UNDERSTANDING HYPERCORTISOLISM

Prevalence

Up to 10% of patients with difficult-to-control type 2 diabetes (T2D) may have hyperglycemia secondary to endogenous hypercortisolism1-3

1 in 10 people icon.

Hyperglycemia driven by hypercortisolism

The underlying cause of hyperglycemia secondary to hypercortisolism is fundamentally different than hyperglycemia driven by T2D.4,5

  • With hyperglycemia secondary to hypercortisolism, excess cortisol may be the underlying cause of elevated glucose levels5

  • 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)6

Increased risk of hypercortisolism

A meta-analysis identified clinical characteristics of persons with T2D that increased the likelihood of being diagnosed with hypercortisolism7:

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. Chiodini I, Torlontano M, Scillitani A, et al. Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients. Eur J Endocrinol. 2005;153(6):837-844. doi:10.1530/eje.1.02045
  2. Catargi B, Rigalleau V, Poussin A, et al. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab. 2003;88(12):5808-5813. doi:10.1210/jc.2003-030254
  3. Costa DS, Conceição FL, Leite NC, Ferreira MT, Salles GF, Cardoso CR. Prevalence of subclinical hypercortisolism in type 2 diabetic patients from the Rio de Janeiro Type 2 Diabetes Cohort Study. J Diabetes Complications. 2016;30(6):1032-1038. doi:10.1016/j.jdiacomp.2016.05.006
  4. 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
  5. 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
  6. 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
  7. 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