2970-LB: High Prevalence of Endogenous Hypercortisolism in Patients with Type 2 Diabetes and Resistant Hypertension: Results from the MOMENTUM Study

Introduction and Objective: Excess cortisol can contribute to type 2 diabetes (T2D) and cardiometabolic diseases, especially when they are difficult to control despite standard of care treatment. The CATALYST study (NCT05772169) found that 24% of 1057 US individuals with difficult-to-control T2D had endogenous hypercortisolism (HC), and the prevalence was 37% in those taking ≥3 antihypertensives. The MOMENTUM study (NCT06829537) found that 27% of individuals with resistant hypertension (rHTN) had HC. We assessed HC prevalence and differences in characteristics in MOMENTUM participants with rHTN and hemoglobin A1c (HbA1c) ≥7.5%. Methods: We screened adults ≥18 years with rHTN (systolic blood pressure SBP ≥130 mmHg on ≥3 antihypertensive classes including a diuretic or on ≥4 classes regardless of SBP) with a 1-mg overnight dexamethasone suppression test (DST; HC=post-DST cortisol 1.8 μg/dL with dexamethasone ≥140 ng/dL). Key exclusion criteria were conditions that could interfere with the DST or lead to an incorrect rHTN diagnosis. Clinical characteristics were summarized using descriptive statistics. Results: Of participants, 17% (181/1086) had rHTN and HbA1c ≥7.5%. HC prevalence differed across HbA1c groups (P0.05; X2 test) and was highest in the HbA1c ≥7.5% group (33%). In this group, individuals with HC vs without HC, respectively, were older (aged ≥65 years, 56% vs 44%), and had more use of insulin (58% vs 49%), metformin (56% vs 50%), SGLT2 inhibitors (37% vs 32%), GLP-1 RAs (including tirzepatide; 41% vs 34%), and lipid-modifying agents (76% vs 72%) and less use of sulfonylureas (14% vs 21%). Atrial fibrillation was more frequent (15% vs 5%), but coronary artery disease was similar (14% vs 15%). Conclusion: About one-third of MOMENTUM participants with rHTN and HbA1c ≥7.5% had HC, consistent with CATALYST results. HC was associated with a higher burden of T2D medications and atrial fibrillation vs no HC. These findings support the need for HC screening in rHTN and T2D. Disclosure G. Umpierrez: Research Support; Current; Abbott, Dexcom, Inc., Bayer AG. Advisory Panel; Ended; Sanofi-Aventis U.S., Dexcom, Inc. Other - Education grant; Current; Lilly Diabetes, Abbott Diabetes. Advisory Panel; Current; Glycare, Glucotrack. Research Support; Current; Corcept Therapeutics. V. Aroda: Research Support; Current; Amgen Inc. Research Support; Ended; Applied Therapeutics. Research Support; Current; AstraZeneca. Other - Biomea; institutional consultant and research support; Current; Biomea. Research Support; Current; Boehringer Ingelheim International GmbH, Corcept Therapeutics, Eli Lilly and Company, Fractyl Health, Inc., Novo Nordisk, Pfizer Inc. Consultant; Current; Recordati S.p.A. Research Support; Current; Rhythm Pharmaceuticals, Inc. Consultant; Ended; Servier Laboratories, Mediflix, Inc., Roche Pharmaceuticals, Sanofi. Other - spouse is an employee; Current; Flagship Pioneering. Other - spouse was an employee; Ended; AditumBio, Johnson Current; Amgen Inc. Research Support; Current; Lilly. Speaker's Bureau; Current; Novo Nordisk A/S, Lilly. R.S. Busch: Research Support; Current; Eli Lilly and Company, Novo Nordisk, Corcept Therapeutics. Speaker's