TY - JOUR
T1 - Cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing's syndrome
T2 - A practical approach
AU - Varlamov, Elena V.
AU - Langlois, Fabienne
AU - Vila, Greisa
AU - Fleseriu, Maria
N1 - Publisher Copyright:
© 2021 European Society of Endocrinology.
PY - 2021/5
Y1 - 2021/5
N2 - Cushing's syndrome (CS) is associated with increased mortality that is driven by cardiovascular, thromboembolic, and infection complications. Although these events are expected to decrease during disease remission, incidence often transiently increases postoperatively and is not complete ly normalized in the long-term. It is important to diagnose and treat cardiovascular, thromboembolic, and infection complications concomitantly with CS treatment. Management of hyperglycemia/diabetes, hypertension, hypokalemia, hyperlipidemia, and other cardiovascular risk factors is generally undertaken in accordance with clinical car e standards. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisoli sm, and treatment adjustments can be made based on disease pathophysiology and drug-drug interactions. Thromboprophylaxis should be considered for CS patients with severe hypercortisolism and/or postoperatively, based on individual risk factors of thromboembolism and bleeding. Pneumocystis jiroveci pneumonia prophylaxis should be considered for patients with h igh urinary free cortisol at the initiation of hypercortisolism treatment.
AB - Cushing's syndrome (CS) is associated with increased mortality that is driven by cardiovascular, thromboembolic, and infection complications. Although these events are expected to decrease during disease remission, incidence often transiently increases postoperatively and is not complete ly normalized in the long-term. It is important to diagnose and treat cardiovascular, thromboembolic, and infection complications concomitantly with CS treatment. Management of hyperglycemia/diabetes, hypertension, hypokalemia, hyperlipidemia, and other cardiovascular risk factors is generally undertaken in accordance with clinical car e standards. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisoli sm, and treatment adjustments can be made based on disease pathophysiology and drug-drug interactions. Thromboprophylaxis should be considered for CS patients with severe hypercortisolism and/or postoperatively, based on individual risk factors of thromboembolism and bleeding. Pneumocystis jiroveci pneumonia prophylaxis should be considered for patients with h igh urinary free cortisol at the initiation of hypercortisolism treatment.
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U2 - 10.1530/EJE-20-1309
DO - 10.1530/EJE-20-1309
M3 - Review article
C2 - 33539319
AN - SCOPUS:85103407564
SN - 0804-4643
VL - 184
SP - R207-R224
JO - European journal of endocrinology
JF - European journal of endocrinology
IS - 5
ER -