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Adrenal (Excluding Mineralocorticoids)

MON-516 - Endogenous Hypercortisolism in Individuals With Resistant Hypertension and Difficult-to-control Type 2 Diabetes: Results From two Large, Prospective Studies

Monday, June 15, 2026
9:00 AM - 2:00 PM CT


Introduction: Endogenous hypercortisolism (HC) is increasingly recognized as a common contributor to metabolic cardiorenal diseases resistant to standard-of-care treatment. CATALYST (NCT05772169) and MOMENTUM (NCT06829537) were the first US-based studies to establish the prevalence of HC in adults with difficult-to-control type 2 diabetes (T2D) and resistant hypertension (rHTN), respectively. Screening of >1000 individuals in each study demonstrated HC prevalence rates of 23.8% and 27.3%, respectively. We aimed to describe the characteristics of individuals with the combination of difficult-to-control T2D and rHTN in these studies.

Methods: CATALYST enrolled 1057 adults with HbA1c 7.5–11.5% despite taking multiple antihyperglycemic and/or antihypertensive medications. MOMENTUM enrolled 1086 adults with rHTN based on AHA criteria. In both studies, HC was defined as post-1 mg dexamethasone suppression test cortisol >1.8 µg/dL. Individuals with conditions that could interfere with the DST were excluded. The subgroups presented here are CATALYST participants with rHTN based on AHA criteria (CAT-rHTN) and MOMENTUM participants with HbA1c ≥7.5% (MOM-T2D).

Results: 146 (14%) participants in CATALYST and 181 (17%) in MOMENTUM had both rHTN and difficult-to-control T2D. The prevalence of HC in the subgroups was 39.7% (CAT-rHTN) and 32.6% (MOM-T2D). Baseline characteristics such as age (63 yrs in both) and BMI (CAT-rHTN: 35.8 kg/m2; MOM-T2D: 34.4 kg/m2) were similar in the overall populations. Blood pressure was higher in MOM-T2D (141/84 vs 136/76 mmHg). In both subgroups, there was no difference in BMI or waist circumference. Individuals with vs without HC tended to be older (CAT-rHTN: 65 vs 61 yrs; MOM-T2D: 65 vs 62 yrs) and had more cardiac disorders (CAT-rHTN: 57 vs 32%; MOM-T2D: 42 vs 38%), including atrial fibrillation (CAT-rHTN: 17 vs 9%; MOM-T2D: 15 vs 5%). Individuals with HC more frequently took ≥10 medications (CAT-rHTN: 93 vs 77%; MOM-T2D: 54 vs 52%), including more use of beta blockers (CAT-rHTN: 83 vs 65%; MOM-T2D: 70 vs 64%) and SGLT2 inhibitors (CAT-rHTN: 62 vs 48%; MOM-T2D: 37 vs 32%).

Conclusions: The CATALYST and MOMENTUM studies demonstrated a high prevalence of HC among individuals with difficult-to-treat T2D and rHTN. The data presented here in individuals from each study with both rHTN and difficult-to-control T2D support a common pathophysiology: The prevalence of HC was similar in both subgroups, higher than in the overall populations, and the subgroups shared many patient characteristics, including older age, higher frequency of cardiac disorders, and more medication use in individuals with HC. Clinical suspicion for HC should be high in individuals with multiple metabolic cardiorenal comorbidities, and HC screening should be performed accordingly.

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