Recognizing Hypercortisolism and Managing Hard-to-Control Diabetes in Primary Care

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Classification and Causes of Hypercortisolism

According to data published in JAMA and cited by the Primary Care Metabolic Group, hypercortisolism is classified into two main categories. ACTH-dependent hypercortisolism includes excess adrenocorticotropic hormone secretion by pituitary tumors, known as Cushing syndrome, as well as non-pituitary tumors through ectopic ACTH secretion. ACTH-independent hypercortisolism involves autonomous cortisol secretion by one or both adrenal glands.

Impact on Type 2 Diabetes Management

Many patients with type 2 diabetes fail to reach treatment goals despite effective therapies and the best efforts of clinicians and patients, according to findings published in BMJ Open and Frontiers in Endocrinology. Excess cortisol increases insulin resistance and decreases insulin sensitivity, which negatively impacts the metabolic defects underlying type 2 diabetes. This dynamic contributes directly to a form of the disease that proves difficult to control with standard therapeutic approaches.

The Role of Primary Care Clinicians

Primary care clinicians play a crucial role in ensuring optimal treatment outcomes for patients with type 2 diabetes, who are frequently managed in primary care environments, according to research published in the British Journal of General Practice. Because many patients with hypercortisolism experience missed or delayed diagnoses and lack direct access to endocrinology care, primary care providers are positioned to identify at-risk individuals.

Implementing multidisciplinary management strategies remains essential for achieving optimal patient outcomes when addressing evidence of hypercortisolism in everyday practice.

Hypercortisolism, a condition driven by prolonged and excessive cortisol activity that is not due to normal physiological processes, frequently goes undiagnosed or faces misdiagnosis in primary care settings, according to presentations from the Primary Care Metabolic Group. Also referred to as Cushing syndrome, endogenous hypercortisolism results in progressive morbidity and increased cardiovascular-related mortality if left unaddressed.

Classification and Causes of Hypercortisolism

Stephen Brunton, MD, FAAFP, CDCES, moderator for the Primary Care Metabolic Group, notes that endogenous hypercortisolism represents a key underlying cause of hard-to-control diabetes.

Presentation materials outline specific learning objectives for clinicians, emphasizing the need to increase awareness of hypercortisolism as a potential driver of treatment-resistant diabetes. Clinicians are encouraged to review new and emerging data for hypercortisolism treatments and understand their specific impact on patients struggling with difficult-to-control diabetes.