8363 Prevalence and risk factors related to venous thromboembolism events in a large cohort of Cushing disease patients

Abstract Disclosure: A.J. Pereira: None. M.B. Cunha-Neto: None. V.A. Cescato: None. G.O. Silva: None. M.C. Fragoso: None. A. Glezer: None. M.C. Machado: None. Background: Cushing’s syndrome (CS) is associated with a hypercoagulation state with an increased risk of venous thromboembolism (VTE) events, regardless of conditions associated with a higher incidence of cardiovascular events. However, the exact risk profile of CS patients who develop VTE events and the prophylactic anticoagulation strategy are heterogeneous in the literature. Objective: To identify the prevalence and risk factors related to VTE events in a large cohort of Cushing’s disease (CD) patients. Patients and Methods: A single-tertiary referral center retrospective study was conducted. Four hundred and eight confirmed CD patients were included, 79% female, median age of 32 years (ranged of 8-71), 73% harbored microadenomas (n=298), evaluated between 1990 to 2022. Most CD patients were submitted to pituitary surgery as the first treatment option. Detailed retrospective data analyses of medical records (physical and electronic) were used to identify and describe the VTE events (VTE group). Numerous clinical, hormonal, radiological and post-surgical parameters were evaluated in VTE group and compared to CD patients without events. Data from both groups were compared using a multivariate logistic regression study aiming to identify the risk profile of VTE events. As a control group, 323 patients with clinically non-functioning pituitary adenomas (NFPA) were evaluated, 51.1% male, median age of 53 years, all with pituitary macroadenomas, submitted to pituitary surgery in the same conditions and Institution. Results: Thirty-five VTE events (8.6%), mainly deep vein thrombosis (60%), were found in CD patients in comparison to only one VTE event in NFPA patient (0.3%). Most events occurred in the preoperative period (54%) and in a hypercortisolism state (71%). After statistical analysis, higher risk factors for VTE events were associated with age >24 years-old, obesity, filling of supraclavicular fossae, purple striae, mood disorders, serum morning cortisol >40 μg/dL, urinary cortisol >3,500 μg/24-h, and in a presence of postoperative complications (cerebrospinal fluid fistula, transient diabetes insipidus, infections). Conclusions: Active Cushing’s disease was associated with a higher rate of VTE events compared to the NFPA control group, especially in those cases with severe hypercortisolism, older patients and with post-surgical complications. In this profile of cases, a prophylactic anticoagulation can be instituted to reduce the morbid mortality. Presentation: 6/3/2024