open access
Cushing`s disease: Fibrinogen and D-dimer levels fail to normalize despite early postoperative remission — a prospective, controlled study
open access
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)
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)
Keywords
hipercortisolemia; cortisol; Cushing’s disease; fibrinogen; D-dimer level; transsphenoidal surgery; thromboembolic complications
About this articleTitle
Cushing`s disease: Fibrinogen and D-dimer levels fail to normalize despite early postoperative remission — a prospective, controlled study
Journal
Issue
Article type
Original paper
Pages
283-291
Published online
2016-01-27
Page views
2077
Article views/downloads
2397
DOI
10.5603/EP.a2016.0034
Pubmed
Bibliographic record
Endokrynol Pol 2016;67(3):283-291.
Keywords
hipercortisolemia
cortisol
Cushing’s disease
fibrinogen
D-dimer level
transsphenoidal surgery
thromboembolic complications
Authors
Przemysław Witek
Grzegorz Zieliński
Katarzyna Szamotulska
Joanna Witek
Grzegorz Kamiński
