Hypercortisolism Treatment and Earlier Recognition

This episode, titled ‘Hypercortisolism Treatment and Earlier Recognition,’ features panelists, expert primary care physicians, discussing how evidence from the second phase of the CATALYST trial reinforces the importance of identifying hypercortisolism in patients with difficult-to-control type 2 diabetes. The panel reviews the outcomes observed after patients with confirmed hypercortisolism received targeted treatment, highlighting improvements in glycemic control, body weight, waist circumference, lipid profiles, and reductions in the need for glucose-lowering medications over 24 weeks.

The panel also explores the practical implications of these findings for primary care clinicians. They discuss why improvements seen after treating the underlying endocrine disorder strengthen the rationale for earlier recognition rather than focusing solely on managing cardiometabolic comorbidities. The conversation emphasizes that while treatment may initially be challenging and requires careful monitoring and patient education, identifying hypercortisolism remains the critical first step toward improving long-term outcomes and quality of life.

In addition, the panel examines emerging evidence suggesting that excess cortisol may impair endogenous GLP-1 and GIP activity, potentially reducing responses to GLP-1 receptor agonists and other advanced glucose-lowering therapies. They explain how suboptimal responses to these agents, particularly in patients receiving multiple diabetes medications or high-dose insulin, should prompt clinicians to consider hypercortisolism as a potential contributor to persistent metabolic dysfunction. Throughout the discussion, the panel of experts reinforces that primary care clinicians do not need to manage hypercortisolism themselves but should recognize when further endocrine evaluation is warranted to ensure patients receive timely diagnosis and appropriate specialized care.

In the next episode, ‘The Role of Hypercortisolism in Resistant Hypertension,’ the panelists explore how findings from the MOMENTUM study broaden the role of hypercortisolism screening in patients with resistant hypertension. The panelists discuss which patients may warrant evaluation and how these data can inform practical decision-making in primary care.