A prospective study of people with endogenous hypercortisolism* revealed that medical treatment of comorbidities, like type 2 diabetes (T2D), without directly treating the underlying hypercortisolism does not reduce cardiovascular risk. This long-term follow up (15 years) compared cardiovascular survival in people with nonfunctioning adenomas (NFA; n=471), people who received medications optimized for comorbidities† (OM; n=118), and people who received surgery (n=29).1,2
People with hypercortisolism who received only optimized medications (OM) for comorbidities† had a 2.6x increased risk for cardiovascular mortality compared to people with nonfunctioning adenoma (NFA).1
Dexamethasone suppression test (DST) >1.8 μg/dL (or >50 nmol/L) plus 1 abnormal hormonal test of hypothalamic-pituitary-adrenal axis.1
†Pharmacological therapy optimized to reduce altered metabolic and cardiovascular parameters (eg, T2D and hypertension).1
In the CATALYST study, people with hypercortisolism (DST >1.8 μg/dL) had significantly more cardiovascular disease compared to people who did not have hypercortisolism (DST ≤1.8 μg/dL)3,4
CATALYST was a phase 4, two-part, multicenter trial. Part one (screening phase) primary endpoint was to determine the prevalence of hypercortisolism in people with difficult-to-control type 2 diabetes (N=1057). Participants were screened with a 1-mg DST. Hypercortisolism defined as cortisol >1.8 μg/dL with dexamethasone ≥140 ng/dL.2,3
A systematic review and meta-analysis of 32 studies with over 4,000 people with adrenal incidentalomas found that people with hypercortisolism experienced worsening T2D and hypertension compared to people with nonfunctioning adenomas.5
Patients with hypercortisolism experienced worsening comorbidities compared to patients with nonfunctioning adenomas.5
Nearly 1 in 4 people with difficult-to-control T2D had endogenous hypercortisolism3
References
1. Petramala L, Olmati F, Concistrè A, et al. Endocrine. 2020;70(1):150-163. doi:10.1007/s12020-020-02297-2 2. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121 3. Buse JB, Kahn SE, Aroda VR, et al. Prevalence of hypercortisolism in patients with difficult-to-control type 2 diabetes: updated results from CATALYST part 1 [symposium]. Presented by Fonseca, V. at the 22nd World Congress Insulin Resistance Diabetes & Cardiovascular Disease; December 12-14, 2024; Los Angeles, CA. 4. Fonseca V, Aroda VR, Budoff M, et al. Prevalence of hypercortisolism in patients with difficult-to-control type 2 diabetes and cardiovascular disease: results from CATALYST. Poster 0046 presentation at: World Congress Insulin Resistance, Diabetes, & Cardiovascular Disease. Los Angeles, CA, December 12–14, 2024. 5. Elhassan YS, Alahdab F, Prete A, et al. Ann Intern Med. 2019;171(2):107-116. doi:10.7326/M18-3630
