OR18-07 Weight Reduction, Body Composition, and Cardiometabolic Changes in Patients with Adrenal Adenomas Treated with GLP-1 or GIP/GLP-1 Receptor Agonists

Abstract Disclosure: E.D. Zhang: None. I. Lingvay: None. S. Zhang: None. A. Shah: None. A. Pham: None. L. Rahimi: None. D.T. Fetzer: None. J.P. Almandoz: None. H. Hickman: None. J. Schellinger: None. O. Hamidi: None. Background: Adrenal adenomas, even without overt adrenal hormone excess, are associated with higher prevalence of obesity, cardiometabolic comorbidities, cardiovascular events, and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dual gastric inhibitory polypeptide and GLP-1 receptor agonists (GIP/GLP-1 RA) are highly effective for patients with overweight/obesity to reduce weight, adiposity, and cardiometabolic risk markers. In this study, we explored whether response to treatment with these agents differed in patients with adrenal adenomas or hyperplasia (collectively referred to as adenomas) compared to those with normal adrenal glands. Methods: We conducted a single-center retrospective longitudinal case-control study evaluating patients with overweight/obesity who were initiated on GLP-1 or GIP/GLP-1 RA through the Weight Wellness clinic. Eligible patients had a body mass index of 27 kg/m2 or greater, abdominal imaging that allowed determination of the presence or absence of adrenal adenomas, and received treatment for a minimum of 6 months. Patients with bariatric surgery within 2 years of starting treatment, supraphysiologic glucocorticoid use, or diagnosis of primary aldosteronism, ACTH-dependent Cushing syndrome, or other non-cortical adrenal tumors were excluded. Outcomes included changes in weight, body mass index, body composition, HbA1c, lipid panel, and blood pressure measured at pre-specified time points. Results: Of 578 eligible patients, 511 (88.4%) had normal adrenal glands and 67 (11.6%) had adrenal adenomas. At baseline, the adrenal adenoma group had higher prevalence of diabetes (47.8% vs 32.5%, p=0.01), congestive heart failure (16.4% vs 8.8%, p=0.048), and obstructive sleep apnea (56.7% vs 42.5%, p=0.03) compared to the normal adrenal group. At 12 months, patients with normal adrenals had a mean percent change in body weight of -10.91% compared to -8.29% in patients with adrenal adenomas [estimated treatment difference -2.62% (95% confidence interval, -4.90% to -0.34%), p=0.02]. The adrenal adenoma group had a numerically larger percent reduction in body fat mass (-22.67% vs -16.78%, p=0.06) and fat free body mass (-4.88% vs 0.29%, p=0.40) and a smaller reduction in skeletal muscle mass (-9.23% vs -10.03%, p=0.62) compared to the normal group, although these differences were not significant. Changes in cardiometabolic risk markers were similar in both groups. Conclusions: Our findings suggested that patients with adrenal adenomas may have attenuated weight reduction in response to incretin-based weight loss medications and may have similar changes in body composition and cardiometabolic risk markers compared to those with normal adrenal glands. Prospective studies are needed to confirm these findings. Presentation: Sunday, July 13, 2025