Secondary hypercoagulability to hyperadrenocorticism in dogs: Review

Abstract

Hyperadrenocorticism or Cushing's Syndrome is an endocrinopathy characterized by a high concentration of cortisol in the circulation. This hormone is responsible for numerous changes in the body, including increased clotting that contributes to the formation of thrombi. This complication is considered highly fatal, in this sense, the objective of the present study was to understand, through literature and academic review of scientific papers, the pathophysiology of hypercoagulability secondary to hyperadrenocorticism, in addition to identifying diagnostic methods for such anomalies and their possible treatments. Numerous possibilities have been found to explain the increase in coagulation, however, all the theories cited by the authors are still poorly understood. The diagnosis of Cushing's Syndrome can be made by several methods, the most used being the low dose dexamethasone suppression test. Hypercoagulability, on the other hand, may be identified through thromboelastrography or rotational thromboelastometry, these tests may fully evaluate hemostasis. In addition to these tests, other diagnostic methods can also assist in the assessment of the animal's hemostatic situation, such as platelet count, measurement of coagulation factors, fibrinogen concentration, among others. The treatment of hyperadrenocorticism basically consists of the administration of trilostane or mitotane. Nevertheless, the control of this hormone does not guarantee a significant improvement in the hypercoagulable state present in the patient, since cortisol has a prolonged effect on the body and depending on the dosage established for a period of time without action of the medication. Hence, this complication must be treated when the tests show signs of hypercoagulability or when the animal has a concomitant condition that predisposes to the formation of thrombi, and then establishes anticoagulant therapy.