Incidence and risk factors of venous thromboembolism in an adrenocortical carcinoma patient cohort.

Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine malignancy. Venous thromboembolic events (VTE) have been reported in ACC patients. ACC is often associated with endogenous hypercortisolism, which is linked to increased VTE risk. The primary objective of this retrospective study in patients who received treatment for ACC in Amsterdam UMC between 2003-2024 was to determine the total incidence of VTE. Secondary objectives included the incidence of VTE after adrenalectomy and to identify risk factors for VTE. Patients were categorized into VTE and non-VTE groups. Mann-Whitney U tests, unpaired t-tests and Chi-square or Fisher's exacts were used in order to assess differences. Seventy-four patients were included, of whom 10 (13.5%) had experienced a VTE during the observation period, amounting to 29 VTEs (CI 13-58) per 1000 patient years. All VTEs were pulmonary embolisms. 64 patients underwent adrenalectomy. 50 (98%) patients of whom data was available used peri-operative thromboprophylaxis or anticoagulant therapy. The median duration of peri-operative thromboprophylaxis was 5 days (IQR 4-11, range 0-90). Two patients experienced a VTE within six months after surgery (3,3%). Four patients with a VTE (40%) had cortisol producing ACC (p=0.83). We conclude that the overall incidence of VTE in ACC patients is high. The incidence of post-operative VTE after adrenalectomy for ACC was lower in this cohort compared with the literature. No risk factors for VTE were identified, most notably hypercortisolism was not associated with increased VTE incidence. Our findings expand the literature addressing this issue and re-affirm the importance of the use of peri-operative thromboprophylaxis in ACC patients undergoing adrenalectomy.