In the final episode, ‘Risk-Based Management in Hypercortisolism,’ the panelists explored how to approach hypercortisolism management in the absence of widely accessible, targeted therapies, emphasizing a risk-based treatment paradigm. The panelists draw a parallel to lipoprotein(a), highlighting hypercortisolism as a prevalent and clinically meaningful risk factor that may not yet have straightforward therapeutic options for all patients. In this context, the expert faculty underscore the importance of aggressive optimization of modifiable cardiovascular and metabolic risk factors.

The discussion reinforces that hypercortisolism contributes broadly to systemic disease, affecting blood pressure, glucose metabolism, bone health, and cardiovascular outcomes. As such, clinicians should intensify management of hypertension, diabetes, dyslipidemia, and lifestyle factors to mitigate overall risk. Panelists note that while controlling these comorbidities may not fully eliminate the impact of cortisol excess, it can significantly improve patient outcomes while the field advances toward more targeted therapies.

The expert faculty also emphasize the concept of hypercortisolism as a continuum, suggesting that future treatment strategies may expand beyond overt disease to include earlier or milder forms. Finally, the panel highlights the practical implications of recent evidence, encouraging clinicians to adopt routine screening in high-risk populations and to integrate hypercortisolism into broader risk assessment and management frameworks.

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