Analysis of clinical characteristics of Cushing's syndrome complicated with pulmonary embolism during perioperative period

Abstract

Objective To retrospectively analyze the clinical characteristics of patients with Cushing's syndrome (CS) complicated with perioperative pulmonary embolism (PE). Methods Depending on Chinese Pituitary Disease Registry Network (CPDRN) and Pituitary Tumor Database in Peking Union Medical College Hospital, 20 patients with CS complicated perioperative PE were collected from January 1, 2013 to September 30, 2020, and the clinical manifestations and laboratory examination data of the patients were investigated. The clinical characteristics were compared between ectopic adrenocorticotropic hormone syndrome (EAS) and CS with PE during the perioperative period. In addition, clinical characteristics were also studied in these patients before and after the operation. Results According to etiology, they were divided into CS (7 cases), EAS (9 cases) and adrenal adenoma (4 cases). The course of CS was longer than EAS (t = ⁃ 2.938, P = 0.011). According to the occurrence time of PE, the patients were divided into preoperative PE (13 cases) and postoperative PE (7 cases). The patients with postoperative PE had a lower body mass index (t = 2.427, P = 0.026) and a higher fibrinogen (t = ⁃ 2.162, P = 0.047). The patients with PE before surgery included 5 cases of CS, 5 cases of EAS, and 3 cases of adrenal adenomas, while those who with PE after surgery included 2 cases of CS, 4 cases of EAS, and one case of adrenal adenoma. Among the 7 patients with PE after surgery, 5 cases did not get remission. Compared with preoperative examination, the erythrocyte count (t = ⁃ 2.032, P = 0.042) and hemoglobin (t = 9.807, P = 0.001) were decreased after operation, the prothrombin time (t = ⁃ 2.847, P = 0.047) and international normalized ratio (t = ⁃ 3.059, P = 0.038) were increased after operation. Conclusions Longer course of disease and no remission hypercortisolemia after surgery may be the risk factors for perioperative PE in CS patients. Patients with elevated fibrinogen before surgery and reduced red blood cell count and hemoglobin after surgery should be alert to the risk of PE.

doi：10.3969/j.issn.1672⁃6731.2021.03.009