Tirzepatide Following Adrenalectomy in Mild Autonomous Cortisol Secretion

NCT07573163 | Not Yet Recruiting Phase 2 FDA Drug

• 1 other identifier: STUDY25030073
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief Summary

Mild Autonomous Cortisol Secretion (MACS) is a condition in which an adrenal gland produces excess cortisol and is associated with high blood pressure, diabetes, and weight gain. Surgical removal of the adrenal gland (adrenalectomy) is standard treatment, but some patients continue to have metabolic health problems after surgery. This randomized study will evaluate whether treatment with tirzepatide after adrenalectomy improves metabolic outcomes in patients with MACS compared with adrenalectomy alone.

Conditions

Mild Autonomous Cortisol Secretion (MACS); Adrenalectomy; Status

Keywords

adrenalectomy; MACS; mild autonomous cortisol secretion

Outcome Measures

Primary Outcomes (1)

• Change in systolic blood pressure

  Changes in blood pressure will be assessed based on patients' average blood pressure readings, mmHg

  Baseline and 12 months

Secondary Outcomes (5)

• weight

  Baseline and 12 months

• medication

  Baseline and 12 months reported in WHO defined daily doses (DDDs)

• HbA1c

  Baseline and 12 months, %

• quality of life metrics

  Baseline and 12 months

• BMI

  Baseline and 12 months

Study Arms (2)

GLP-1 Treatment

ACTIVE COMPARATOR

GLP-1 dose of 2.5 mg once weekly for 4 weeks. The dose will then be titrated every 4 weeks based on patient tolerance to 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg.

Drug: Tirzepatide

Standard of Care arm

ACTIVE COMPARATOR

Participants in this arm will receive standard of care management for as determined by their treating clinician.

Other: Standard medical treatment

Interventions

Tirzepatide DRUG

Tirzepatide will be initiated at the lowest dose of 2.5 mg once weekly for 4 weeks. The dose will then be titrated every 4 weeks based on patient tolerance to 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg.

GLP-1 Treatment

Standard medical treatment OTHER

Participants will receive postoperative care and follow up per institutional standard-of-care practices

Standard of Care arm

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 18 years and older
• Diagnosis of MACS, defined as morning cortisol \>1.8 mcg/dL after a 1 mg dexamethasone suppression test
• Elevated blood pressure (SBP ≥120 mmHg or DBP ≥80 mmHg per the 2017 American College of Cardiology/American Heart Association \[ACC/AHA\] criteria, or current use of antihypertensive medication)
• BMI ≥27
• Undergoing or having undergone adrenalectomy for the treatment of MACS

You may not qualify if:

• Bilateral adrenal lesions
• Adrenal malignancy
• Concurrent primary aldosteronism with MACS
• Current use of GLP-1 receptor agonists
• Personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN2)
• Pregnancy or breastfeeding

Sponsors & Collaborators

• Alaa Sada: lead

Study Sites (1)

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, 15213, United States

Location

Related Publications (17)

• Kanbay M, Copur S, Siriopol D, Yildiz AB, Gaipov A, van Raalte DH, Tuttle KR. Effect of tirzepatide on blood pressure and lipids: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2023 Dec;25(12):3766-3778. doi: 10.1111/dom.15272. Epub 2023 Sep 12.

  PMID: 37700437 BACKGROUND

• Krumholz HM, de Lemos JA, Sattar N, Linetzky B, Sharma P, Mast CJ, Ahmad NN, Bunck MC, Stefanski A. Tirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial. Heart. 2024 Sep 16;110(19):1165-1171. doi: 10.1136/heartjnl-2024-324170.

  PMID: 39084707 BACKGROUND

• Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, Fishman E, Kharlip J; American Association of Clinical Endocrinologists; American Association of Endocrine Surgeons. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract. 2009 Jul-Aug;15 Suppl 1:1-20. doi: 10.4158/EP.15.S1.1. No abstract available.

  PMID: 19632967 BACKGROUND

• Pelsma ICM, Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J, Marina L, Lorenz K, Bancos I, Arlt W, Dekkers OM. Comorbidities in mild autonomous cortisol secretion and the effect of treatment: systematic review and meta-analysis. Eur J Endocrinol. 2023 Oct 17;189(4):S88-S101. doi: 10.1093/ejendo/lvad134.

  PMID: 37801655 BACKGROUND

• Vanek C, Loriaux L. The 1 mg overnight dexamethasone suppression test: a danger to the adrenal gland? Curr Opin Endocrinol Diabetes Obes. 2022 Aug 1;29(4):403-405. doi: 10.1097/MED.0000000000000752.

  PMID: 35799460 BACKGROUND

• Kelsall A, Iqbal A, Newell-Price J. Adrenal incidentaloma: cardiovascular and metabolic effects of mild cortisol excess. Gland Surg. 2020 Feb;9(1):94-104. doi: 10.21037/gs.2019.11.19.

  PMID: 32206602 BACKGROUND

• Araujo-Castro M, Reincke M, Lamas C. Epidemiology and Management of Hypertension and Diabetes Mellitus in Patients with Mild Autonomous Cortisol Secretion: A Review. Biomedicines. 2023 Nov 22;11(12):3115. doi: 10.3390/biomedicines11123115.

