The Role of Cardiology and Primary Care in Hypercortisolism
An expert discusses new data showing unexpectedly high rates of hypercortisolism among patients with difficult-to-control diabetes, hypertension, and cardiovascular disease, emphasizing the need for targeted screening in these high-risk groups.
By
Bob Busch, MD| Published on November 5, 2025
3 min read
Recent research has revealed that the prevalence of hypercortisolism among certain at-risk patient populations is significantly higher than previously recognized. Traditionally considered a rare endocrine disorder, newer data suggest that subclinical or mild hypercortisolism may affect a substantial portion of individuals with chronic metabolic and cardiovascular conditions. Fonseca (2024) and Handelsman (2024) report that approximately 24% of patients with difficult-to-control diabetes exhibit biochemical evidence of cortisol excess. This prevalence rises dramatically—to around 40%—in patients who struggle with both diabetes and resistant hypertension, suggesting a synergistic relationship between cortisol dysregulation and metabolic-cardiovascular dysfunction. Moreover, among individuals with cardiovascular disease, hypercortisolism was detected in 33.3% compared with 20.9% in those without, reinforcing the hormone’s profound influence on cardiovascular health and disease progression.
These findings highlight that hypercortisolism may be underdiagnosed in patients with complex metabolic or cardiovascular profiles. Cortisol excess contributes to insulin resistance, hypertension, dyslipidemia, and visceral obesity—all common in diabetes and heart disease—thereby creating a diagnostic overlap that can obscure recognition of the underlying hormonal cause. The new prevalence data underscore the importance of proactive screening strategies in these high-risk groups, as early detection and treatment may substantially improve outcomes by mitigating cardiometabolic risk and reducing mortality.
According to Kushner (2024), screening for hypercortisolism should be considered in patients with difficult-to-control diabetes or hypertension, premature osteoporosis, unexplained weight gain with muscle weakness, or cardiovascular disease disproportionate to traditional risk factors. Individuals with multiple cortisol-related features—such as skin thinning, mood changes, or recurrent infections—should also be evaluated. Broader and more systematic screening approaches can help identify mild or atypical forms of hypercortisolism earlier, enabling timely intervention and improved long-term quality of life for affected patients.
