Oksana Hamidi, DO, is an associate professor in the division of endocrinology and metabolism at UT Southwestern Medical Center

Oksana Hamidi, DO

Integrating Hypercortisolism Screening into Clinical Practice

In the final episode, ‘Integrating Hypercortisolism Screening into Clinical Practice,’ the panelists explore practical strategies for improving recognition, screening, and management of hypercortisolism in routine clinical care. Drawing on emerging evidence and extensive clinical experience, the expert faculty discuss how clinicians can identify patients who may benefit most from screening, particularly those with difficult-to-control type 2 diabetes, resistant hypertension, and other cardiometabolic comorbidities that may signal underlying cortisol excess.

The panel of experts emphasizes the importance of targeted rather than universal screening, highlighting the need to focus on high-yield patient populations where the likelihood of detecting hypercortisolism is greatest. They discuss how clinical suspicion should be guided by both comorbidity burden and characteristic clinical features, while acknowledging the complexities involved in interpreting screening results and managing borderline or discrepant findings. The discussion also addresses practical considerations surrounding test selection, repeat testing, and the role of standardized screening pathways that may help streamline identification of at-risk patients across healthcare settings.

Throughout the conversation, the panelists stress the importance of multidisciplinary collaboration among endocrinologists, primary care physicians, cardiologists, and other specialists to reduce diagnostic delays and improve patient outcomes. They examine the challenges associated with expanding awareness of hypercortisolism and educating clinicians on appropriate testing, interpretation, and treatment strategies.

As the series concludes, the expert faculty reflect on the evolving understanding of hypercortisolism as a spectrum of disease and underscore the value of teamwork, patient engagement, and ongoing education. They also reinforce the importance of establishing the underlying etiology of hypercortisolism and pursuing curative treatment whenever possible, with surgery remaining the preferred first-line approach when appropriate. Thank you for watching this peer exchange series on hypercortisolism. Please subscribe to our newsletter for information on upcoming video series.

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In the final episode, ‘Integrating Hypercortisolism Screening into Clinical Practice,’ the panelists explore practical strategies for improving recognition, screening, and management of hypercortisolism in routine clinical care. 

Management Strategies for Hypercortisolism

This episode, titled ‘Management Strategies for Hypercortisolism,’ features panelists discussing the practical considerations involved in long-term management of hypercortisolism and the importance of maintaining sustained disease control while minimizing treatment-related complications. The expert faculty examine the factors that prompt treatment modification, emphasizing that management decisions extend beyond biochemical markers alone. They explore how clinicians balance cortisol normalization with the risk of adrenal insufficiency, medication-related adverse events, persistent comorbidities, and the potential for disease progression or recurrence.

The panel of experts highlights the importance of individualized monitoring strategies, including the use of biochemical assessments and clinical outcomes to guide dose adjustments and treatment selection over time. They discuss how persistent metabolic complications, despite apparent cortisol control, may necessitate changes in therapy and reinforce the need for aggressive management of cardiovascular and metabolic risk factors alongside cortisol-directed treatment.

The discussion also focuses on strategies for preventing recurrence and achieving durable disease control. Panelists review the long-term recurrence risk associated with certain forms of hypercortisolism and emphasize the value of ongoing surveillance, patient education, and convenient monitoring tools that can support earlier detection of disease recurrence. They note that treatment plans often require flexibility, particularly when surgery is not curative or when additional therapies are needed to maintain remission.

Finally, the expert endocrinologists underscore the importance of setting realistic expectations with patients and fostering strong communication throughout the treatment journey. They explain how educating patients about recovery timelines, treatment goals, and potential challenges can improve adherence and engagement. The panel concludes by discussing multidisciplinary collaboration and the need for greater awareness across specialties to improve recognition and management of hypercortisolism in high-risk populations.

In the last episode, ‘Integrating Hypercortisolism Screening into Clinical Practice,’ panelists will discuss best practices for identifying patients who may benefit from screening, implementing targeted diagnostic approaches, and improving collaboration across specialties to reduce delays in diagnosis. They also highlight the importance of determining the underlying cause of hypercortisolism and pursuing appropriate, potentially curative treatment strategies.

This episode, titled ‘Management Strategies for Hypercortisolism,’ features panelists discussing the practical considerations involved in long-term management of hypercortisolism and the importance of maintaining sustained disease control while minimizing treatment-related complications. 

