Do you recommend the use of Korlym (Mifepristone) for patients with difficult to control diabetes and evidence of mild endogenous hypercortisolism of unknown source?
Do you recommend the use of Korlym (Mifepristone) for patients with difficult to control diabetes and evidence of mild endogenous hypercortisolism of unknown source?
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This is an ongoing question - stimulated by the CATALYST study. The impetus for the study is the observation that many persons with uncontrolled Type 2 DM will fail an overnight 1-mg dexamethasone suppression test (~25%). Subjects with ACTH-dependent hypercortisolism were excluded from further study. Subjects with ACTH-independent hypercortisolism were evaluated with CT of the adrenals and treated with mifepristone for 6 months - final data are pending. The question of endogenous hypercortisolism being a proximate cause of uncontrolled diabetes remains open. My personal experience performing 1-mg dexamethasone suppression tests to patients admitted for inpatient management of major depressive disorders while a chemist at the National Institute of Mental Health demonstrated a similar failure to suppress cortisol (~27%). Interestingly, in this patient group suppression of cortisol by dexamethasone returned when the depression remitted. I await the study results planned for release in June 2025 - until then I do not treat hypercortisolism as evidenced by a failed dexamethasone suppression test - if from an unknown source.