Screening and Diagnosis of Hypercortisolism in Type 2 Diabetes

In this episode, ‘Screening and Diagnosis of Hypercortisolism in Type 2 Diabetes,’ the panelists explore the clinical features that should raise suspicion for underlying hypercortisolism in patients with type 2 diabetes and discuss practical approaches to screening and diagnosis in endocrinology practice. The expert faculty emphasize that many manifestations of hypercortisolism overlap with common metabolic conditions, making identification particularly challenging in this patient population. They explain how clinicians can look beyond traditional metabolic risk factors and focus on additional signs that may indicate cortisol excess.

Throughout the discussion, the panel of experts highlights the importance of recognizing catabolic features such as proximal muscle weakness, sarcopenia, osteoporosis, fragility fractures, delayed wound healing, and characteristic skin findings. They also examine neurocognitive symptoms, including depression, memory impairment, and cognitive decline, as well as cardiovascular indicators such as resistant hypertension, hypokalemia, and thromboembolic events. The faculty stress that these findings may serve as important clues when evaluating patients with difficult-to-control diabetes who do not fit the expected clinical picture.

The conversation also addresses the diagnostic evaluation of suspected hypercortisolism and reviews commonly used first-line screening tests. Panelists discuss the role of the overnight dexamethasone suppression test, late-night salivary cortisol measurements, and 24-hour urinary free cortisol collection, including practical considerations for test administration and interpretation. They emphasize the importance of proper patient preparation and awareness of factors that can influence results. By combining clinical insight with practical diagnostic guidance, the panel provides a framework for identifying patients who may benefit from further evaluation and highlights the importance of maintaining a high index of suspicion for hypercortisolism in individuals with type 2 diabetes.

The next episode in this series, ‘Interpreting Screening and Diagnostic Tests in Hypercortisolism,’ features the panelists discussing how to evaluate and interpret commonly used screening tests for hypercortisolism while accounting for potential confounding factors and false-positive results. The panel of experts also explores strategies for confirmatory testing, managing discordant findings, and applying clinical judgment throughout the diagnostic process.