Vol 67, No 3 (2016)
Original paper
Published online: 2016-01-27

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Cushing`s disease: Fibrinogen and D-dimer levels fail to normalize despite early postoperative remission — a prospective, controlled study

Przemysław Witek, Grzegorz Zieliński, Katarzyna Szamotulska, Joanna Witek, Grzegorz Kamiński
DOI: 10.5603/EP.a2016.0034
Pubmed: 26884303
Endokrynol Pol 2016;67(3):283-291.

Abstract

Introduction: Effective transsphenoidal surgery (TSS) for Cushing`s disease (CD) normalizes cortisol levels and reduces complications of hypercortisolism. However, there is evidence of increased cardiovascular morbidity even after successful surgery.

Objective. A prospective, controlled study on the dynamics of fibrinogen and D-dimer levels with a six-month follow-up after an effective TSS for CD.

Material and methods: Forty patients with CD and forty healthy age- and sex-matched subjects were included. We assessed ACTH, urinary and serum cortisol, and fibrinogen and D-dimer levels before TSS and during follow-up.

Results: Baseline BMI (P < 0.001), fibrinogen (P = 0.002), and D-dimer (P = 0.001) levels in CD patients were significantly higher than those in healthy controls. High fibrinogen levels in the CD group were independent of BMI, and were positively associated with hsCRP (rS = 0.61, P < 0.001) and arterial hypertension (P = 0.029). After the six-month follow-up we confirmed a sustained difference between the remission group and controls in fibrinogen and D-dimer levels (P = 0.001 and P = 0.017, respectively).

Conclusions: Despite early biochemical remission of CD the levels of fibrinogen and D-dimer failed to decrease. This probably contributes to the high risk of thrombotic events and indicates the need for a close follow-up for signs of thromboembolic and cardiovascular complications in patients with early CD remission. (Endokrynol Pol 2016; 67 (3): 283–291)