Mikamoto Masaaki, Chang Ye Rim, Lee Hang, Tritos Nicholas A, Nachtigall Lisa B, Swearingen Brooke, Miller Karen K, Jones Pamela S
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, Nakamura Memorial Hospital, 1-14, South 1 West 14, Chuo-ku, Sapporo, Hokkaido, 060-8570, Japan.
Pituitary. 2025 May 26;28(3):64. doi: 10.1007/s11102-025-01536-x.
Cushing's Disease (CD) has been linked to increased venous thromboembolism (VTE) risk. This study investigates the incidence and risk factors of postoperative VTE in patients undergoing transsphenoidal surgery (TSS) for CD.
This retrospective study analyzed patients with CD and non-functioning pituitary adenomas (NFPAs) who underwent TSS at Massachusetts General Hospital from 2005 to 2019. The incidence of VTE within 90 days post-TSS was compared between groups, with early VTE defined as occurring within 7 days. VTE diagnosis was confirmed through imaging, including ultrasound and CT, following clinical suspicion.
Of six CD patients with symptomatic post-TSS VTE, five developed VTE within one week ("early"), while no NFPA patients experienced early VTE (p = 0.006). Two CD patients presented with pulmonary embolism (PE) on postoperative day (POD) 1 or 2. Two of three with early deep venous thrombosis (DVT) had a history of prior DVT. The overall post-TSS VTE incidence was similar between CD and NFPA patients [6/315 (1.9%) vs. 4/559 (0.7%), p = 0.18]. Patients with CD who developed post-TSS VTE had significantly higher rates of prior history of VTE (p = 0.003) and hypertension (p = 0.038) and larger tumor sizes (p = 0.045) compared to those without post-TSS VTE on univariate analysis.
CD patients are at higher risk for early post-TSS VTE, including symptomatic PE. Identifying high-risk patients and implementing perioperative prophylaxis in the immediate postoperative period may help mitigate these complications. Further research is needed to optimize prevention strategies in this population.
库欣病（CD）与静脉血栓栓塞（VTE）风险增加有关。本研究调查接受经蝶窦手术（TSS）治疗CD的患者术后VTE的发生率及危险因素。
这项回顾性研究分析了2005年至2019年在马萨诸塞州总医院接受TSS的CD患者和无功能垂体腺瘤（NFPA）患者。比较两组患者TSS后90天内VTE的发生率，早期VTE定义为在7天内发生。临床怀疑后通过超声和CT等影像学检查确诊VTE。
6例有症状的TSS后VTE的CD患者中，5例在1周内发生VTE（“早期”），而NFPA患者无早期VTE发生（p = 0.006）。2例CD患者在术后第1天或第2天出现肺栓塞（PE）。3例早期深静脉血栓形成（DVT）患者中有2例有既往DVT病史。CD患者和NFPA患者TSS后VTE的总体发生率相似[6/315（1.9%）对4/559（0.7%），p = 0.18]。单因素分析显示，发生TSS后VTE的CD患者与未发生TSS后VTE的患者相比，既往VTE病史（p = 0.003）、高血压（p = 0.038）发生率显著更高，肿瘤体积更大（p = 0.045）。
CD患者TSS后早期VTE风险更高，包括有症状的PE。识别高危患者并在术后即刻实施围手术期预防措施可能有助于减轻这些并发症。需要进一步研究以优化该人群的预防策略。
