SPI-62 as a Treatment for Hypercortisolism Related to a Benign Adrenal Tumor

Inclusion Criteria: Diagnosis and main criteria for inclusion and exclusion: The following are the main inclusion criteria: * Adults able to provide informed consent. * Documented characteristically benign adrenal nodule, with diameter ≤ 4 cm, homogenous texture, and non-contrast computerized tomography ≤ 20 HU attenuation or proven to be non malignant. * Diagnosis of diabetes mellitus, pre-diabetes or impaired glucose tolerance, either untreated or on stable standard of care treatment, based on at least one of: * HbA1c ≥ 5.7% but not \> 9.5% * 2-hour glucose level ≥ 7.8 mmol (140 mg/dL) on a 75 g OGTT * At least one additional documented cortisol-related morbidities, either untreated or on stable standard of care treatment: * hypercholesterolemia with total cholesterol \> 3.9 mM (150 mg/dL); * hypertriglyceridemia with triglycerides \> 2.3 mM (200 mg/dL); * osteopenia with bone densitometry Z-score \< -2.0 or T-score \< -1.0; * history or evidence of minimally traumatic or osteoporotic fracture; or * hypertension with resting supine blood pressure \> 130 but \< 180 mmHg systolic or \> 85 but \< 120 mmHg diastolic. * Poorly suppressible hypercortisolemia: * Morning serum cortisol \> 50 nM (1.8 mcg/dL) after a 1 mg ONDST. * Subjects with dexamethasone \< 3.3 nmol/L (130 ng/dL) will undergo a high-dose (8 mg) ONDST. * Subjects who take estrogen-containing medicines will be evaluated based on free cortisol \> 2.2 nM (80 ng/dL). * For subjects with morning serum cortisol \> 138 nM (5.0 mcg/dL) after ONDST, the Investigator will assess for adrenal Cushing's syndrome. Exclusion Criteria: * Diagnosis of ACTH-dependent Cushing's syndrome, pheochromocytoma, aldosteronoma, adrenocortical carcinoma, or congenital adrenal hyperplasia, or other malignancy associated hypercortisolism including history of adrenal carcinoma. * History of adrenalectomy or planned adrenalectomy within 4 months after randomization. * Exogenous hypercortisolism. * Uncontrolled, clinically significant hypo- or hyperthyroidism. * History of idiopathic thrombocytopenia. * Moderately impaired renal function (estimated glomerular filtration rate \< 60 mL/min/1.73m2). * History of cancer (other than non-melanoma skin, thyroid, or early-stage prostate cancer) within 3 years. * Any major surgery, or significant post-operative sequelae, within 1 month prior to informed consent or planned during the trial. * Pregnant or lactating. * Positive test for severe acute respiratory syndrome coronavirus 2 infection within 4 weeks, or hospitalization for Coronavirus disease 2019 within 6 months, prior to randomization. * Any other current or prior medical condition expected to interfere with the conduct of the trial or the evaluation of its results. * Participation in any clinical trial within 3 months prior to the first dose of study drug, or longer depending on half-life of the investigational therapy.