The coagulation system in endocrine disorders: A narrative review

Squizzato, Alessandro; Gerdes, Victor E. A.; Ageno, Walter; Büller, Harry R.

doi:10.1007/s11739-007-0026-x

Cited by 53 publications

(48 citation statements)

References 80 publications

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“…Signs or symptoms related to coagulation disorders are not commonly described in AI (97), despite the fact that increased mortality from cardiovascular disorders has been reported. AI is not usually complicated by thrombotic or bleeding episodes; however, neither in vitro nor in vivo studies have been performed to explore these aspects (98). To date, no studies that describe platelet count or function, vWF, coagulation cascade, regulators or fibrinolysis have been performed.…”

Section: Hypocortisolismmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: The spectrum of haemostatic abnormalities in glucocorticoid excess and defect

Isidori

Minnetti

Sbardella

et al. 2015

European Journal of Endocrinology

107

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Glucocorticoids (GCs) target several components of the integrated system that preserves vascular integrity and free blood flow. Cohort studies on Cushing's syndrome (CS) have revealed increased thromboembolism, but the pathogenesis remains unclear. Lessons from epidemiological data and post-treatment normalisation time suggest a bimodal action with a rapid and reversible effect on coagulation factors and an indirect sustained effect on the vessel wall. The redundancy of the steps that are potentially involved requires a systematic comparison of data from patients with endogenous or exogenous hypercortisolism in the context of either inflammatory or non-inflammatory disorders. A predominant alteration in the intrinsic pathway that includes a remarkable rise in factor VIII and von Willebrand factor (vWF) levels and a reduction in activated partial thromboplastin time appears in the majority of studies on endogenous CS. There may also be a rise in platelets, thromboxane B2, thrombin-antithrombin complexes and fibrinogen (FBG) levels and, above all, impaired fibrinolytic capacity. The increased activation of coagulation inhibitors seems to be compensatory in order to counteract disseminated coagulation, but there remains a net change towards an increased risk of venous thromboembolism (VTE). Conversely, GC administered in the presence of inflammation lowers vWF and FBG, but fibrinolytic activity is also reduced. As a result, the overall risk of VTE is increased in long-term users. Finally, no studies have assessed haemostatic abnormalities in patients with Addison's disease, although these may present as a consequence of bilateral adrenal haemorrhage, especially in the presence of antiphospholipid antibodies or anticoagulant treatments. The present review aimed to provide a comprehensive overview of the complex alterations produced by GCs in order to develop better screening and prevention strategies against bleeding and thrombosis.

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Section: Hypocortisolismmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: The spectrum of haemostatic abnormalities in glucocorticoid excess and defect

Isidori

Minnetti

Sbardella

et al. 2015

European Journal of Endocrinology

107

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“…Moreover, it has been demonstrated that CS is associated with a hypercoagulable state and increased incidence of venous thromboembolic events (VTE) (5)(6)(7)(8)(9). Some studies showed a shortening of the activated partial thromboplastin time (aPTT) (10)(11)(12) and elevated levels of factor VIII (F8), factor IX (F9) and von Willebrand factor (VWF) in CS with a consequent increased prevalence of cardiovascular disease such as ischaemic disease, cerebrovascular disease, vascular peripheral and lung disorders (10)(11)(12)(13)(14)(15)(16)(17)(18). Patients with CS also showed an impairment of the fibrinolytic system due to an excess of the fast-activating plasminogen activator inhibitor 1 (PAI-1 or SERPINE1) (19).…”

Section: Introductionmentioning

confidence: 99%

Changes in coagulation indexes and occurrence of venous thromboembolism in patients with Cushing's syndrome: results from a prospective study before and after surgery

