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NCT Number: NCT05255900

Effects of Metyrapone in Patients With Hypercortisolism

The aims of the present study are to evaluate in patients with mild hypercortisolism the effect of metyrapone treatment on glycometabolic control, blood pressure, thrombotic risk parameters, lipid profile, bone turnover markers, mental health and cortisol circadian rhythm.

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Key information

Conditions

Hypercortisolism Adrenal Gland Diseases Adrenocortical Hyperfunction Cushing Syndrome Endocrine System Diseases

Age range

18 year–85 year

Sex eligibility

All sexes

Study type

Observational

Primary location

Istituto Auxologico Italiano

Milan, 20149, Italy

About this study

This open prospective observational study will include patients with mild hypercortisolism of both adrenal and pituitary origin not candidate for surgery. Patients taking metyrapone since less than a week will be followed up for 24 weeks. During this period of time, patients will be re-evaluated as far as blood pressure control, glycometabolic control, thrombotic risk parameters, lipid profile, bone turnover markers and cortisol circadian rhythm is concerned.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients with mild Cushing's Syndrome not candidate for surgery
  • Current therapy with metyrapone since less than 1 week
  • Cortisol levels at 08:00 after 1 mg-overnight dexamethasone suppression test (1mgDST) >1.8 μg/dL
  • Confirmed with 2 mg two days dexamethasone suppression test (2mgx2dDST)
  • Presence of at least one out of the following conditions: type 2 diabetes mellitus, impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), arterial hypertension, bone mineral density (BMD) Z-score < -2.0 and/or fragility fracture at any skeletal site
  • Stable anti-hypertensive therapies and blood pressure (BP) levels in the month before enrolment
  • Stable anti-diabetic therapies and glycometabolic control during the month before enrolment
  • Stable body weight during the month before enrolment

Exclusion criteria

  • Signs and/or symptoms of overt hypercortisolism (striae rubrae, moon facies, easy bruising, buffalo hump, hypertrichosis)
  • Malignant hypertension and/or BP <200/120 mmHg
  • Severe hyperglycemia (i.e. FG >350 mg/dL)
  • Urinary free cortisol (UFC) higher than 1.5 fold the upper normal range
  • Presence of pheochromocytoma or primary hyperaldosteronism
  • Possible adrenal metastases or radiological features suggestive for adrenal malignancy (i.e. not homogeneous pattern, necrosis, calcifications, irregular margins, local invasion and high density at computed tomography)
  • Congenital adrenal hyperplasia
  • Intake of drugs influencing cortisol metabolism and/or secretion
  • Women in child-bearing age
  • Patients with body mass index (BMI) >35 kg/m2

Treatment and study plan

Metyrapone Capsules

Drug

Exposure to 24 weeks of treatment with metyrapone

Primary outcomes

  1. Proportion of patients with a mean systolic BP reduction of ≥5 mm Hg

    Time frame: Baseline, 24 weeks

    BP levels will be measured with arterial blood pressure monitoring (ABPM)

Secondary outcomes

  1. Changes in glycometabolic control

    Time frame: 12 and 24 weeks

    i) the proportion of patients without type 2 diabetes achieving normalization of FG (<100 mg/dL) and/or the reduction of 2-hour glucose levels below 140 mg/dL after OGTT; ii) the proportion of patients with type 2 diabetes achieving HbA1c <7% among those with baseline HbA1c ≥7%;

  2. Normalization of cortisol circadian rhythm

    Time frame: baseline, 12 weeks, 24 weeks.

    The cortisol circadian rhythm will be assessed by salivary cortisol levels determination (at 8 AM, 12 AM, 4 PM, 8 PM and 11 PM).

  3. Changes of thrombotic risk parameters

    Time frame: Baseline, 12 and 24 weeks

    The thrombotic risk profile will be evaluated by measuring C-Protein, S-Protein, coagulation factor VIII and anti-thrombin III levels

  4. Changes of lipid profile

    Time frame: Baseline, 12 and 24 weeks

    The lipid profile modifications will be evaluated by measuring total cholesterol, low-density lipoprotein, high-density lipoprotein and triglycerides

  5. Changes of bone turnover markers

    Time frame: Baseline, 12 and 24 weeks

    The bone turnover changes will be assessed by measuring calcium, phosphorous, osteocalcin (OC), carboxy-terminal cross-linked telopeptide of type I collagen (CTX) and 24-h urinary calcium/creatinine ratio

  6. Amelioration of psychological symptoms

    Time frame: Baseline, 12 and 24 weeks

    Psychological symptoms wil be evaluated with Beck Depression Inventory-II (BDI-II), a 21-item self-administered inventory designed to measure the intensity of depressive symptoms (Beck, Steer, & Brown, 1996). Scores ranging between 0 and 13 are indicative of minimal depression; scores that fall between 14 and 19 are considered to reflect a mild level of depression; scores of 20 to 28 are considered moderate; and a score ranging from 29 to 63 is labeled severe.

Sponsors and collaborators

Lead sponsor

Istituto Auxologico Italiano

Other

Collaborators

  • HRA Pharma

Registry information

Official study title

Metabolic, Pressor and Neuropsychological Effects of Metyrapone Treatment in Patients With Hypercortisolism

Acronym: CEM

Important dates

Study start
2022
Primary completion
2025
Study completion
2025
First posted
Feb 25, 2022
Registry last updated
Mar 30, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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