Evaluation of haemostatic and fibrinolytic markers in patients with Cushing's syndrome and in patients with adrenal incidentaloma

It is known that either chronic glucocorticoid administration or endogenous hypercortisolism frequently induce an hypercoagulable condition. Since lit tle is known about the evaluation of markers of haemostatic and fibrinolyti c systems in other adrenal disorders, we studied plasminogen activator inhi bitor (PAI-I), tissue-plasminogen activator (t-PA), fibrinogen and von Will ebrand factor antigen (vWF-Ag) levels in 11 patients with Gushing's syndrom e and in 12 patients with adrenal incidentaloma. In patients with Gushing's syndrome mean PAI-1, t-PA and vWF-Ag levels did not significantly differ f rom those found in 50 age- and sex-matched controls, while mean fibrinogen levels were significantly higher in patients (337.0 +/- 39.1 mg/dl) than in normal subjects (278.9 +/- 8.4 mg/dl). Patients dth adrenal incidentaloma showed PAI-1, t-PA and vWF-Ag mean levels superimposable to those in contro ls, while fibrinogen (319.7 +/- 27.9 mg/dl) was slightly, although not sign ificantly, higher than in normals. Considering the limits of normal values (as mean +/- 2 SD) obtained in the control group, high PAI-1 levels were fo und in 2 patients with Gushing's syndrome and in 3 patients with incidental oma. An elevation of fibrinogen levels was found in 3 patients with Gushing 's syndrome and in 3 with incidentaloma. Increased vWF-Ag levels were found only in 1 patient with Gushing's syndrome. An increased t-PA level was occ asionally observed only in the patient with adrenal carcinoma. On the whole , an alteration of at least one of haemostatic and fibrinolytic parameters was detected in 55% of the patients with Gushing's syndrome and in 42% of t hose with adrenal incidentaloma. In conclusion, early alterations of coagul ation and fibrinolytic systems may be found in some patients with adrenal d isorders, thus suggesting the opportunity of an accurate follow-up in order to identify possible risk factors for cardiovascular disease and thromboem bolism.