MON-514 Metabolic Implications of Hypercortisolemia in Patients With Pheochromocytoma

Abstract Disclosure: M. Park: None. A. Hong: None. S. Ahn: None. J. Lee: None. S. Park: None. J. Koh: None. S. Lee: None. J. Kim: None. Background: Bidirectional cortico-medullary interaction has been reported in patients with pheochromocytoma (PCC). However, the characteristics of patients with PCC accompanied by hypercortisolemia remain unclear. Also, the metabolic impact of hypercortisolemia in patients with PCC has not been investigated. Materials and Methods: A total of 805 patients with PCC were enrolled from five tertiary centers. Clinical and biochemical data were collected from electronic medical records. Of these, 389 patients underwent a 1mg overnight dexamethasone suppression test (ODST) to evaluate the presence of hypercortisolemia. Hypercortisolemia was defined if cortisol after 1 mg ODST exceeded 1.8μg/dL. The clinical features and characteristics of PCC in patients with and without hypercortisolemia were compared. The correlation between log-transformed cortisol after ODST and log-transformed catecholamine was analyzed. Factors associated with diabetes mellitus and hypertension in patients with PCC were analyzed using logistic regression analysis. Results: Among the 389 patients, hypercortisolemia was identified in 144 patients (37.0%), including 68 males. Despite the lower BMI (22.9 vs. 23.6 kg/m2, P = 0.050), patients with hypercortisolemia exhibited a significantly higher prevalence of diabetes mellitus (61% vs 46%, P = 0.004) and hypertension (31% vs 17%, P = 0.001) compared to those without. Patients with hypercortisolemia had larger PCC size (4.0 vs. 3.6 cm, P = 0.021) and a higher frequency of bilateral PCC (9.7 vs. 4.1%, P = 0.026). Log-transformed cortisol after ODST were significantly correlated with plasma metanephrine (MN) (r= 0.15, P = 0.011) and normatenephrine (NM) (r = 0.14, P = 0.016). In multivariable logistic regression analysis, diabetes mellitus was associated with hypercortisolemia (Odds ratio [OR] = 2.13, 95% confidence interval [CI]: 1.16 - 3.90, P = 0.014), older age (OR= 1.06, CI: 1.03-1.09, P <0.001), and male sex (OR = 2.35, CI: 1.27-4.36, P = 0.007). but not with the ratio of plasma MN to total metanephrines. The multivariable logistic regression analysis revealed that hypertension in patients with PCC was significantly associated with hypercortisolemia (OR = 1.75, CI: 1.04 - 2.95, P = 0.034), older age (OR = 1.03 , CI: 1.01-1.05, P = 0.002), higher BMI (OR = 1.15, CI: 1.07-1.24, P <0.001), and elevated urinary NM (OR 1.15, CI: 1.067-1.25, P <0.001). However, tumor size and plasma MN were not significantly associated with hypertension. Conclusion: This study revealed that larger-sized, bilateral PCCs, as well as high plasma MN and NM levels were more likely to be associated with hypercortisolemia. The presence of hypercortisolemia in patients with PCC was associated with a higher prevalence of diabetes mellitus and hypertension. Presentation: Monday, July 14, 2025