In this episode, ‘Hypercortisolism and Difficult to Control Diabetes,’ the panelists explore the relationship between hypercortisolism and difficult-to-control diabetes, highlighting the role of excess cortisol as a key driver of metabolic dysfunction. The panelists discuss how elevated cortisol levels contribute to hyperglycemia, primarily through mechanisms such as increased insulin resistance, altered lipid metabolism, and increased hepatic glucose production. Although the exact pathways are not fully elucidated, the expert panel emphasizes that both endogenous and exogenous cortisol appear to produce similar metabolic effects, reinforcing the clinical relevance of cortisol dysregulation regardless of its source.

From a clinical perspective, the faculty highlight that patients with poorly controlled or “resistant” diabetes may warrant evaluation for hypercortisolism, particularly when standard therapeutic approaches fail to achieve glycemic control. The panelists note that recent insights have led to greater adoption of practical screening approaches, such as the dexamethasone suppression test, which can be easily implemented in routine practice.

The discussion also underscores the importance of considering medication adherence when evaluating patients with uncontrolled diabetes, as nonadherence may mimic or confound underlying pathophysiology. Overall, the expert faculty emphasize the need for clinicians to look beyond treatment escalation and instead identify underlying drivers of disease, positioning hypercortisolism as an important and potentially modifiable contributor to diabetes management challenges.

The next episode in this series, ‘Hypercortisolism Hidden in Resistant Hypertension,’ features the panelists reviewing the MOMENTUM study and its findings demonstrating a high prevalence of hypercortisolism in resistant hypertension. The panel highlights its implications for redefining disease prevalence and clinical practice.