Hypercortisolism and pregnancy upregulate von Willebrand factor through different mechanisms: report on a pregnant patient with Cushing's syndrome.

Von Willebrand factor (VWF) is reportedly increased in pregnancy and Cushing's syndrome, inducing a hypercoagulable state. In Cushing's syndrome, VWF gene promoter polymorphisms modulate cortisol-dependent VWF upregulation, haplotype 1 (GCAG) and short GT-repeats (GT)(S) being the susceptible, and haplotype 2 (CTGA) and long GT-repeats (GT)(L) the protective pattern. We report on a Cushing's syndrome patient who became pregnant under hypercortisolism, in whom we monitored the evolution of her hypercoagulable state. During the active phase of Cushing's syndrome, the patient's VWF and factor VIII concentrations were normal, despite high urinary-free cortisol levels consistent with the presence of haplotype 2 and (GT)(L) alleles in the VWF gene promoter. VWF and factor VIII increased significantly and progressively after she became pregnant and peaked just before delivery, returning to normal 5 months later, while her hypercortisolism persisted. Our data indicate that two different mechanisms upregulate VWF under hypercortisolism and pregnancy, the latter being independent of the VWF promoter haplotypes sensitive to cortisol excess.