Pam Taub, MD, FACC, FASPC

Risk-Based Management in Hypercortisolism

In the final episode, ‘Risk-Based Management in Hypercortisolism,’ the panelists explored how to approach hypercortisolism management in the absence of widely accessible, targeted therapies, emphasizing a risk-based treatment paradigm. The panelists draw a parallel to lipoprotein(a), highlighting hypercortisolism as a prevalent and clinically meaningful risk factor that may not yet have straightforward therapeutic options for all patients. In this context, the expert faculty underscore the importance of aggressive optimization of modifiable cardiovascular and metabolic risk factors.

The discussion reinforces that hypercortisolism contributes broadly to systemic disease, affecting blood pressure, glucose metabolism, bone health, and cardiovascular outcomes. As such, clinicians should intensify management of hypertension, diabetes, dyslipidemia, and lifestyle factors to mitigate overall risk. Panelists note that while controlling these comorbidities may not fully eliminate the impact of cortisol excess, it can significantly improve patient outcomes while the field advances toward more targeted therapies.

The expert faculty also emphasize the concept of hypercortisolism as a continuum, suggesting that future treatment strategies may expand beyond overt disease to include earlier or milder forms. Finally, the panel highlights the practical implications of recent evidence, encouraging clinicians to adopt routine screening in high-risk populations and to integrate hypercortisolism into broader risk assessment and management frameworks.

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In the final episode, ‘Risk-Based Management in Hypercortisolism,’ the panelists explored how to approach hypercortisolism management in the absence of widely accessible, targeted therapies, emphasizing a risk-based treatment paradigm. 

Emerging Therapies in Hypercortisolism

In ‘Emerging Therapies in Hypercortisolism,’ our panel explores the evolving therapeutic landscape for hypercortisolism and the future direction of treatment development. The panelists emphasize that while diagnostic approaches have been simplified, particularly using the dexamethasone suppression test, therapeutic strategies must also become more practical and accessible to enable broader adoption across specialties, including cardiology.

The discussion highlights several emerging treatment approaches, including adrenal-directed therapies, more selective glucocorticoid receptor modulators, and enzyme-targeting strategies aimed at reducing cortisol production. Expert faculty note that improving specificity and minimizing off-target effects will be critical to enhancing tolerability and usability in clinical practice. At the same time, they underscore physiological challenges associated with treatment, such as patient adaptation to chronically elevated cortisol levels, which may complicate normalization efforts.

Importantly, the panelists draw parallels to other conditions once considered rare, such as amyloidosis and pulmonary hypertension, where advances in therapeutics drove increased awareness, screening, and diagnosis. A similar shift may occur in hypercortisolism as new therapies emerge. However, the expert faculty emphasizes the need for robust clinical trials, including cardiovascular outcomes data, to support broader adoption. Overall, the discussion reflects cautious optimism that innovation in therapeutics will expand both recognition and management of hypercortisolism.

Our next episode, ‘Risk-Based Management in Hypercortisolism,’ the expert faculty discuss managing hypercortisolism as a cardiovascular risk factor in the absence of targeted therapies. The focus is on aggressive risk factor control and routine screening in high-risk patients.

In ‘Emerging Therapies in Hypercortisolism,’ our panel explores the evolving therapeutic landscape for hypercortisolism and the future direction of treatment development.

Hypercortisolism and Cardiovascular Risk Management

In this episode, ‘Hypercortisolism and Cardiovascular Risk Management,’ the panelists explore the broader implications of hypercortisolism on cardiovascular risk and the role of cardiologists in comprehensive patient management. The panelists emphasize that hypercortisolism should not be viewed solely as an endocrine disorder, but rather as a condition deeply intertwined with cardiovascular disease, including atrial fibrillation, heart failure, coronary artery disease, and chronic kidney disease.

The expert panel highlights that patients with hypercortisolism represent a particularly high-risk population, requiring aggressive and holistic risk factor management. In addition to addressing the underlying cortisol excess, faculty stress the importance of optimizing lipid control, screening for additional risk markers, and managing comorbidities across the cardiovascular spectrum. The discussion reinforces the need to move beyond isolated treatment of hypertension or diabetes and instead adopt a global risk reduction strategy.

Importantly, the panelists introduced the concept of interconnected cardiometabolic systems, aligning with emerging frameworks such as cardiovascular-kidney-metabolic care. They also highlight the need for future research to better define the impact of treating hypercortisolism on cardiovascular outcomes. Overall, the expert faculty underscore a shift toward integrated, multidisciplinary care and the identification of hypercortisolism as a key driver of residual cardiovascular risk.

The next episode in this series, ‘Emerging Therapies in Hypercortisolism,’ features the panelists discuss emerging therapies and future directions in hypercortisolism treatment. The panel highlights the need for simpler, effective therapies to drive broader diagnosis and care.

In this episode, ‘Hypercortisolism and Cardiovascular Risk Management,’ the panelists explore the broader implications of hypercortisolism on cardiovascular risk and the role of cardiologists in comprehensive patient management.

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.

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. 

Pam Taub, MD, FACC, FASPC

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