Episode 8: Final Thoughts on Cortisol Surveillance: Key Patient Takeaways
A panelist discusses how cortisol excess often goes undetected in patients with poorly controlled type 2 diabetes and resistant hypertension, emphasizing the importance of proactive screening to improve diagnosis and treatment outcomes and reduce long-term complications.
By
Pamela Kushner, MD
| Published on June 18, 2025
2 min read
The following is an AI-generated summary based on the video content above:
Cortisol excess, or hypercortisolism, can significantly complicate the management of type 2 diabetes, particularly in patients who are already struggling with glycemic control and hypertension. Elevated cortisol levels contribute to increased insulin resistance, impaired glucose tolerance, and higher risks of both microvascular and cardiovascular complications. Despite these serious consequences, hypercortisolism often goes undetected. This is partly because its symptoms—such as weight gain, fatigue, and blood sugar variability—can easily be attributed to more common conditions. That is why it is critical for clinicians to maintain a high index of suspicion, especially in patients with persistent metabolic issues despite receiving appropriate treatment.
Recent data underscore the importance of screening in the right populations. In the CATALYST study, a prospective multicenter trial, 24% of patients with difficult-to-control type 2 diabetes and resistant hypertension were found to have hypercortisolism. This highlights the need for greater awareness and timely diagnostic workups. Tests such as the dexamethasone suppression test, late-night salivary cortisol test, and urinary free cortisol test offer accessible, effective means for detecting cortisol dysregulation. Although no test is perfect—false-positive and false-negative results can occur—repeating tests or using a combination of them can enhance diagnostic accuracy. Identifying and treating cortisol excess early may lead to improved blood glucose control and a lower risk of long-term complications.
In conclusion, recognizing and managing cortisol excess in patients with type 2 diabetes requires a proactive and informed approach. Clinicians are encouraged to think beyond common metabolic causes and consider endocrine contributors when standard therapies fail. Early identification not only improves outcomes but also prevents years of unnecessary morbidity.
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