Incidence and risk factors of venous thromboembolism in an adrenocortical carcinoma patient cohort

Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine malignancy. Venous thromboembolic events (VTE) have been reported in ACC patients. ACC is often associated with endogenous hypercortisolism, which is linked to increased VTE risk. The primary objective of this retrospective study in patients who received treatment for ACC at Amsterdam UMC between 2003 and 2024 was to determine the total incidence of VTE. Secondary objectives included determining the incidence of VTE after adrenalectomy and identifying risk factors for VTE. Patients were categorised into VTE and non-VTE groups. Mann-Whitney U tests, unpaired t-tests, and Chi-square or Fisher's exact tests were used in order to assess differences. Seventy-four patients were included, of whom ten (13.5%) had experienced a VTE during the observation period, amounting to 29 VTEs (CI 13-58) per 1,000 patient-years. All VTEs were pulmonary embolisms. Sixty-four patients underwent adrenalectomy. Fifty (98%) patients, for whom data were available, used peri-operative thromboprophylaxis or anticoagulant therapy. The median duration of peri-operative thromboprophylaxis was 5 days (IQR 4-11, range 0-90). Two patients experienced a VTE within 6 months after surgery (3.3%). Four patients with a VTE (40%) had cortisol-producing ACC (P = 0.83). We conclude that the overall incidence of VTE in ACC patients is high. The incidence of post-operative VTE after adrenalectomy for ACC was lower in this cohort compared with that reported in the literature. No risk factors for VTE were identified; most notably, hypercortisolism was not associated with increased VTE incidence. Our findings expand the literature addressing this issue and reaffirm the importance of the use of peri-operative thromboprophylaxis in ACC patients undergoing adrenalectomy.