Effects of Metyrapone in Patients With Hypercortisolism

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