Recognizing Hypercortisolism in Primary Care

Welcome back to another Patient Care Online Peers and Perspectives series. In this episode titled, ‘Recognizing Hypercortisolism in Primary Care,’ expert faculty discuss the growing recognition of hypercortisolism as an underrecognized secondary cause of type 2 diabetes and the important role primary care clinicians play in identifying patients who may benefit from further endocrine evaluation. The panel explores how to recognize patients with difficult-to-control type 2 diabetes whose persistent hyperglycemia, hypertension, or multiple cardiometabolic comorbidities may signal an underlying endocrine disorder rather than routine disease progression.

Drawing on emerging evidence, including findings from the CATALYST trial, the panelists examine why hypercortisolism has historically been overlooked and how greater awareness may help reduce years of delayed diagnosis. They discuss the clinical characteristics that should prompt consideration of hypercortisolism, emphasizing that many patients present without classic Cushingoid features and instead exhibit more common metabolic or systemic manifestations encountered in primary care.

The discussion also addresses practical considerations for identifying appropriate candidates for screening while avoiding unnecessary testing in patients with well-controlled diabetes. Throughout the conversation, the panel highlights the importance of maintaining a broad differential diagnosis when patients fail to achieve expected treatment goals despite optimized therapy. By sharing real-world clinical insights and evolving evidence, the panel of experts provides practical strategies to help primary care clinicians recognize potential hypercortisolism earlier, initiate appropriate evaluation, and facilitate timely referral to endocrinology. The episode reinforces the critical role of primary care in shortening the diagnostic journey and improving care for patients with suspected hypercortisolism.

In the next episode, ‘The Role of Hypercortisolism in Difficult-to-Control Type 2 Diabetes,’ panelists will continue their discussion on hypercortisolism and highlight how the CATALYST trial informs patient selection for screening and challenges traditional assumptions about difficult-to-control type 2 diabetes. They also discuss why recognizing the underlying endocrine disorder is critical to improving long-term patient outcomes.