Importance of Multidisciplinary Care in Hypercortisolism Management
An expert discusses when patients with hypercortisolism should be referred to a cardiologist and how coordinated teamwork between primary care, endocrinology, and cardiology ensures timely diagnosis and comprehensive management.
By
Bob Busch, MD
| Published on November 5, 2025
2 min read
A patient should be referred to a cardiologist after screening for hypercortisolism if there is evidence of significant cardiovascular complications or risk factors commonly associated with excess cortisol exposure. These may include hypertension resistant to standard therapy, unexplained arrhythmias, left ventricular hypertrophy, heart failure, premature atherosclerosis, or other manifestations of cortisol-related cardiovascular damage. Because hypercortisolism contributes to metabolic syndrome, insulin resistance, dyslipidemia, and endothelial dysfunction, early cardiology evaluation can help prevent progression to more serious cardiac disease. Referral is also appropriate for patients who already have established heart disease but whose symptoms worsen despite optimal management, suggesting an endocrine contribution to their cardiovascular dysfunction.
Effective collaboration between primary care clinicians and specialists is essential for early detection and management of hypercortisolism. Primary care providers are often the first to identify suspicious features—such as rapid weight gain, proximal muscle weakness, new-onset or difficult-to-control hypertension, or unexplained diabetes—and should initiate screening with first-line tests such as the overnight dexamethasone suppression test, 24-hour urine-free cortisol, or late-night salivary cortisol. Clear communication of test results, clinical context, and comorbidities to endocrinologists and cardiologists ensures coordinated and efficient patient evaluation.
Optimal care relies on a multidisciplinary approach, where endocrinologists confirm the diagnosis and guide management, while cardiologists assess and address the cardiovascular effects of chronic cortisol excess. Regular case discussions, shared electronic health records, and agreed-upon referral protocols facilitate timely identification and treatment. This collaboration allows for integrated care that targets both the hormonal source and the systemic consequences of hypercortisolism, improving patient outcomes and reducing long-term cardiovascular morbidity and mortality.
