MANAGEMENT OF ENDOCRINE DISEASE: Cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing's syndrome: a practical approach

Eur J Endocrinol. 2021 Apr 22;184(5):R207-R224. doi: 10.1530/EJE-20-1309.


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 completely 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 care standards. Medical therapy for CS may be needed even prior to surgery in severe and/or prolonged hypercortisolism, 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 high urinary free cortisol at the initiation of hypercortisolism treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control
  • Comorbidity
  • Cushing Syndrome / epidemiology*
  • Cushing Syndrome / mortality
  • Cushing Syndrome / surgery
  • Female
  • Heart Disease Risk Factors*
  • Humans
  • Infection Control
  • Infections / epidemiology*
  • Male
  • Middle Aged
  • Pneumocystis carinii
  • Pneumonia, Pneumocystis / epidemiology
  • Pneumonia, Pneumocystis / prevention & control
  • Pre-Exposure Prophylaxis
  • Risk Assessment
  • Risk Factors
  • Thromboembolism / epidemiology
  • Thromboembolism / physiopathology
  • Thromboembolism / prevention & control*