Post-ODST cortisol >1.8 μg/dL in patients with pheochromocytoma was independently linked to a higher prevalence of T2DM and HTN, suggesting an additive cardiometabolic burden.
Non-suppressed cortisol after overnight dexamethasone suppression test (ODST) was identified in 37.0% of pheochromocytoma patients who underwent the test.
Patients with non-suppressed cortisol had significantly higher rates of hypertension than those with suppressed cortisol.
Patients with non-suppressed cortisol had significantly higher rates of type 2 diabetes mellitus (T2DM) than those with suppressed cortisol.
Post-ODST cortisol concentration was positively correlated with plasma metanephrine and normetanephrine levels.
Patients with non-suppressed cortisol had larger tumors and more frequent bilateral pheochromocytoma than those with suppressed cortisol.
Despite differences in cardiometabolic comorbidities, body mass index was comparable between patients with and without non-suppressed cortisol.
This research studied a group of 389 patients with pheochromocytoma (a rare tumor of the adrenal gland that produces excess adrenaline-like hormones) to understand what happens when these patients also show signs of cortisol (a stress hormone) not being properly suppressed. Normally, a low dose of a synthetic steroid called dexamethasone should suppress cortisol levels; when it doesn't, it can indicate abnormal cortisol activity. The study found that about 37% of pheochromocytoma patients showed this non-suppressed cortisol pattern, and these patients were significantly more likely to have high blood pressure (61% vs. 46%) and type 2 diabetes (31% vs. 17%) compared to patients whose cortisol was properly suppressed. Notably, these differences in metabolic disease rates existed even though the two groups had similar body weights, suggesting the elevated cortisol—not just obesity—was contributing to the health problems. The study also found that higher levels of the hormones produced by the pheochromocytoma tumor (metanephrine and normetanephrine) were associated with higher post-test cortisol levels, pointing to a possible link between the tumor's catecholamine output and cortisol dysregulation. Patients with non-suppressed cortisol also tended to have larger tumors and were more likely to have tumors in both adrenal glands. These findings suggest that in pheochromocytoma, the combination of excess catecholamines and concurrent cortisol abnormality may compound cardiovascular and metabolic risks beyond what either condition alone would cause. This research suggests that clinicians managing pheochromocytoma patients should consider routinely testing for cortisol suppression, as a significant proportion of these patients have concurrent cortisol abnormalities that are independently associated with serious conditions like diabetes and hypertension. Identifying this subgroup could have implications for monitoring and managing cardiometabolic risk in these patients, both before and after tumor removal.
Park M, Hong A, Ahn S, Lee J, Park S, Jung K, et al.. (2026). Clinical characteristics and cardiometabolic association of non-suppressed cortisol after dexamethasone suppression test in patients with pheochromocytoma.. European journal of endocrinology. https://doi.org/10.1093/ejendo/lvag093