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.