However, hypercortisolism also impairsfibrinolysis by increasing inhibitors such as plasminogen activator inhibitor-1(PAI-1) and thrombin-activatable fibrinolysis inhibitor (TAFI), furtherpromoting clot formation (28,29,31,32).Studies have shown increased clot formation speed and clot strength in patientswith active CS, particularly in those with obesity, reinforcing the role ofcortisol excess in accelerating thrombogenesis (33). Here, SERPINE1 is linked to obesity due to melanocortin 4 receptor deficiency.