Category: Adrenal Disorders

Monitor: 9

9 - PREVALENCE OF HYPERCORTISOLISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH INCIDENTALLY FOUND ADRENAL ADENOMAS: AN INTERIM ANALYSIS

Thursday, Apr 25
1:30 PM – 2:00 PM

Objective : Adrenal adenomas frequently are discovered incidentally during imaging, with 5% to 30% secreting cortisol. Presented are the interim results of an investigator-initiated study on the prevalence of hypercortisolism in patients with type 2 diabetes mellitus (T2DM) with incidentally discovered adrenal adenomas at the NYC Health + Hospitals Queens Diabetes Center of Excellence. 


Methods : Electronic medical records (EMR) were analyzed for patients 18 years or older with T2DM and adrenal adenomas incidentally found from October 2014 to October 2017. The study had 2 cohorts: (1) patients with existing biochemical results (of a 1-mg DST and ACTH assay) and (2) patients requiring biochemical workup. All patients were to have a repeat CT scan to assess any change in nodule size. Target study enrollment was 30 patients.


Results :

Twenty-two patients with T2DM and adrenal adenomas were identified through EMR database. Eight of 22 patients had complete evaluations (CT scans and biochemical evaluations). The adrenal nodules in these 8 patients ranged in size from 1 cm to 2.4 cm and remained stable over time, and HbA1c was greater than 7%. Of these 8 patients, 4 had an abnormal 1-mg DST value >1.8 µg/dL. Average ACTH in these 4 patients was 20.27 pg/mL.

Fourteen of 22 patients require either biochemical evaluation or repeat imaging. Three of the 14 patients with incidentally discovered adrenal nodules who have not yet undergone repeat imaging had a positive 1-mg DST, with an average ACTH of 15 pg/mL. Adrenal nodules in this cohort were < 1.2 cm. One subject withdrew consent.


Discussion : n/a


Conclusion : In our interim analysis, 7 of 22 patients (32%) with T2DM and incidental adrenal adenomas had hypercortisolism using the diagnostic criteria of 1-mg DST >1.8 µg/dL. Full data analysis of the remaining 11 patients is required to determine hypercortisolism prevalence at our clinic, but our interim data suggests a high prevalence of hypercortisolism in patients with T2DM with incidentally discovered adrenal adenomas.

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Isaac Sachmechi

Chief of the Division of Endocrinology
NYC Health + Hospitals/Queens
New York, New York

Chief of Endocrinology at NYC Health+Hospitals/Queens

Mina EFFAT. fransawy Alkomos

Research Assistant
NYC Health + Hospitals
S Richimondhill, New York

Research Assistant at NYC Health+Hospitals/Queens

Paria Zarghamravanbakhsh

Resident Internal Medicine
NYC Health + Hospitals/Queens
New York, New York

Internal Medicine Resident at NYC Health + Hospitals/Queens.

Rupak Mahendhar

Research Assistant
NYC Health + Hospitals

n/a

Kiruthi Palaniswamy

Medical Affairs
Corcept Therapeutics, California

na

Isaac Sachmechi

Chief of the Division of Endocrinology
NYC Health + Hospitals/Queens
New York, New York

Chief of Endocrinology at NYC Health+Hospitals/Queens