Optimizing Multidisciplinary Care
Panelists discuss how pharmacists can optimize multidisciplinary care for hypercortisolism by leveraging their training in chronic disease management and collaborative practice agreements to flag patients with persistent uncontrolled diabetes for screening, coordinate the diagnostic process and referrals to endocrinologists, and manage diabetes and hypertension while incorporating diabetes technology into treatment plans, and potentially oversee the use of newly approved medications like mifepristone for hypercortisolism treatment with appropriate monitoring for adverse effects like hypokalemia, while also exploring innovative solutions such as virtual care consultations, artificial intelligence–assisted imaging interpretation, and deprescribing of diabetes and blood pressure medications when hypercortisolism treatment successfully reduces cortisol levels.
This video segment focuses on optimizing multidisciplinary care for patients with hypercortisolism, emphasizing the evolving role of pharmacists in this process. Pharmacists are well-positioned to contribute to hypercortisolism management through their training in chronic disease management and authorization in many states to initiate, adjust, and discontinue medications under collaborative practice agreements. Clinical pharmacy teams are developing protocols to participate in the screening, diagnostic, and referral processes for patients with persistent uncontrolled diabetes, creating pathways to connect these patients with endocrinologists for further workup while continuing to manage their diabetes and hypertension through medication adjustments and diabetes technology integration.
The treatment landscape for hypercortisolism includes both pharmacological and surgical approaches. Medications like mifepristone can reduce cortisol levels, though they require careful monitoring for adverse effects such as hypokalemia, making pharmacist involvement crucial for patient education and safety monitoring. Surgical intervention may be appropriate for patients with cortisol-secreting tumors. An important aspect of successful treatment is that patients will likely need to reduce their diabetes and blood pressure medications as their hypercortisolism is addressed, creating opportunities for pharmacist-led deprescribing initiatives.
Given the shortage of endocrinologists, innovative care delivery models are emerging to address access challenges. Virtual care presents significant opportunities for managing hypercortisolism patients, particularly for initial screening and follow-up consultations. Once imaging studies are completed, virtual consultations can effectively determine whether patients are surgical candidates versus medication candidates by sharing imaging results remotely. The integration of artificial intelligence for scan interpretation further enhances these capabilities. This interprofessional approach, combining in-person screening and medication management with virtual specialist consultations, represents a promising model for addressing the growing recognition of hypercortisolism prevalence while working within current health care system constraints and specialist availability limitations.
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