Monitoring and Maintaining Long-Term Disease Control in Hypercortisolism 

In ‘Monitoring and Maintaining Long-Term Disease Control in Hypercortisolism,’ our panel explores how clinicians balance sustained cortisol control with the need to manage long-term metabolic risk in patients with hypercortisolism. The expert faculty discuss the importance of avoiding both undertreatment, which may prolong exposure to cortisol excess, and overtreatment, which may increase the risk of adrenal insufficiency and reduce treatment adherence.

Throughout the discussion, the panelists emphasize that long-term disease control requires attention to both biochemical and clinical outcomes. They discuss the importance of monitoring cortisol control while also aggressively managing comorbidities such as hypertension, diabetes, bone disease, and thromboembolic risk. The panel highlights that even after remission, patients may require continued management of residual metabolic complications and long-term follow-up to assess recovery and prevent further morbidity.

The conversation also examines the complexity of monitoring patients receiving different types of medical therapy. Faculty members explain how monitoring strategies may vary depending on whether a patient is treated with a glucocorticoid receptor antagonist or a cortisol synthesis inhibitor. They discuss the role of urinary free cortisol, late-night salivary cortisol, morning cortisol, ACTH, clinical symptoms, and comorbidity trends in guiding treatment decisions.

The panel of experts further explores how resource availability, patient factors, and test reliability can influence monitoring approaches in real-world practice. They emphasize that no single strategy applies to every patient and that management must be individualized based on disease severity, treatment response, tolerability, and long-term goals. By sharing clinical experience, the faculty provide practical guidance for achieving durable disease control while minimizing metabolic risk.

Our next episode, ‘Management Strategies for Hypercortisolism,’ explores how expert faculty balance cortisol control with treatment-related risks, optimize long-term disease management, and monitor for recurrence. The panelists also discuss patient education, multidisciplinary collaboration, and practical approaches to improving outcomes in individuals with hypercortisolism.

In ‘Monitoring and Maintaining Long-Term Disease Control in Hypercortisolism,’ our panel explores how clinicians balance sustained cortisol control with the need to manage long-term metabolic risk in patients with hypercortisolism. 

Monitoring and Maintaining Long-Term Disease Control in Hypercortisolism

Long-Term Treatment Adherence and Persistence in Hypercortisolism

In this episode, ‘Long-Term Treatment Adherence and Persistence in Hypercortisolism,’ the panelists explore the factors that influence long-term treatment success and the challenges of maintaining adherence to medical therapy in patients with hypercortisolism. The expert faculty emphasize that effective management extends beyond medication selection and requires patient education, clear expectations, ongoing monitoring, and coordinated multidisciplinary care.

The panel examines how individualized treatment strategies can support long-term persistence by aligning therapy choices with patient comorbidities, treatment goals, and tolerability. They discuss the importance of helping patients understand the chronic nature of hypercortisolism and preparing them for the realities of long-term disease management.

The conversation also addresses common barriers to adherence, including adverse effects, complex monitoring requirements, healthcare access limitations, and the burden of frequent testing and follow-up. The panelists highlight how treatment-related glucocorticoid withdrawal symptoms and overly aggressive dose escalation may contribute to early discontinuation, underscoring the need for careful titration and close clinical follow-up.

Finally, the faculty review real-world adherence patterns and discuss disease-specific challenges, such as cyclic disease activity, persistent comorbidities, and ongoing cortisol dysregulation. Through practical insights and clinical experience, the panel reinforces the value of a patient-centered, team-based approach to improving long-term outcomes and sustaining engagement throughout the treatment journey.

The next episode in this series, ‘Monitoring and Maintaining Long-Term Disease Control in Hypercortisolism,’ features the panelists discussing how clinicians balance sustained cortisol control with long-term metabolic risk management. The expert faculty also explore monitoring strategies, treatment individualization, and the importance of assessing both biochemical control and clinical outcomes over time.

In this episode, ‘Long-Term Treatment Adherence and Persistence in Hypercortisolism,’ the panelists explore the factors that influence long-term treatment success and the challenges of maintaining adherence to medical therapy in patients with hypercortisolism. 

Oksana Hamidi, DO

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