Hypercortisolism Screening in Primary Care

In ‘Hypercortisolism Screening in Primary Care,’ our panel explores the practical implementation of screening for hypercortisolism in patients with difficult-to-control type 2 diabetes. Expert primary care faculty discuss why the 1-mg overnight dexamethasone suppression test (DST) is a practical and accessible screening tool for frontline clinicians and explain how familiarity with the test may help overcome hesitation to evaluate patients for hypercortisolism.

The panel reviews the steps involved in performing the DST, including patient instructions, appropriate timing of dexamethasone administration, morning cortisol measurement, and the rationale for obtaining a concurrent dexamethasone level to confirm adequate drug exposure. They also discuss how to counsel patients about the purpose of screening, emphasizing the importance of partnering with patients to identify a potentially treatable cause of persistent metabolic dysfunction when standard diabetes therapies have not achieved expected results.

In addition, the panel compares the DST with other available screening approaches, including late-night salivary cortisol and 24-hour urinary free cortisol testing. They explain why these alternative methods may be less practical in many primary care settings and review situations in which they may still have an important role. The discussion concludes with practical considerations that may influence test interpretation, including medication use and patient factors that can affect screening results. Throughout the episode, the panel of experts provides practical guidance to help primary care clinicians confidently incorporate evidence-based hypercortisolism screening into routine practice when appropriate.

Our next episode, ‘Hypercortisolism Treatment and Earlier Recognition,’ explores how treatment outcomes from the CATALYST trial and emerging evidence on impaired incretin activity reinforce the importance of recognizing hypercortisolism in patients with difficult-to-control type 2 diabetes. The panelists discuss why poor responses to advanced diabetes therapies should prompt consideration of an underlying endocrine disorder.