Recognizing Hypercortisolism in Cardiovascular Practice

This episode, titled ‘Recognizing Hypercortisolism in Cardiovascular Practice,’ features panelists discussing the patient presentations that should raise suspicion for underlying hypercortisolism in patients with hypertension and cardiovascular disease. Expert faculty explore how traditional teaching has focused on the classic features of Cushing syndrome, while emerging evidence suggests that many patients with clinically significant cortisol excess may not present with these recognizable signs.

The panel examines practical clues that may help cardiologists identify patients who warrant further evaluation, including resistant hypertension, early-onset hypertension, heart failure without an obvious cause, difficult-to-control diabetes, and obesity that does not respond as expected to standard therapies. They also discuss how psychological symptoms and other nontraditional manifestations may provide insights into underlying cortisol excess.

Throughout the discussion, the panel of experts reflects on findings from recent studies and considers how hypercortisolism may present differently across patients. They highlight moving beyond reliance on classic phenotypic features and emphasize that many patients with hypercortisolism may not have obvious metabolic abnormalities, elevated hemoglobin A1C levels, or severe obesity despite having significant cardiovascular risk.

The faculty discuss how growing awareness of hypercortisolism may influence cardiovascular practice and underscore the need to consider cortisol excess in patients with resistant hypertension and other challenging clinical scenarios. By identifying patterns that may otherwise be overlooked, clinicians may be better positioned to recognize patients who could benefit from further diagnostic evaluation and targeted management strategies.

In the next episode, ‘Hypercortisolism and Other Secondary Causes of Hypertension’, panelists will discuss how hypercortisolism compares with other secondary causes of hypertension and why cortisol excess may deserve greater consideration in patients with resistant hypertension. They will also explore emerging evidence supporting broader awareness and screening efforts within cardiovascular practice.