and Main Results -Nine dogs were diagnosed with HAC de novo, 19 dogs were presented for therapeutic monitoring of previously diagnosed HAC, and 18 dogs did not have HAC. Variables compared between groups were age, body weight, platelet count, mean platelet volume, serum concentrations of cholesterol, triglycerides, antithrombin, PT, aPTT, fibrinogen, and TEG parameters (eg, alpha angle, R, K, and maximum amplitude [MA]). Dogs with HAC and dogs treated for HAC had higher serum cholesterol than dogs without HAC (P < 0.05). All groups had mean MA greater than the institutional reference interval. There was a weak, positive correlation between hematocrit and MA that was independent of diagnosis (r 2 = 0.266, P = 0.004). Conclusions -The results of this study do not support the supposition that a significant difference exists in coagulation tendencies between dogs with HAC prior to treatment, dogs with HAC during treatment, and dogs without HAC. This disagreement with the classically accepted notion that HAC leads to a hypercoagulable state could be due to a couple of possibilities. Namely, the link between HAC and hypercoagulability may be relatively weak, or our findings may be the result of a type II error either as a result of a small sample size or the use of coagulation assays that are insensitive to the effects of HAC on the hemostatic system. (J Vet Emerg Crit Care 2011; 21(6): 625-632)

show abstract

Increased Factor VIII Associated Activities in Cushing's Syndrome: A Probable Hypercoagulable State

Cited by 73 publications

References 2 publications

Role and Operative Risk of Bilateral Adrenalectomy in Hypercortisolism

Role and Operative Risk of Bilateral Adrenalectomy in Hypercortisolism

Thromboembolism in children with acute lymphoblastic leukaemia treated on Dana‐Farber Cancer Institute protocols: effect of age and risk stratification of disease

Evaluation of coagulation status in dogs with naturally occurring canine hyperadrenocorticism

Contact Info

Product

Resources

About