Cardiovascular risk assessment, thromboembolism and infection prevention in Cushing’s syndrome – a practical approach

in European Journal of Endocrinology
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  • 1 E Varlamov, 1Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health and Science University, Portland, United States
  • 2 F Langlois, Endocrinology, Universite de Sherbrooke, Sherbrooke, Canada
  • 3 G Vila, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Wien, Austria
  • 4 M Fleseriu, Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health and Science University, Portland, United States

Correspondence: Maria Fleseriu, Email: fleseriu@ohsu.edu
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Cushing’s syndrome (CS) is associated with increased mortality that is driven by cardiovascular, thromboembolic, and infection complications. Although complications can be expected to decrease during disease remission, incidence often transiently increases postoperatively and is not completely normalized in the long-term. It is important to diagnose and treat cardiovascular, thromboembolic, and infection complications concomitantly with CS treatment. Management of hyperglycemia/diabetes, hypertension, hypokalemia, hyperlipidemia, and other cardiovascular risk factors is generally undertaken in accordance with standard of clinical care. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisolism, and treatment adjustments can be made based on disease pathophysiology and drug-drug interactions. Thromboprophylaxis should be considered for CS patients with severe hypercortisolism and/or postoperatively, based on individual risk factors of thromboembolism and bleeding. Pneumocystis jiroveci pneumonia prophylaxis should be considered for patients with high urinary free cortisol at initiation of hypercortisolism treatment.

 

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