Deepak Bhatt, MD, MPH, FACC, FAHA, FESC, MSCAI

Hypercortisolism Treatment and Care Pathways

This episode, titled ‘Hypercortisolism Treatment and Care Pathways,’ features panelists discussing the management of hypercortisolism following diagnosis, with a focus on the roles of cardiologists and endocrinologists in coordinating care. The panelists emphasize that cardiologists are often the first to identify patients at risk—particularly those with resistant hypertension or difficult-to-control diabetes—and play a critical role in initiating evaluation and referral. Beyond diagnosis, the expert faculty highlight the importance of education, both for patients and referring providers, to ensure broader awareness and appropriate screening.

The discussion then shifts to therapeutic approaches, where the panel outlines current treatment strategies based on the underlying source of cortisol excess. Faculty describe how surgical intervention remains the preferred and potentially curative option in cases of identifiable pituitary or adrenal tumors, while medical therapies may be used to reduce cortisol production or block its effects when surgery is not feasible. The panelists also note the complexity and limitations of currently available pharmacologic options, including side effect profiles and their historical focus on rare Cushing-specific populations. Overall, the expert panel underscores the importance of multidisciplinary care, accurate diagnostic workup, and individualized treatment strategies to effectively manage hypercortisolism and its cardiometabolic consequences.

In the next episode, ‘Hypercortisolism and Cardiovascular Risk Management,’ panelists will discuss the impact of hypercortisolism on overall cardiovascular risk and comorbidities. The panel highlights the need for comprehensive, multidisciplinary risk management strategies.

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This episode, titled ‘Hypercortisolism Treatment and Care Pathways,’ features panelists discussing the management of hypercortisolism following diagnosis, with a focus on the roles of cardiologists and endocrinologists in coordinating care. 

Hypertension Management in Hypercortisolism

In ‘Hypertension Management in Hypercortisolism,’our panel explores the clinical implications of emerging data on hypercortisolism and outline a forward-looking approach to hypertension management. The panelists emphasize that recent findings from studies such as MOMENTUM and CATALYST should prompt immediate changes in clinical practice, particularly the routine use of simple screening tools like the dexamethasone suppression test in patients with resistant hypertension and difficult-to-control diabetes.

The expert panel highlights the importance of moving beyond traditional medical training that has framed hypercortisolism as rare and easily identifiable by classic features. Instead, faculty encourage clinicians to recognize hypercortisolism as a more common, heterogeneous condition that often presents without overt physical signs but contributes significantly to cardiometabolic disease.

Importantly, the discussion expands to a broader paradigm shift in cardiovascular care, one that prioritizes identifying underlying drivers of disease rather than solely managing symptoms. Drawing parallels to advances in heart failure, the panelists describe a future in which hypertension and metabolic disorders are more precisely phenotyped, enabling targeted and potentially disease-modifying interventions. Overall, the expert faculty underscore the importance of integrating screening, diagnosis, and emerging therapeutics into a more personalized, mechanism-driven approach to patient care.

Our next episode, ‘Hypercortisolism Treatment and Care Pathways,’ the panelists explore treatment approaches for hypercortisolism following diagnosis. The panel highlights the importance of multidisciplinary care and individualized management strategies.

In ‘Hypertension Management in Hypercortisolism,’our panel explores the clinical implications of emerging data on hypercortisolism and outline a forward-looking approach to hypertension management.

Hypercortisolism and Guideline Implications

In this episode, ‘Hypercortisolism and Guideline Implications,’ the panelists explore the implications of emerging hypercortisolism data for clinical guidelines and routine cardiovascular practice. Building on findings from the MOMENTUM and CATALYST studies, the panelists emphasize that the high prevalence of hypercortisolism in patients with resistant hypertension and difficult-to-control diabetes warrants reconsideration of current screening recommendations.

The expert panel highlights that, despite guideline-supported screening for conditions such as primary aldosteronism, hypercortisolism remains underrecognized and is not routinely incorporated into diagnostic algorithms. Faculty argue that given its higher-than-expected prevalence—often exceeding that of other secondary causes of hypertension—screening with a simple dexamethasone suppression test should be integrated into guidelines for patients meeting resistant hypertension criteria.

The discussion also explores important clinical nuances, including the potential coexistence of hypercortisolism and hyperaldosteronism and the shared involvement of the mineralocorticoid receptor pathway. The panelists note that this overlap further supports the need for comprehensive endocrine evaluation in high-risk patients. Overall, the expert faculty advocate for a paradigm shift in guideline development, emphasizing the need to align screening practices with emerging evidence and prioritize detection of common, yet underrecognized, endocrine drivers of cardiovascular disease.

The next episode in this series, ‘Hypertension Management in Hypercortisolism,’features the panelists discuss how hypercortisolism is reshaping the future of hypertension management. The panel highlights a shift toward identifying underlying drivers and adopting more personalized care strategies.

In this episode, ‘Hypercortisolism and Guideline Implications,’ the panelists explore the implications of emerging hypercortisolism data for clinical guidelines and routine cardiovascular practice.

Recognizing Hypercortisolism in Cardiology

This episode, titled ‘Recognizing Hypercortisolism in Cardiology,’ features panelists discuss the clinical implications of emerging hypercortisolism data for cardiologists and how these findings should influence everyday practice. The panelists emphasize that, despite historically being considered rare, hypercortisolism is increasingly recognized as a common and underdiagnosed contributor to resistant hypertension and broader cardiometabolic disease.

The expert panel highlights that cardiologists frequently manage patients with complex medication regimens for hypertension, diabetes, and cardiovascular disease, yet often overlook potentially reversible underlying drivers such as cortisol excess. Faculty stress that identifying hypercortisolism offers an opportunity to address the root cause of disease, potentially reducing medication burden and improving outcomes across multiple conditions, including metabolic syndrome and glucose dysregulation.

Importantly, the panelists challenge existing clinical paradigms and screening algorithms, noting that hypercortisolism may be more prevalent than traditionally prioritized secondary causes of hypertension, such as renal artery stenosis or pheochromocytoma. As a result, the expert faculty advocate for incorporating routine screening in the cardiovascular practice, particularly with using the dexamethasone suppression test. Overall, the discussion underscores a shift toward more proactive, mechanism-driven care, encouraging cardiologists to rethink diagnostic strategies and prioritize detection of common, yet often overlooked, endocrine contributors to cardiovascular disease.

In the next episode, ‘Hypercortisolism and Guideline Implications,’ panelists will discuss how emerging data should inform updates to clinical guidelines for hypercortisolism screening. The panel highlights the need to prioritize detection of endocrine drivers in resistant hypertension.

This episode, titled ‘Recognizing Hypercortisolism in Cardiology,’ features panelists discuss the clinical implications of emerging hypercortisolism data for cardiologists and how these findings should influence everyday practice. 

Deepak Bhatt, MD, MPH, FACC, FAHA, FESC, MSCAI

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