Evolving Hypercortisolism Screening and Diagnosis

In ‘Evolving Hypercortisolism Screening and Diagnosis,’ our panel explored how emerging evidence is reshaping the approach to screening and diagnosing hypercortisolism in cardiovascular practice. The panelists emphasized that recent findings from studies such as MOMENTUM are not only expanding the population of patients who should be evaluated but also simplifying how clinicians can screen for the condition. Rather than relying on complex and historically emphasized diagnostic methods, the expert panel highlighted the practicality of the dexamethasone suppression test as an accessible and effective tool for identifying patients with cortisol dysregulation.

From a cardiology perspective, the faculty reflected on how these insights are prompting a shift in clinical thinking, particularly in patients with resistant hypertension or difficult-to-control diabetes. The panelists noted that a substantial proportion of these patients may have underlying, potentially reversible causes such as hypercortisolism or hyperaldosteronism, challenging long-standing assumptions that most cases are primary or essential.

The discussion also underscored the importance of overcoming entrenched clinical paradigms that have historically minimized the role of endocrine causes of hypertension. The expert faculty highlighted both physician and patient perspectives, noting that patients are highly receptive to evaluation when presented with the possibility of an identifiable and treatable underlying cause. Overall, the panelists described a paradigm shift toward more proactive screening and interdisciplinary collaboration.

Our next episode, ‘Hypercortisolism in Resistant Diabetes and Cardiometabolic Disease,’ the panelists discuss the role of hypercortisolism in patients with resistant diabetes and its contribution to cardiometabolic disease. The panel highlights the importance of identifying underlying, potentially reversible drivers of disease across disciplines.