In ‘Hypercortisolism Hidden in Resistant Hypertension,’ our panel explored the design, findings, and clinical implications of the MOMENTUM study, a large, multicenter trial evaluating the prevalence of hypercortisolism in patients with resistant hypertension. Building on prior findings from the CATALYST study in patients with difficult-to-control diabetes, the panelists highlight how MOMENTUM confirmed a similarly high prevalence of cortisol excess, approximately 27%, in a broad, real-world cardiovascular population.

The expert panel emphasizes the robustness and generalizability of the study, noting its inclusion of diverse patient populations across academic, community, and private practice settings. The findings challenge longstanding assumptions that hypercortisolism is rare and reinforce its relevance in routine cardiology practice, particularly among patients requiring multiple anti-hypertensive therapies.

Importantly, the faculty discussed how these data support a paradigm shift in understanding hypercortisolism as a continuum, with clinically meaningful effects even at lower levels of cortisol elevation. The panelists also reflect on the difficulty of overcoming entrenched clinical dogma and the historical reluctance to incorporate cortisol screening into guidelines. Overall, this segment underscores the growing body of evidence positioning hypercortisolism as a prevalent and underrecognized contributor to cardiometabolic disease, with significant implications for screening and patient management.

Our next episode, ‘Recognizing Hypercortisolism in Cardiology,’ the expert faculty discuss why cardiologists should prioritize screening for hypercortisolism in patients with resistant hypertension. The panel highlights a shift toward identifying reversible endocrine drivers of cardiovascular disease.