Evolving Treatment Paradigms in Hypercortisolism: Integrating Emerging Evidence into Practice - Episode 1
Clinical Reflections On CATALYST: Identifying Hypercortisolism In Practice
Panelists discuss how the CATALYST trial results revealed a surprisingly high 25% prevalence of hypercortisolism in patients with difficult-to-control diabetes, fundamentally changing their approach to screening and recognizing this previously underdiagnosed condition affecting an estimated 1.2 million Americans.
Video content above is prompted by the following:
The CATALYST trial results revealed shocking prevalence rates of hypercortisolism in patients with difficult-to-control diabetes, fundamentally changing how clinicians should approach uncontrolled diabetes cases. Vivian Fonseca, MD, FRCP, explains that approximately 25% of patients with poorly controlled diabetes (hemoglobin A1C [HbA1C] >7.5% on multiple medications) were found to have hypercortisolism, translating to an estimated 1.2 million Americans with type 2 diabetes. This population consisted of patients already on comprehensive diabetes regimens, including glucagon-like peptide-1 agonists, SGLT2 inhibitors, and insulin, yet remained uncontrolled with mean HbA1C of 8.5%. The study results also found that 35% of patients with both uncontrolled diabetes and hypertension requiring 3 or more medications had hypercortisolism.
Ralph DeFronzo, MD, emphasizes how hypercortisolism aggravates the core pathophysiological abnormalities in type 2 diabetes, including insulin resistance in liver and muscle, and β-cell failure. He proposes expanding his famous “ominous octet” of diabetes pathophysiology to the “noxious 9” by adding hypercortisolism as the ninth major contributor. This recognition is crucial because hypercortisolism represents a potentially treatable cause of difficult-to-control diabetes that has been largely overlooked in clinical practice.
Following the CATALYST findings, participating clinicians began systematically screening their own patients and discovered similar prevalence rates in their practices. Natalie Bellini, DNP, FNP, BC-ADM, CDCES, describes how her practice implemented screening protocols and began identifying more patients with hypercortisolism. DeFronzo reports screening 10,000 patients at his center, identifying nearly 1000 who met criteria, with an estimated 240 to 250 expected to have abnormal dexamethasone suppression test results. This systematic approach demonstrates the practical feasibility of identifying this previously underdiagnosed condition in routine clinical practice.