Manetti

Bogazzi

Giovannetti

et al. 2010

European Journal of Endocrinology

115

118

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Objectives: To evaluate whether patients with Cushing's syndrome (CS) had i) changes in coagulative and fibrinolytic parameters associated with CS activity and ii) higher prevalence of venous thromboembolic events (VTE). Design: Prospective study conducted on patients with CS evaluated at diagnosis and 12 months after surgery. Patients and methods: Forty patients with active CS (36 with Cushing's disease (CD) and 4 with an adrenal adenoma) were evaluated. Forty normal subjects and 70 patients with non-ACTH-secreting pituitary adenomas served as controls. All patients and controls underwent an assessment of coagulation and fibrinolysis indexes before and after surgery. Results: CS patients at baseline had a hypercoagulative phenotype when compared with normal subjects (activated partial thromboplastin time (aPTT), fibrinogen, D-Dimer, von Willebrand factor (VWF), plasminogen activator inhibitor 1 (PAI-1 or SERPINE1), antithrombin III (ATIII or SERPINC1), P!0.0001, a 2 antiplasmin, PZ0.0004, thrombin-antithrombin complex (TAT), PZ0.01, factor IX (F9), PZ0.03). Patients with still active disease after surgery had higher coagulative parameters than those in remission (VWF (P!0.0001), PAI-1 (PZ0.004), TAT (PZ0.0001), ATIII (PZ0.0002) and a 2 antiplasmin (or SERPINF2; PZ0.006)), whereas aPTT levels (PZ0.007) were significantly reduced. VTE occurred in three patients with CD (7.5%): one had a pulmonary embolism and two patients had a deep venous thrombosis; no patients submitted to transsphenoidal surgery for non-Cushing's pituitary adenoma had VTE (PZ0.04). Conclusions: Patients with CS have a procoagulative phenotype due to cortisol-associated changes in haemostatic and fibrinolytic markers, leading to increased incidence of VTE. Thromboprophylaxis seems to be appropriated in patients with active disease, particularly in the postoperative period.

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“…Note that abnormal coagulation has been reported as a complication of endocrine disregulation, 29 and it is possible that chronic exposure to elevated catecholamines altered the patient's baseline substrate. Future studies and larger patient cohorts are needed to make definitive conclusions.…”

Section: Discussionmentioning

confidence: 99%

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

Kaloostian

Zadnik

Kim

et al. 2014

SPI

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Pheochromocytomas of the spine are uncommon and require careful preoperative planning. The authors retrospectively reviewed the charts of 5 patients with metastatic spinal pheochromocytoma who had undergone surgical treatment over the past 10 years at their medical center. They reviewed patient age, history of pheochromocytoma resection, extent and location of metastases, history of alpha blockage, surgical level, surgical procedure, postoperative complications, tumor recurrence, and survival. Metastases involved the cervical (1 patient), thoracic (3 patients), and lumbar (2 patients) levels. Preoperative treatment included primary pheochromocytoma resection, chemotherapy, alpha blockade, embolization, and radiation. Three patients had tumor recurrence, and 2 underwent 2-stage reoperations for tumor extension. Hemodynamic complications were common: 2 patients developed pulseless electrical activity arrest within 4 months after surgery, 1 patient had profound postoperative tachycardia with fever and an elevated creatine kinase level, and 1 patient experienced transient postoperative hypotension and paraplegia. One patient died of complications related to disseminated cerebral and spinal disease. With careful preoperative and surgical management, patients with symptomatic metastatic spinal pheochromocytoma can benefit from aggressive surgical treatment. Postoperative cardiovascular complications are common even months after surgery, and patients should be closely monitored long term.

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The coagulation system in endocrine disorders: A narrative review

Cited by 53 publications

References 80 publications

MECHANISMS IN ENDOCRINOLOGY: The spectrum of haemostatic abnormalities in glucocorticoid excess and defect

MECHANISMS IN ENDOCRINOLOGY: The spectrum of haemostatic abnormalities in glucocorticoid excess and defect

Changes in coagulation indexes and occurrence of venous thromboembolism in patients with Cushing's syndrome: results from a prospective study before and after surgery

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

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