Prevalence and Recognition of Hypercortisolism

Welcome back to another HCP Live Peer Exchange series. In this episode titled, ‘Prevalence and Recognition of hypercortisolism’, expert faculty discuss the growing body of evidence highlighting the prevalence of hypercortisolism in patients with type 2 diabetes (T2D) and explore why the condition may be more common than previously recognized. The panel reviews data suggesting that while overt hypercortisolism may affect a small percentage of patients with T2D, rates increase substantially when evaluating individuals with so-called hidden hypercortisolism, particularly among those with difficult-to-control diabetes despite optimized treatment.

Throughout the discussion, the panel of experts examines recent findings demonstrating abnormal dexamethasone suppression test responses in patients with poorly controlled T2D, resistant hypertension, and other metabolic complications. They explore how these observations are reshaping clinical understanding of hypercortisolism and prompting greater consideration of cortisol excess in patient populations that may not exhibit classic signs or symptoms of the disease.

The faculty also discuss which patient groups are most likely to be underrecognized in clinical practice, including individuals with refractory diabetes and resistant hypertension who continue to experience poor outcomes despite multiple therapeutic interventions. Panelists emphasize that many patients with hypercortisolism do not present with the traditional cushingoid features commonly described in medical training, making recognition particularly challenging.

By examining evolving prevalence data and discussing real-world clinical experience, the panel highlights the importance of looking beyond traditional phenotypic presentations to identify patients who may benefit from further evaluation for hypercortisolism. The discussion underscores the need for heightened awareness and consideration of cortisol excess in patients with difficult-to-manage metabolic disease.

In the next episode, ‘Screening and Diagnosis of Hypercortisolism in Type 2 Diabetes’, panelists will continue their discussion on hypercortisolism and highlight the clinical features that may raise suspicion for cortisol excess in patients with type 2 diabetes. The panel of experts will also review common screening and diagnostic approaches used in endocrinology practice and discuss practical considerations for identifying patients who may benefit from further evaluation.