UvA-DARE ( Digital Academic Repository ) Hormones , haemostasis , and the risk of thrombosis

Endocrine disorders can influence the haemostatic balance. Abnormal coagulation test results have been observed in patients with abnormal hormone levels. The aim of the present review is to update the available evidence on the influence of pituitary, adrenal, and parathyroid hormones on the coagulation and the fibrinolytic system, and their possible clinical implications. The literature supports a possible relevant clinical effect of the imbalance between coagulation and fibrinolysis on thrombotic events in endogenous Cushing’s syndrome. An effect on markers of coagulation and fibrinolysis has been shown for hyperprolactinaemia, growth hormone excess or deficiency, exogenous hypercortisolism, pheocromocytoma, primary hyperaldosteronism, and hyperparathyroi dism. However, the clinical relevance is still unproven. Until definitive evidence is available, clinicians should be aware of the possibility that endocrine disorders may be risk factors for thrombotic events. Introduction Haemostasis is a complex biological process that prevents individuals from bleeding and which also should prevent thrombosis. Many factors are responsible for maintaining the haemostatic balance, among which, hormones may directly influence both primary and secondary haemostasis. A wide variety of endocrine disorders have been associated with both mild abnormalities in laboratory coagulation tests and clinical thrombotic or bleeding manifestations. In 2007, we summarised the published evidence on this topic in a narrative review. In the present manuscript, we discuss the influence of common endocrine disorders of the pituitary, adrenal, and parathyroid gland on the coagulation system and their possible clinical effects, providing supplementary data to that we had already reviewed. Thyroid dysfunction and diabetes mellitus have been previously discussed in detail and are outside the scope of this review. Literature search Search strategy We attempted to identify all recent publications that evaluated the effects of anterior pituitary, adrenal, and parathyroid gland dysfunction on laboratory coagulation and fibrinolytic markers and on clinical thrombotic risk in order to provide supplementary data to that we had already reviewed in 2007. We used the PubMed (2006 to November, Week 2, 2009) electronic database. The following search terms (textwords) were used: Haemostasis, Thrombosis, Bleeding, Prolactin, Hyperprolactinaemia, Growth Hormone, Hypercortisolism, Hypocortisolism, Pheochromocytoma, Aldosterone, Renin, Hyperparathyroidism. The search strategy was developed without any language restriction. Study selection One author (AS) independently reviewed all selected titles and/or abstracts. Studies were excluded if the title and/or abstract were not appropriate for the aim of our review. Selected studies were eligible if they included the following endocrine dysfunctions in adult patients: hyperprolactinaemia, growth hormone (GH) excess or deficiency, endogenous and exogenous hypercortisolism, hypocortisolism, pheochromocytoma, hyperaldosteronism, hyperparathyroidism. Both observational and experimental studies were included. Systematic reviews were also included. Narrative reviews were used only to identify missed references. Case reports, editorials and animal studies were excluded.