Hypercortisolism Recognition and Referral in Primary Care

In ‘Hypercortisolism Recognition and Referral in Primary Care,’ our panel explores practical strategies for recognizing patients with suspected hypercortisolism, initiating appropriate evaluation, and ensuring timely referral to endocrinology. Expert faculty discuss why primary care clinicians should maintain a high index of suspicion in patients with difficult-to-control type 2 diabetes or cardiometabolic disease, emphasizing that the low burden of screening should encourage clinicians to test when clinical concern exists rather than delay evaluation.

The panel reviews the role of the overnight dexamethasone suppression test as an accessible first step in primary care and explains how a positive result can guide subsequent management. They discuss when additional testing, including ACTH, DHEA, and adrenal imaging, may help distinguish ACTH-dependent from ACTH-independent disease, while reinforcing that primary care clinicians are not required to complete the entire diagnostic workup before referral.

The conversation also highlights the importance of clinical advocacy throughout the referral process. The panelists emphasize maintaining ownership of the patient’s care, communicating clearly with endocrinology colleagues, and pursuing additional evaluation or second opinions when persistent clinical suspicion remains despite an initial negative assessment. They review evidence from the CATALYST trial demonstrating that not all patients with hypercortisolism have identifiable adrenal abnormalities on imaging and discuss how treatment decisions differ depending on the underlying source of cortisol excess. Finally, they reinforce that early recognition and coordinated multidisciplinary care can improve metabolic control, reduce long-term cardiovascular risk, and help patients receive treatment for an often-overlooked but manageable endocrine disorder.

Our next episode, ‘Hypercortisolism Screening Pearls and Pitfalls,’ explores the common screening pitfalls, practical strategies for incorporating hypercortisolism evaluation into primary care, and the importance of maintaining a high index of suspicion in appropriate patients.