Interpreting Screening and Diagnostic Tests in Hypercortisolism

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.

Throughout the discussion, the panelists review how laboratory reference ranges, patient characteristics, and collection techniques can influence test interpretation. They explain how factors such as oral estrogen use, shift work, fluid intake, and incomplete specimen collection may contribute to false-positive or misleading results. The panel also highlights the importance of patient education and preparation prior to testing, noting that accurate test performance is essential for obtaining clinically meaningful results.

The panel of experts further examines how clinical suspicion influences diagnostic decision-making and describes strategies for managing discordant or inconclusive findings. They discuss the value of confirmatory testing, the role of repeated evaluations in patients with persistent clinical concern, and approaches for distinguishing overt hypercortisolism from milder or evolving forms of cortisol excess. Faculty members also address the importance of considering non-neoplastic causes of hypercortisolism and explain how additional endocrine testing may help clarify the underlying etiology once cortisol excess has been established. By sharing practical insights and clinical experience, the panel provides guidance on navigating one of endocrinology’s most challenging diagnostic processes and underscores the importance of combining laboratory data with clinical judgment when evaluating patients for hypercortisolism.

Our next episode, ‘Differential Diagnosis of Hypercortisolism,’ explores the overlap between hypercortisolism and common cardiometabolic, endocrine, and psychiatric conditions that can complicate diagnosis. The panelists discuss strategies for distinguishing cortisol excess from other disorders and highlight the challenges associated with evaluating patients who present with overlapping clinical features.