Journal of Endocrinological Investigation

, Volume 20, Issue 4, pp 211–214 | Cite as

Recurrent thromboembolism as a hallmark of Cushing’s syndrome

  • A. La Brocca
  • M. Terzolo
  • A. Pia
  • P. Paccotti
  • P. De Giuli
  • A. Angeli


The present report describes a 54-year-old woman with a history of recurrent thromboembolic events. The clinical and physical examination led to suspect Cushing’s syndrome. Screening tests (urinary free Cortisol excretion and 1 mg dexamethasone) were inconclusive, but a detailed endocrine work up confirmed the presence of ACTH-dependent hypercortisolism. The patient was cured by the removal of a ACTH-secreting microadenoma by transsphenoidal route. The present case provides a clinical demonstration of a previous experimental evidence that a hypercoagulable state is present in Cushing’s syndrome.


Cushing’s syndrome ketoconazole treatment recurrent thromboembolism 


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  1. 1.
    Sjoberg H.E., Blomback M., Granberg P.O. Thromboembolic complications, heparin treatment and increase in coagulation factors in Cushing’s syndrome. Acta Med. Scand. 199: 95, 1976.PubMedCrossRefGoogle Scholar
  2. 2.
    Dal Bo Zanon R., Fornasiero L., Boscaro M., Cappellato G., Fabris F., Girolami A. Increased factor VIII associated activities in Cushing’s syndrome: a probable hypercoagulable state. Throm. Haemostas. 47: 116, 1982.Google Scholar
  3. 3.
    Patrassi G.M., Dal Bo Zanon R., Boscaro M., Martinelli S., Girolami A. Further studies on the hypercoagulable state of patients with Cushing’s syndrome. Thromb. Haemostas. 54: 518, 1985.Google Scholar
  4. 4.
    Blichert-Toft M., Bagerskov A., Lockwood K., Hasner E. Operative treatment, surgical approach, and related complications in 195 operations upon the adrenal glands. Surg. Gynecol. Obstet. 135: 261, 1972.PubMedGoogle Scholar
  5. 5.
    Casonato A., Pontara E., Bertomoro A., Scarpa E., Sonino N., Girolami A. Abnormalities of primary haemostasis with consequent hypercoagulable state in patients with Cushing’s syndrome. J. Endocrinol. Invest. 18 (Suppl. no. 5): 75, 1995, abstract number 256.Google Scholar
  6. 6.
    Ikkala E., Myllyla G., Pelkonen R., Rasi V., Viinikka L., Ylikorkala O. Haemostatic parameters in Cushing’s syndrome. Acta Med. Scand. 217: 507, 1985.PubMedCrossRefGoogle Scholar
  7. 7.
    Patrassi G.M., Sartori M.T., Viero M.L., Scarano L., Boscaro M., Girolami A. The fibrinolytic potential in patients with Cushing’s disease: a clue to their hypercoagulable state. Blood Coagul. Fibrinolysis 3: 789, 1992.PubMedCrossRefGoogle Scholar
  8. 8.
    Simmons P.S., Miles J.M., Gerich J.E., Haymond M.W. Increased proteolysis. An effect of increased in plasma Cortisol within the physiological range. J. Clin. Invest. 73: 412, 1984.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Huges A., McVerry B.A., Wilkinson L., Goldstone A.H., Lewis D., Bloom A. Diabetes, a hypercoagulable state? Haemostatic variables in newly diagnosed type 2 diabetic patients. Acta Haematol. 69: 254, 1983.CrossRefGoogle Scholar
  10. 10.
    Boneu B., Durand D., Connilon F., Charlet J.P., Bierme R., Suc G.M. Increased level in factor VIII complex in severe arterial hypertension. Haemostasis 7: 332, 1978.PubMedGoogle Scholar
  11. 11.
    Patrassi G.M., Fallo F., Martinelli S., Mantero F., Boeri G., Girolami A. The contact phase of blood coagulation and renin activation in essential hypertension before and after Captopril. Eur. Heart J. 5: 561, 1984.PubMedGoogle Scholar
  12. 12.
    Jorgensen M., Bonnevie-Nielsen V. Increased concentration of the fast-acting plasminogen activator inhibitor in plasma associated with familial venous thrombosis. Br. J. Haematol. 65: 175, 1987.PubMedCrossRefGoogle Scholar
  13. 13.
    Engesser L., Brommer E.G.P., Kluft C., Briet E. Elevated plasminogen activator inhibitor (PAI), a cause of thrombophilia? A study in 203 patients with familial or sporadic venous thrombophilia. Thromb. Haemostas. 62: 673, 1989.Google Scholar
  14. 14.
    Patrassi G.M., Sartori M.T., Viero M., Boscaro M., Boeri G., Girolami A. Venous thrombosis and tissue plasminogen activator release deficiency: a family study. Blood Coagul. Fibrinol. 2: 231, 1991.CrossRefGoogle Scholar
  15. 15.
    Petaja J., Rasi V., Myllyla G., Vahtera E., Hallman H. Familial hypofibrinolysis and venous thrombosis. Br. J. Haematol. 71: 393, 1989.PubMedCrossRefGoogle Scholar
  16. 16.
    Korninger C., Lechner K., Neissner H., Gossinger H., Kundi M. Impaired fibrinolytic capacity predisposes for recurrence of venous thrombosis. Thromb. Haemostas. 52: 127, 1984.Google Scholar
  17. 17.
    O’Connor N.T.J., Cederholm-Williams S.A., Fletcher E.W., Allington M., Sharp A.A. Significance of idiopathic deep venous thrombosis. Postgrad. Med. J. 60: 275, 1984.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Atkinson A.B., Kennedy A.L., Carson D.J., Hadden D.R., Weaver J.A., Sheridan B. Five cases of cyclical Cushing’s syndrome. Br. Med. J. 292: 1453, 1985.CrossRefGoogle Scholar
  19. 19.
    Schweikert H.U., Fehm H.L., Fahlbusch R., Martin R., Kolloch R., Higuchi M., Kruck F. Cyclic Cushing’s syndrome combined with Cortisol suppressible, dexamethasone non-suppressible ACTH secretion: a new variant of Cushing’s syndrome. Acta Endocrinol. (Copenh.) 110: 289, 1985.Google Scholar
  20. 20.
    Sheeler L.R., Bay J.W. Normal overnight dexamethasone suppression tests (ODST) in patients with proven Cushing’s disease. In: Landolt A.M. et al. (Eds.), Advances in Pituitary Adenoma Reserch (Advances in the Biosciences, vol. 69). Pergamon Press, New York, 1988, p. 373.Google Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 1997

Authors and Affiliations

  • A. La Brocca
    • 1
  • M. Terzolo
    • 2
  • A. Pia
    • 2
  • P. Paccotti
    • 2
  • P. De Giuli
    • 3
  • A. Angeli
    • 2
  1. 1.Divisione di Medicina Interna e Servizio di Endocrinologia e Malattie del MetabolismoOspedale Civile di GiavenoItaly
  2. 2.Dipartimento di Scienze Cliniche e Biologiche, Cattedra di Medicina InternaUniversità di TorinoTorinoItaly
  3. 3.Dipartimento di Servizio di Anatomia ed Istologia Patologica, Azienda Ospedaliera San Luigi GonzagaUniversità di TorinoTorinoItaly

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