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Is Hypercortisolism Key to Managing T2DM?

Written by Jobeth Augustyniak

July 2, 2024

What is Hypercortisolism?

Simply put, it is a state of having high levels of cortisol. Cortisol has a vital role in our bodies. It is a hormone that is produced by the adrenal glands, small glands that sit just above/on the kidneys and controlled by a small gland in the brain, the pituitary gland. Cortisol is what is referred to the “stress” hormone or our “fight or flight” response. However, it has important roles in metabolism, inflammation/suppression of, blood pressure and blood sugar. It can, also, effect sleep-wake cycles. High levels of cortisol (hypercortisolism) can result in the following:

High levels of cortisol for long periods of time can be due to adrenal tumors, pituitary tumors, long-term use of steroids. This is referred to as Cushing Syndrome. However, when talking about diabetes, specifically, recurrent or constantly elevated levels of cortisol results in constantly elevated blood sugar levels, potentially leading to, or at least contributing to, difficult to control diabetes. That is what we will focus on here.

One in four diabetic patients, of a recent study, showed inappropriately high levels of cortisol.

A recent study, the CATALYST study (2024), results were recently presented at the American Diabetes Association 84th Scientific Sessions. The investigators of the study screened more than 1,000 people whose diabetes was uncontrolled despite being on multiple medications. After identifying participants for the study, an overnight test that is used to detect hypercortisolism (dexamethasone suppression test) was performed. It was found that 24% of patients showed hypercortisolism, and this was even higher in a subset of patients that were also taking more than three blood pressure medications. To take this even further, patients were then sent for CT scans. CT scans showed adrenal abnormalities in approximately 1/3 of patients, 1/4 had an adrenal tumor. This study is relatively large enough to draw some conclusion, it is not perfect, but it is definitely interesting and would be easy to incorporate into clinical outpatient care.

What do we do about this?

Many healthcare professionals make the assumption that poor diabetes control must be something a patient is doing, or not doing, when the HgbA1c is continuing to worsen over time or is increasingly had to control. It is a bias that is present with many healthcare professionals. I have tried to get away from this thought process. This is such an interesting study and is a reminder to all healthcare professionals that it is important to look at the whole person, and to listen to patients. I, personally, will start assessing for Cushing Syndrome, hypercortisolism, and/or giving patients the option of monitoring/evaluating cortisol levels when there is a continuous worsening of their Type 2 Diabetes Mellitus and requiring a continued increase in medications with poor control.

At Uplift Family Medicine, we would be happy to help you, especially if you have been experiencing continued worsening of your diabetes despite medication changes and increasing dosing and medication, despite following exercise and dietary guidelines. Each patient is an individual and deserves the best care.

By: JoBeth Augustyniak, DO, Board Certified Family Medicine by AOBFP, Owner/physician Uplift Family Medicine

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