Polycythemia as the first manifestation of Cushing’s disease

Dušek, Tina; Kaštelan, Darko; Solak, Mirsala; Kinda, Sandra Bašić; Aganović, Izet; Koršić, Marta

doi:10.1007/bf03346446

Cited by 10 publications

(8 citation statements)

References 3 publications

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“…Our findings indicate that changes are clearly genderdependent, with men with Cushing's disease presenting low-normal RBC counts and haemoglobin concentration and women, on the contrary, presenting normal, if slightly above average peripheral erythroid cell counts. This distribution is the reversal of RBC parameters in the normal population and substantiates findings reported in a small group of patients with Cushing's disease (9). Common causes of anaemia, e.g.…”

Section: European Journal Of Endocrinologysupporting

confidence: 89%

“…Harvey Cushing reported that his first patient, Minnie G., presented 5.30!10 12 /l erythrocytes and bright mucosae notwithstanding frequent nose and bowel bleedings (7). More recently, polycythaemia was the presenting feature in two patients with Cushing's disease (8,9). However, a thorough evaluation of RBC counts in patients with Cushing's syndrome and their course after remission of hypercortisolism is yet to be performed.…”

Section: Introductionmentioning

confidence: 99%

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Gender-dependent changes in haematological parameters in patients with Cushing's disease before and after remission

Ambrogio

Martin

Ascoli

et al. 2014

European Journal of Endocrinology

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Objective: Glucocorticoids stimulate several steps in red blood cell (RBC) development; however, little is known on changes in erythroid parameters in patients with Cushing's disease. The aim of this study was to assess both RBC and white blood cell (WBC) parameters in a large cohort of patients with Cushing's disease and report on alterations in the active phase and after surgical remission. Design and methods: A total of 80 patients with Cushing's disease (63 women and 17 men) were studied before and for up to 254 months' follow-up (mean follow-up 65.8G6.71 months) after pituitary/adrenal surgery. Details of blood counts were reviewed and compared with data obtained from a database of healthy subjects. Results: The RBC counts and haemoglobin levels were low in men with active Cushing's disease (over 80% of values in the lowest quartile) and four patients were overtly anaemic, whereas erythrocyte counts and haemoglobin levels were evenly distributed across the normal range in women with active Cushing's disease. Low erythroid parameters were linked to hypogonadism in men with Cushing's disease. Recovery in erythroid parameters occurred slowly after remission of hypercortisolism in men, in parallel with improvements in testosterone levels. Over 50% of patients with active disease presented increased WBC counts, irrespective of gender, and prompt normalisation within 1 month after surgery. Conclusions: Male patients with Cushing's disease present reduced RBC counts and haemoglobin levels, associated with low testosterone concentrations, which resolve over time after remission of hypercortisolism. Anaemia should therefore be regarded as another unfavourable feature in men with Cushing's disease.

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Section: European Journal Of Endocrinologysupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Gender-dependent changes in haematological parameters in patients with Cushing's disease before and after remission

Ambrogio

Martin

Ascoli

et al. 2014

European Journal of Endocrinology

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“…The most likely underlying mechanism for this phenomenon is cortisol‐induced upregulation of mRNA transcription of various coagulation factors. Furthermore, hypercoagulability in CS may also be related to hypertension, diabetes, polycythaemia and increased BMI, all of which are hallmarks of this disease …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, hypercoagulability in CS may also be related to hypertension, diabetes, polycythaemia and increased BMI, all of which are hallmarks of this disease. [13][14][15][16] Increased levels of a wide range of coagulation factors have been reported in patients with CS across several studies. [1][2][3][4][5][6]16,17 Accordingly, in this study, we found enhanced levels of factors II, V, VIII, IX and XI, protein C, protein S, antithrombin, antithrombin Ag, C1 inhibitor and PAI-1 in patients with CS compared with the controls.…”

Section: Discussionmentioning

confidence: 99%

Hypercoagulable state in Cushing's syndrome is reversible following remission

Kaštelan

Dušek

Kraljević

et al. 2012

Clinical Endocrinology

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Summary Objective Hypercoagulability is a commonly described complication in patients with Cushing's syndrome (CS). The aim of this study was to assess the long‐term effects of surgical remission from CS on serum levels of coagulation and fibrinolytic markers. Design and methods Eighteen patients with active CS (16 women, 2 men; age: 38·6 ± 13·7 years) were enrolled in the study. We measured serum levels of coagulation and fibrinolytic markers during active CS and 6 months after remission. The control group comprised 18 age‐ and sex‐matched healthy individuals. Results Six months after remission from CS, patients had lower levels of factors II (P < 0·001), V (P = 0·02), XI (P = 0·04) and XII (P < 0·001), protein C (P < 0·001), protein S (P = 0·002), antithrombin (P = 0·03), antithrombin Ag (P = 0·008), plasminogen (P = 0·03) and C1 inhibitor (P = 0·001), and aPTT was longer than at enrolment (P = 0·001). Levels of PAI‐1 and factors VII, VIII and IX tended to normalize, but there were no significant differences in these parameters before and after surgery, nor were differences found in haemostatic and fibrinolytic markers between the patients in remission and control individuals, except for factor XII (P = 0·02) and protein C (P = 0·004), which were lower among patients in remission. Conclusion Six months after remission from CS, patients' risk of thromboembolism is comparable to that of healthy individuals.

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“…It is well documented that release of cortisol from the adrenal glands is increased during conditions of SE, such as sepsis or severe trauma (18). Direct effects of cortisol on erythropoiesis are demonstrated, by polycythemia as an early clinical manifestation of Cushing's syndrome, (19) and by the therapeutic effect of prednisone in patients with the red cell progenitor disorder Diamond‐Blackfan Anemia (DBA) (20). Although the molecular events following glucocorticoid receptor activation in inflammation and metabolism are well understood (21), relatively little is known of how GCs promote red cell formation during SE.…”

Section: Introductionmentioning

confidence: 99%

From stem cell to erythroblast: Regulation of red cell production at multiple levels by multiple hormones

2010

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SummaryThis article reviews the regulation of production of red blood cells at several levels: (1) the ability of erythropoietin and adhesion to a fibronectin matrix to stimulate the rapid production of red cells by inducing terminal proliferation and differentiation of committed erythroid CFU-E progenitors; (2) the regulated expansion of the pool of earlier BFU-E erythroid progenitors by glucocorticoids and other factors that occurs during chronic anemia or inflammation; and (3) the expansion of the hematopoietic cell pool to produce more progenitors of all hematopoietic lineages. IUBMBIUBMB Life, 62(7): [492][493][494][495][496] 2010

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Polycythemia as the first manifestation of Cushing’s disease

Cited by 10 publications

References 3 publications

Gender-dependent changes in haematological parameters in patients with Cushing's disease before and after remission

Gender-dependent changes in haematological parameters in patients with Cushing's disease before and after remission

Hypercoagulable state in Cushing's syndrome is reversible following remission

From stem cell to erythroblast: Regulation of red cell production at multiple levels by multiple hormones

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