Higher VTE Risk in Cushing vs Other Pituitary Tumours

TOPLINE:

Patients with Cushing disease faced a substantially higher risk for venous thromboembolism (VTE) than those with non-functioning pituitary adenomas or acromegaly, with the risk peaking around the time of diagnosis and surgery. A history of diabetes also remained an independent risk factor for VTE.

METHODOLOGY:

• Researchers in England conducted a multicentric retrospective cohort study to evaluate the risk for VTE in patients with Cushing disease compared with that in those with other pituitary tumours.
• They analysed 827 patients (median age at diagnosis, 54 years; 51.6% men), including 107 with Cushing disease, 502 with non-functioning pituitary adenomas, and 218 with acromegaly.
• Data on VTE events spanning 4 years prior to the diagnosis of pituitary adenoma through the last follow-up were obtained from patient records, with a median follow-up duration of 13.4 years; if multiple VTE events occurred in a single individual, only the first event was analysed.
• Demographic and clinical data such as sex, date and age at tumour diagnosis, date of surgery for the pituitary tumour, history of diabetes or impaired glucose tolerance, and specific details of VTE events were also extracted from patient records.

TAKEAWAY:

• VTE events were significantly more common in patients with Cushing disease than in those with non-functioning pituitary adenomas (odds ratio [OR], 21.05; P < .001) or acromegaly (OR, 4.48; P = .002).
• In the adjusted analysis, Cushing disease was associated with a markedly higher risk for VTE events than non-functioning pituitary adenomas (hazard ratio [HR], 46.87; P < .001); acromegaly also conferred an elevated risk (HR, 6.96; P = .007).
• Diabetes or impaired glucose tolerance was independently associated with an increased risk for VTE (HR, 3.48; P = .008).
• Among 12 VTE events that occurred in patients with Cushing disease, eight occurred within 1 year before or after the diagnosis of the condition; moreover, four events occurred within 45 days post-transsphenoidal surgery.

IN PRACTICE:

“[The study] findings provide further evidence of the need for rigorous thromboprophylaxis in patients with CD [Cushing disease] from the time of diagnosis and subsequently throughout the perioperative period,” the authors wrote.

SOURCE:

This study was led by Kristina Isand, University of Tartu, Tartu, Estonia. It was published online on July 03, 2025, in the European Journal of Endocrinology.

LIMITATIONS:

The retrospective design of the study may have introduced potential bias. Data on confounding factors, such as oral contraceptive use, pregnancy history, and family history of VTE, were not collected. The small number of VTE events further limited the complexity of multivariable modelling, particularly in subgroup analyses.

DISCLOSURES:

This study did not receive any funding. One author reported serving on the editorial board of the European Journal of Endocrinology. The other authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.