Understanding Hypercortisolism and Its Impact on Cardiovascular Diseases - Episode 4
Hypercortisolism in Resistant Diabetes and Cardiometabolic Disease
This episode, titled ‘Hypercortisolism in Resistant Diabetes and Cardiometabolic Disease,’ features panelists expanding the discussion of hypercortisolism beyond hypertension to include patients with poorly controlled or “resistant” diabetes, highlighting another high-risk population where cortisol excess may be underrecognized.
This episode, titled ‘Hypercortisolism in Resistant Diabetes and Cardiometabolic Disease,’ features panelists expanding the discussion of hypercortisolism beyond hypertension to include patients with poorly controlled or “resistant” diabetes, highlighting another high-risk population where cortisol excess may be underrecognized. The panelists describe how emerging data from studies such as CATALYST demonstrate that a substantial proportion of patients with difficult-to-control diabetes, defined as those requiring multiple therapies yet remaining above glycemic targets, may have underlying hypercortisolism.
The expert panel emphasizes that prevalence rates in these populations are significantly higher than previously anticipated, with estimates approaching 20–25%, particularly among patients with coexisting cardiovascular disease. Faculty also discuss the concept of “resistant diabetes” as a clinical framework, drawing parallels to resistant hypertension, and suggest that identifying these patients may help clinicians more effectively target screening efforts.
Importantly, the panelists highlight that hypercortisolism should be considered as a potential driver of cardiometabolic dysfunction regardless of its underlying source, reinforcing the importance of focusing on cortisol excess, itself rather than etiology alone. The discussion underscores the need for clinicians across cardiology, endocrinology, and primary care to shift toward identifying reversible drivers of disease, rather than escalating therapies alone. Overall, the expert faculty advocates for a more proactive, multidisciplinary approach to improving diagnosis and management in these complex patients.
In the next episode, ‘Hypercortisolism and Difficult to Control Diabetes,’ panelists will discuss how hypercortisolism contributes to difficult-to-control diabetes through mechanisms such as insulin resistance and metabolic dysfunction. The panel highlights the importance of identifying cortisol excess as a potential underlying driver in patients with persistent hyperglycemia.
