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This shift has lowered the threshold for screening and encouraged clinicians to consider HC even in the absence of classic physical findings, particularly in patients presenting with common features, including metabolic, cardiovascular, musculoskeletal and neuropsychiatric comorbidities. Chronic cortisol excess is associated with substantial morbidity and increased mortality through widespread effects on glucose metabolism, lipid homeostasis, cardiovascular function, blood pressure control, bone and muscle health, reproductive function, cognition and mental health. Importantly, many of these complications are frequently seen in patients with MACS, particularly in association with difficult\u2010to\u2010control diabetes and hypertension, emphasising the importance of earlier disease recognition. Recent data suggest that this abnormality may be more common than previously recognised, and its identification can have important implications for patient management. 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