High Serum Cortisol Levels at Mid-night and After LDDST are Associated with Elevated Levels of D-dimer in Patients with Cushing's Syndrome

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 1-25-Glucocorticoid Actions & HPA Axis
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-25
Hidenori Fukuoka*1, Takehito Takeuchi1, Yushi Hirota1, Genzo Iguchi1 and Yutaka Takahashi2
1Kobe University Hospital, Kobe, Japan, 2Kobe Univ Graduate School of Med, Kobe, Japan
Background; Recently, it has been reported that venous thromboembolism (VTE) is frequent in patients with Cushing’s syndrome (CS). The risk of VTE is high especially after surgical treatment of the disease. To perform selective thromboprophylaxis, it is important to clarify useful prediction marker for VTE in pre-operative patients with CS. It is well known that elevated serum D-dimer is closely associated with VTE.

Objectives; The aim of this study was to clarify the prediction marker of VTE in pre-operative patients with CS. 

Design and Methods; Twenty-seven pre-operative patients with CS and Subclinical CS due to pituitary adenoma, adrenal adenoma, or ectopic ACTH syndrome, who diagnosed at Kobe University Hospital from 2002 to 2012, were included in this study. Patients were divided to two groups; D-dimer (+); serum D-dimer levels ³a 1 mg/ml (n = 11) or D-dimer (-); serum D-dimer levels < 1mg/ml (n = 16), and compared various risk factors related to VTE. Patients who already treated with anti-coagulant drugs were excluded.

Results; Serum cortisol levels at mid-night and after low-dose dexamethasone suppression test (LDDST) were significantly higher in D-dimer (+) than in D-dimer (-) (26.6 ± 10.8 vs 14.8 ± 6.7 mg/dl, p < 0.01 and 23.0 ± 6.8 vs 14.6 ± 7.4 mg/dl, p < 0.01, respectively), while cortisol levels at morning and 24 hour urinary free cortisol (UFC) levels did not show differences (22.4 ± 11.7 vs 16.1 ± 5.6 mg/dl, p = 0.12 and 512 ± 446 vs 230 ± 253 mg/24h, p = 0.09, respectively). The aPTT were significantly shortened in D-dimer (+) than in D-dimer (-) (23.8 ± 3.3 vs 29.0 ± 7.9 sec, p < 0.05). Linear regression analysis revealed that both cortisol levels at mid-night and after LDDST were negatively correlated with the aPPT (r = - 0.45, p < 0.05 and r = - 0.53, p < 0.05, respectively).

Conclusion; High serum cortisol levels at mid-night and after LDDST, both of which negatively correlated with the aPTT, were associated with elevated levels of D-dimer rather than morning cortisol levels or UFC levels. These results suggest that a sustained exposure to high cortisol levels at night increases susceptibility to thrombogenesis in CS.

Nothing to Disclose: HF, TT, YH, GI, YT

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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