Prevalence and Unmet Needs in Screening of Hypercortisolism
An expert discusses how hypercortisolism is often diagnosed late because its gradual, nonspecific symptoms mimic common conditions, while inconsistent test results and limited clinical awareness further delay recognition and treatment.
By
Bob Busch, MD
| Published on October 29, 2025
2 min read
The diagnosis of hypercortisolism is frequently delayed for several years due to its gradual onset, nonspecific symptoms, and the tendency for its clinical features to overlap with far more common disorders. Early signs such as fatigue, weight gain, hypertension, and emotional changes often mimic conditions like obesity, depression, or type 2 diabetes, leading both patients and clinicians to attribute them to lifestyle or psychological causes. Because hypercortisolism develops insidiously, patients may adapt to subtle changes in appearance or energy levels over time, delaying their pursuit of medical evaluation. Clinicians, in turn, may not suspect a rare endocrine disorder when faced with such commonplace symptoms, especially in primary care settings where exposure to Cushing syndrome is uncommon.
Another major contributor to diagnostic delay is the intermittent or mild nature of cortisol excess in many patients. This can result in inconsistent biochemical findings that complicate confirmation of the disorder. Stress, illness, and certain medications can transiently alter cortisol levels, increasing the risk of false-negative test results. Additionally, standard screening methods—such as the dexamethasone suppression test or late-night salivary cortisol—require careful timing and patient adherence, both of which can affect accuracy. When results are inconclusive, repeat testing and specialist referral are often necessary, prolonging the diagnostic process.
Systemic factors also play a role. Limited access to endocrinologists, variability in clinical expertise, and lack of awareness about hypercortisolism’s subtler manifestations contribute to missed or delayed diagnoses. The psychological burden of chronic illness and the normalization of symptoms within the patient’s daily life can further obscure recognition. Collectively, these challenges emphasize the need for greater clinical vigilance, improved education among health care providers, and enhanced diagnostic tools to shorten the time to identification and treatment of hypercortisolism.