Bureau; Current; Corcept Therapeutics, Bayer AG, Madrigal Pharmaceuticals, Inc., Ascendis Pharma A/S. Research Support; Current; AstraZeneca. D. Cheung: Research Support; Current; Lilly, Corcept Therapeutics. R.A. DeFronzo: Advisory Panel; Ended; AstraZeneca. Research Support; Current; AstraZeneca. Advisory Panel; Current; Novo Nordisk. Research Support; Current; Eli Lilly and Company. Advisory Panel; Current; Corcept Therapeutics. Speaker's Bureau; Current; Corcept Therapeutics. Consultant; Current; Alnylam Pharmaceuticals, Inc. Advisory Panel; Current; Regeneron Pharmaceuticals Inc., Aardvark. B. Eilerman: Speaker's Bureau; Current; Corcept Therapeutics, Lilly, Novo Nordisk, Abbott, Dexcom, Inc. Advisory Panel; Current; Recordati S.p.A. V. Fonseca: Consultant; Current; Abbott Diabetes. Stock/Shareholder; Current; BRAVO4HEALTH, LLC. Consultant; Ended; Bayer AG. Consultant; Current; Eli Lilly and Company, Corcept Therapeutics, Regeneron Pharmaceuticals Inc., Boehringer Ingelheim International GmbH. Stock/Shareholder; Current; Vertex Pharmaceuticals Incorporated. S. Gupta: None. Y. Handelsman: Consultant; Current; Amgen Inc. Advisory Panel; Current; AstraZeneca. Research Support; Current; AstraZeneca. Advisory Panel; Ended; Bayer AG. Advisory Panel; Current; Corcept Therapeutics. Research Support; Current; Corcept Therapeutics. Advisory Panel; Ended; Boehringer Ingelheim International GmbH. Research Support; Current; Ionis Pharmaceuticals. Advisory Panel; Current; Merck Sharp Current; Merck Sharp Current; Dexcom, Inc., Lilly, Novo Nordisk. Advisory Panel; Current; Novo Nordisk, Gan Current; Sanofi-Aventis U.S. L. Sloan: Speaker's Bureau; Current; Abbott, AstraZeneca. Advisory Panel; Current; Corcept Therapeutics. Speaker's Bureau; Current; Corcept Therapeutics, Boehringer Ingelheim International GmbH, Bayer AG, Eli Lilly and Company, Lilly. Advisory Panel; Current; Idorsia Pharmaceuticals Ltd. Speaker's Bureau; Current; Madrigal Pharmaceuticals, Inc. Advisory Panel; Current; Novo Nordisk. Advisory Panel; Ended; Xeris Pharmaceuticals, Inc. Speaker's Bureau; Ended; Xeris Pharmaceuticals, Inc. Y. Tian: Employee; Current; Corcept Therapeutics. Employee; Ended; Gilead Sciences, Inc. T.K. Schlafly: Employee; Current; Corcept Therapeutics. Stock/Shareholder; Current; Corcept Therapeutics. D.F. Einhorn: Employee; Current; Corcept Therapeutics. J.B. Buse: Consultant; Current; Aardvark Therapeutics, Altimmune, Alveus Therapeutics, Amgen Inc., Antag Therapeutics, Aqua Medical, AstraZeneca, Boehringer Ingelheim International GmbH. Other - Consultant and clinical trial support; Current; Corcept Therapeutics. Consultant; Ended; Dexcom, Inc. Consultant; Current; Eli Lilly and Company. Consultant; Ended; embecta. Consultant; Current; General Medicines Inc. Other - Consultant and clinical trial support; Current; GentiBio. Consultant; Ended; Insulet Corporation. Consultant; Current; Kayothera. Other - Consultant and stock options; Current; Metsera. Other - Expert witness; Ended; Medtronic. Other - Consultant and investigator; Current; Novo Nordisk. Consultant; Current; Recordati S.p.A, Sparrow Pharmaceuticals. Consultant; Ended; Tandem Diabetes Care, Inc. Consultant; Current; Vertex Pharmaceuticals Incorporated, vTv Therapeutics, Zealand Pharma A/S. Funding This study is funded by Corcept Therapeutics Incorporated