Coagulation Profile Dynamics in Pediatric Patients with Cushing Syndrome: A Prospective, Observational Comparative Study - 23/09/16
, Amit Tirosh, MD 2, Prashant Chittiboina, MD 3, Meg Keil, PhD 2, Charlampos Lyssikatos, MD 2, Elena Belyavskaya, MD 2, Richard A. Feelders, MD 4, Constantine A. Stratakis, MD, D(Med)Sci 2Abstract |
Objective |
To evaluate the association between Cushing syndrome and hypercoagulability in children.
Study design |
A prospective, observational study was performed of 54 patients with Cushing syndrome, 15.1 ± 3.9 years, treated at the National Institutes of Health Clinical Center. Coagulation profiles were taken before and 6-12 months after surgery and compared with18 normocortisolemic children, 13.7 ± 3.6 years.
Results |
At baseline, patients with Cushing syndrome had greater levels of the procoagulant factor VIII (FVIII) vs controls (145 IU/dL ± 84 vs 99 ± 47, P = .04); 6-12 months after surgery, FVIII levels decreased to 111 ± 47, P = .05. Patients with Cushing syndrome had greater levels of the antifibrinolytic α2-antiplasmin, 96 ± 17% vs 82 ± 26%, P = .015. After surgery, antifibrinolytic α2-antiplasmin levels decreased to 82 ± 24%, P < .001. Anticoagulants were greater in patients with Cushing syndrome vs controls at baseline, including protein C (138 ± 41% vs 84 ± 25%, P < .001), protein S (94 ± 19% vs 74 ± 19%, P = .001), and antithrombin III (96 ± 18% vs 77 ± 13%, P < .0001). The 24-hour urinary free cortisol levels correlated positively with FVIII levels, r = 0.43, P = .004.
Conclusion |
Children with Cushing syndrome had elevated procoagulants, antifibrinolytics, and anticoagulants at baseline compared with controls; normalization of coagulation measures was seen after surgical cure. Despite the increase in anticoagulants, hypercortisolemia is associated with a hypercoagulable state in children, as is the case in adults. This finding has potential implications for prevention of venous thromboembolism in children with Cushing syndrome.
Trial registration |
ClinicalTrials.gov:NCT00001595
Le texte complet de cet article est disponible en PDF.Keywords : thromboembolic event, hypercoagulable state, blood clot
Abbreviations : A2AP, ACTH, ATIII, BMI, CRH, DVT, FVIII, NIH, PAI-1, PTT, UFC, VTE, vWF
Plan
| Supported by the Intramural research program of the Eunice Kennedy ShriverNational Institute of Child Health and Human Development. The authors declare no conflicts of interest. |
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| Portions of the study were presented as a presidential poster at the meeting of the Pediatric Academic Societies, April 30-May 3, 2016, Baltimore, MD. |
Vol 177
P. 227-231 - octobre 2016 Retour au numéro
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