{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T07:20:42Z","timestamp":1787901642873,"version":"build-2784847793"},"reference-count":91,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To provide a practical guide on when to suspect endogenous hypercortisolism, how to use the overnight 1\u2010mg dexamethasone suppression test (DST) for targeted case\u2010finding, and which patients are most likely to benefit from treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This narrative review synthesizes evidence from clinical practice guidelines, prospective prevalence studies, randomized controlled trials, systematic reviews, and meta\u2010analyses addressing the recognition, diagnosis, and management of endogenous hypercortisolism in patients with treatment\u2010resistant type 2 diabetes (T2D), resistant hypertension, and adrenal incidentalomas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Confirmed endogenous hypercortisolism is found in 0.6%\u20103.4% of broader T2D cohorts after stepwise biochemical evaluation, but recent prospective studies\u2014including CATALYST and MOMENTUM\u2014report abnormal cortisol suppression in approximately one in four patients within selected high\u2010risk groups. Mild autonomous cortisol secretion (MACS), defined as ACTH\u2010independent cortisol production with post\u2010dexamethasone serum cortisol &gt;\u200950\u2009nmol\/L (&gt;\u20091.8\u2009\u03bcg\/dL) in the absence of classic Cushingoid features, is associated with clinically meaningful increases in hypertension, T2D, visceral adiposity, and all\u2010cause mortality. Routine screening of all patients with diabetes or hypertension is not recommended; testing should be reserved for those with multiple, progressive, or atypical cardiometabolic features, or with adrenal incidentalomas. Attention to test timing, drug interactions, and physiologic non\u2010neoplastic hypercortisolism is essential for accurate interpretation. When etiology and laterality permit, surgical resection offers the best chance for durable remission. When surgery is not feasible, not curative, or declined, medical alternatives\u2014including glucocorticoid\u2010receptor antagonists (e.g., mifepristone) and steroidogenesis inhibitors (e.g., osilodrostat, ketoconazole)\u2014can reduce cortisol activity or lower cortisol production, each with specific efficacy, tolerability, and safety considerations warranting endocrinologist involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>As cortisol activity falls, glucose\u2010 and blood\u2010pressure medications often require down\u2010titration. Monitoring for adrenal insufficiency, cortisol withdrawal syndrome, and drug\u2010specific adverse effects requires coordinated multidisciplinary follow\u2010up. Through careful evaluation and targeted treatment, hypercortisolism can be recognized and managed as a modifiable contributor to cardiometabolic risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71163","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:02:04Z","timestamp":1785484924000},"page":"34-49","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Hypercortisolism Treatable? 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