  PMID: 38137336 BACKGROUND

• Prete A, Bancos I. Mild autonomous cortisol secretion: pathophysiology, comorbidities and management approaches. Nat Rev Endocrinol. 2024 Aug;20(8):460-473. doi: 10.1038/s41574-024-00984-y. Epub 2024 Apr 22.

  PMID: 38649778 BACKGROUND

• Morelli V, Ghielmetti A, Caldiroli A, Grassi S, Siri FM, Caletti E, Mucci F, Aresta C, Passeri E, Pugliese F, Di Giorgio A, Corbetta S, Scillitani A, Arosio M, Buoli M, Chiodini I. Mental Health in Patients With Adrenal Incidentalomas: Is There a Relation With Different Degrees of Cortisol Secretion? J Clin Endocrinol Metab. 2021 Jan 1;106(1):e130-e139. doi: 10.1210/clinem/dgaa695.

  PMID: 33017843 BACKGROUND

• Sojat AS, Dunjic-Kostic B, Marina LV, Ivovic M, Radonjic NV, Kendereski A, Cirkovic A, Tancic-Gajic M, Arizanovic Z, Mihajlovic S, Vujovic S. Depression: another cortisol-related comorbidity in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion. J Endocrinol Invest. 2021 Sep;44(9):1935-1945. doi: 10.1007/s40618-021-01509-4. Epub 2021 Feb 2.

  PMID: 33528757 BACKGROUND

• Reimondo G, Puglisi S, Pia A, Terzolo M. Autonomous hypercortisolism: definition and clinical implications. Minerva Endocrinol. 2019 Mar;44(1):33-42. doi: 10.23736/S0391-1977.18.02884-5. Epub 2018 Jul 2.

  PMID: 29963828 BACKGROUND

• Prete A, Subramanian A, Bancos I, Chortis V, Tsagarakis S, Lang K, Macech M, Delivanis DA, Pupovac ID, Reimondo G, Marina LV, Deutschbein T, Balomenaki M, O'Reilly MW, Gilligan LC, Jenkinson C, Bednarczuk T, Zhang CD, Dusek T, Diamantopoulos A, Asia M, Kondracka A, Li D, Masjkur JR, Quinkler M, Ueland GA, Dennedy MC, Beuschlein F, Tabarin A, Fassnacht M, Ivovic M, Terzolo M, Kastelan D, Young WF Jr, Manolopoulos KN, Ambroziak U, Vassiliadi DA, Taylor AE, Sitch AJ, Nirantharakumar K, Arlt W; ENSAT EURINE-ACT Investigators*; ENSAT EURINE-ACT Investigators. Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors : A Cross-Sectional Multicenter Study. Ann Intern Med. 2022 Mar;175(3):325-334. doi: 10.7326/M21-1737. Epub 2022 Jan 4.

  PMID: 34978855 BACKGROUND

• Bancos I, Prete A. Approach to the Patient With Adrenal Incidentaloma. J Clin Endocrinol Metab. 2021 Oct 21;106(11):3331-3353. doi: 10.1210/clinem/dgab512.

  PMID: 34260734 BACKGROUND

• Reimondo G, Castellano E, Grosso M, Priotto R, Puglisi S, Pia A, Pellegrino M, Borretta G, Terzolo M. Adrenal Incidentalomas are Tied to Increased Risk of Diabetes: Findings from a Prospective Study. J Clin Endocrinol Metab. 2020 Apr 1;105(4):dgz284. doi: 10.1210/clinem/dgz284.

  PMID: 31900474 BACKGROUND

• Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velazquez-Fernandez D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544.

  PMID: 35976622 BACKGROUND

• Ebbehoj A, Li D, Kaur RJ, Zhang C, Singh S, Li T, Atkinson E, Achenbach S, Khosla S, Arlt W, Young WF, Rocca WA, Bancos I. Epidemiology of adrenal tumours in Olmsted County, Minnesota, USA: a population-based cohort study. Lancet Diabetes Endocrinol. 2020 Nov;8(11):894-902. doi: 10.1016/S2213-8587(20)30314-4.

  PMID: 33065059 BACKGROUND

• Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J, Pelsma I, Marina L, Lorenz K, Bancos I, Arlt W, Dekkers OM. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023 Jul 20;189(1):G1-G42. doi: 10.1093/ejendo/lvad066.

  PMID: 37318239 BACKGROUND

MeSH Terms

Interventions

Tirzepatide

Intervention Hierarchy (Ancestors)

Glucagon-Like Peptide-1 Receptor; Glucagon-Like Peptide Receptors; Receptors, G-Protein-Coupled; Receptors, Cell Surface; Membrane Proteins; Proteins; Amino Acids, Peptides, and Proteins; Receptors, Gastrointestinal Hormone; Receptors, Peptide

Study Officials

• Alaa Sada, MD

  University of Pittsburgh

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Meghan Kelley

CONTACT

4125789429; hilkoml@upmc.edu

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: May 1, 2026
• First Posted: May 7, 2026
• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): July 31, 2028
• Study Completion (Estimated): December 31, 2028
• Last Updated: May 7, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)