Clinical Learnings Based on a Case Series: Considerations for Identifying and Treating Hypercortisolism in Patients with Diabetes

Summary

When diabetes remains unresponsive or only partially responsive to known effective medications, endogenous hypercortisolism may be a potential underlying driver of the disease
Patient characteristics associated with a high risk of hypercortisolism include hard-to-control diabetes despite standard-of-care therapy and additional morbidities such as obesity and hypertension In these patients, screening for hypercortisolism is warranted
This case series highlights the importance of recognizing hypercortisolism as a differential diagnosis in patients with hard-to-control diabetes
The patients were diagnosed with hypercortisolism based on their clinical presentation, biochemical evaluation (1-mg overnight dexamethasone suppression test), and radiologic imaging results
Treatment of hypercortisolism with mifepristone was initiated, which resulted in meaningful clinical benefits, including cardiometabolic improvements and reductions in antihyperglycemic and antihypertensive medication burden
To ensure the best possible outcomes for each patient, diagnosis and treatment should be tailored to the individual with the patient’s medical history considered