UNDERSTANDING HYPERCORTISOLISM

Prevalence

In the CATALYST study of over 1,000 people with difficult-to-control type 2 diabetes (T2D), 24% (252/1057) were diagnosed with endogenous hypercortisolism1,2*†

24 percent.
24 percent.

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.1,2

†Difficult-to-control T2D was defined as people having an HbA1c of ≥7.5% and ≤11.5% AND taking: ≥3 T2D medications OR insulin and other T2D medication(s) OR ≥2 T2D medications AND the presence of ≥1 microvascular or macrovascular complications AND/OR concomitant hypertension requiring ≥2 hypertension medications.2

Hyperglycemia driven by hypercortisolism

The underlying cause of hyperglycemia secondary to hypercortisolism is fundamentally different than hyperglycemia driven by T2D.3,4

  • With hyperglycemia secondary to hypercortisolism, excess cortisol may be the underlying cause of elevated glucose levels4

  • Hypercortisolism is usually caused by an adenoma located on the adrenal gland (adrenocorticotropic hormone [ACTH] independent), an adenoma on the pituitary gland, or an ectopic tumor (both considered ACTH dependent)5

Increased risk of hypercortisolism

A meta-analysis identified clinical characteristics of persons with T2D that increased the likelihood of being diagnosed with hypercortisolism6:

There is a ~3.5 times increased risk of hypercortisolism in patients with difficult-to-control T2D (n=2283).

increased risk with
difficult-to-control T2D
(n=2184)‡

There is a ~2.0 times increased risk of hypercortisolism in patients with insulin therapy (n=1400), and T2D and hypertension (n=2184).

increased risk with
insulin therapy
(n=1400)§

There is a ~2.0 times increased risk of hypercortisolism in patients with insulin therapy (n=1400), and T2D and hypertension (n=2184).

increased risk with
T2D and hypertension
(n=2283)

‡DerSimonian and Laird (DSL) method (OR, 3.4; 95% CI, 2.12-5.67; P<0.0001) and Hartung-Knapp-Sidik-Jonkman (HKSJ) method (OR, 3.60; 95% CI, 2.03-6.41; P =0.004).

§DSL method (OR, 1.92; 95% CI, 1.05-3.50; P =0.034) and HKSJ method (OR, 2.13; 95% CI, 0.81-5.65; P =0.100).

DSL method (OR, 2.29; 95% CI, 1.07-4.91; P =0.034) and HKSJ method (OR, 2.50; 95% CI, 0.30-21.01; P =0.205).

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References:
  1. Buse JB, 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.
  2. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121
  3. Galicia-Garcia U, Benito-Vicente A, Jebari S, et al. Pathophysiology of type 2 diabetes mellitus. Int J Mol Sci. 2020;21(17):6275. doi:10.3390/ijms21176275
  4. Scaroni C, Zilio M, Foti M, Boscaro M. Glucose metabolism abnormalities in Cushing syndrome: from molecular basis to clinical management. Endocr Rev. 2017;38(3):189-219. doi:10.1210/er.2016-1105
  5. Guaraldi F, Salvatori R. Cushing syndrome: maybe not so uncommon of an endocrine disease. J Am Board Fam Med. 2012;25(2):199-208. doi:10.3122/jabfm.2012.02.110227
  6. Aresta C, Soranna D, Giovanelli L, et al. When to suspect hidden hypercortisolism in type 2 diabetes: a meta-analysis. Endocr Pract. 2021;27(12):1216-1224. doi:10.1016/j.eprac.2021.07.014