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.

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.

In ‘Interpreting Screening and Diagnostic Tests in Hypercortisolism,’ our panel explores how endocrinologists evaluate and interpret commonly used screening tests for hypercortisolism while navigating the challenges of confirming a diagnosis in real-world clinical practice. The expert faculty discuss practical approaches to interpreting results from the overnight dexamethasone suppression test, late-night salivary cortisol measurements, and 24-hour urinary free cortisol collections, emphasizing the importance of understanding test limitations and potential confounding factors.

This episode, titled ‘Differential Diagnosis of Hypercortisolism,’ features panelists discussing the challenges of distinguishing hypercortisolism from common cardiometabolic and endocrine conditions that share similar clinical features. The expert faculty examine the substantial overlap between hypercortisolism and disorders frequently encountered in clinical practice, emphasizing how these similarities can complicate diagnosis and delay appropriate evaluation.

In this episode, ‘Delayed Diagnosis in Hypercortisolism,’ the expert endocrinologists explore why patients with hypercortisolism often experience prolonged diagnostic delays despite presenting with progressive symptoms and worsening comorbidities. The panelists discuss how many patients report years of symptoms and multiple physician visits before receiving a diagnosis, reflecting the complexity of recognizing a rare and heterogeneous condition in real-world practice.

In ‘Clinical Impact of Hypercortisolism and Early Intervention,’ our panel explores the long-term consequences of sustained cortisol excess and discusses why timely diagnosis and treatment are critical for improving patient outcomes. The expert faculty examine how prolonged exposure to elevated cortisol levels contributes to progressive cardiometabolic dysfunction and increases the risk of serious complications across a broad spectrum of patients with hypercortisolism.

This episode, titled ‘Pathophysiology of Hypercortisolism,’ features panelists examining the biological mechanisms through which excess cortisol contributes to metabolic dysfunction and cardiometabolic disease. The expert faculty discuss how chronic cortisol exposure affects multiple organ systems and drives many of the clinical manifestations commonly observed in patients with hypercortisolism.

In this episode, ‘Navigating Treatment Selection in Hypercortisolism,’ the expert endocrinologists explore available treatment options for hypercortisolism and discuss how clinicians individualize therapy based on disease etiology, severity, comorbidities, and long-term treatment goals. The panelists explain that while surgery remains the preferred approach when a removable source of cortisol excess is identified, medical therapy plays an important role for patients who are not immediate surgical candidates, require preoperative optimization, or need chronic disease management.

In ‘Emerging Clinical Evidence and Cardiometabolic Outcomes in Hypercortisolism,’ our panel explores recent clinical data evaluating the impact of available therapies on cortisol control, metabolic health, and long-term disease management. The expert faculty discuss findings from clinical trials and real-world studies that continue to shape treatment decisions in patients with hypercortisolism.

This episode, titled ‘Evaluating Clinical and Real-World Evidence in Hypercortisolism,’ features panelists discussing key clinical trial findings, real-world treatment experiences, and emerging research that continue to shape the management of hypercortisolism. The expert faculty review efficacy, safety, and practical considerations associated with several established therapies while also exploring new insights into the relationship between cortisol excess and metabolic dysfunction.

In this episode, ‘Long-Term Treatment Adherence and Persistence in Hypercortisolism,’ the panelists explore the factors that influence long-term treatment success and the challenges of maintaining adherence to medical therapy in patients with hypercortisolism.

In ‘Monitoring and Maintaining Long-Term Disease Control in Hypercortisolism,’ our panel explores how clinicians balance sustained cortisol control with the need to manage long-term metabolic risk in patients with hypercortisolism.

This episode, titled ‘Management Strategies for Hypercortisolism,’ features panelists discussing the practical considerations involved in long-term management of hypercortisolism and the importance of maintaining sustained disease control while minimizing treatment-related complications.

In the final episode, ‘Integrating Hypercortisolism Screening into Clinical Practice,’ the panelists explore practical strategies for improving recognition, screening, and management of hypercortisolism in routine clinical care.