{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:13:31Z","timestamp":1790712811151,"version":"4.1.0"},"reference-count":86,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Recently, it has been reported that there is a great diversity in strategies used for thromboprophylaxis in patients with Cushing\u2019s syndrome (CS). An aim of this review was to discuss these practices in light of the existing data on the thrombotic risk in patients with CS and guidelines for medically ill patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The four relevant topics and questions on thrombotic risk in CS were identified. The current guidelines on prevention and diagnosis of venous thromboembolism (VTE) were reviewed for the answers. An algorithm to consider in the assessment of the thrombotic risk in patients with CS was proposed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>To address both generic and CS-specific risk factors for VTE, the algorithm includes the stepwise approach consisting of Padua Score, urine free cortisol, and CS-VTE score, with no indication for routine thrombophilia testing in the prediction of an index VTE episode. Having confirmed VTE, selected patients require thrombophilia testing to aid the duration of anticoagulant treatment. The separate part of the algorithm is devoted to patients with ectopic adrenocorticotropic hormone syndrome in whom exclusion of VTE precedes introducing routine thromboprophylaxis to prevent VTE. The cancer-related VTE also prompts thromboprophylaxis, with the possible vessel invasion. The algorithm presents a unifactorial and multifactorial approach to exclude high-bleeding risks and safely introduce thromboprophylaxis with low-molecular-weight heparin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>Our article is the first to present an algorithm to consider in the thrombotic risk assessment among patients with Cushing\u2019s syndrome as a starting point for a broader discussion in the environment. A plethora of factors affect the VTE risk in patients with CS, but no studies have conclusively evaluated the best thromboprophylaxis strategy so far. Future studies are needed to set standards of care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2024.1350010","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T04:33:20Z","timestamp":1710131600000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The thrombotic risk in Cushing\u2019s syndrome\u2014questions, answers, and the algorithm to consider in its assessment: part I\u2014thrombotic risk not related to surgery"],"prefix":"10.3389","volume":"15","author":[{"given":"Agata Hanna","family":"Bryk-Wi\u0105zania","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Minasyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"\u015awi\u0105tkowska-Stodulska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anetta","family":"Undas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Hubalewska-Dydejczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Webb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Valassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Gilis-Januszewska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68699-6","article-title":"Cushing\u2019s syndrome","volume":"367","author":"Newell-Price","year":"2006","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2018.00805","article-title":"Hypercoagulability and risk of venous thromboembolic events in endogenous Cushing\u2019s syndrome: A systematic meta-analysis","volume":"9","author":"Wagner","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0290","article-title":"Hypercoagulable state in Cushing\u2019s syndrome: A systematic review","volume":"94","author":"Van Zaane","year":"2009","journal-title":"J Clin Endocrinol Metabol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0308","article-title":"The spectrum of haemostatic abnormalities in glucocorticoid excess and defect","volume":"173","author":"Isidori","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s13023-022-02320-x","article-title":"Current clinical practice for thromboprophylaxis management in patients with Cushing\u2019s syndrome across reference centers of the European Reference Network on Rare Endocrine Conditions (Endo-ERN)","volume":"17","author":"van Haalen","year":"2022","journal-title":"Orphanet J Rare Dis"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00235-7","article-title":"Consensus on diagnosis and management of Cushing\u2019s disease: a guideline update","volume":"9","author":"Fleseriu","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.8.8703","article-title":"Anticoagulant prophylaxis markedly reduces thromboembolic complications in Cushing\u2019s syndrome","volume":"87","author":"Boscaro","year":"2002","journal-title":"J Clin Endocrinol Metabol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-014-0600-y","article-title":"Perioperaztive thromboprophylaxis in Cushing\u2019s disease: What we did and what we are doing","volume":"18","author":"Barbot","year":"2015","journal-title":"Pituitary"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing\u2019s syndrome: An endocrine society clinical practice guideline","volume":"93","author":"Nieman","year":"2008","journal-title":"J Clin Endocrinol Metabol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1210\/jendso\/bvz033","article-title":"Hypercoagulability in Cushing syndrome, prevalence of thrombotic events: A large, single-center, retrospective study","volume":"4","author":"Suarez","year":"2020","journal-title":"J Endocr Soc"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1818","article-title":"Treatment of Cushing\u2019s syndrome: an endocrine society clinical practice guideline","volume":"100","author":"Nieman","year":"2015","journal-title":"J Clin Endocrinol Metabol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-19-0877","article-title":"Management of endocrine disease. 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