The Impact on Quality of Life and Relevant Clinical Studies

EP: 1.Examining the Differential Diagnosis of Hypercortisolism

EP: 2.Exploring Reasons for the Underdiagnosis of Hypercortisolism

EP: 3.Selecting the Appropriate Screening Test

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EP: 4.The Impact on Quality of Life and Relevant Clinical Studies

EP: 5.The Role of the Pharmacist in Screening

This video segment explores the chronic effects of untreated hypercortisolism on patients' quality of life and discusses the groundbreaking CATALYST study findings. Untreated hypercortisolism has significant detrimental impacts across multiple domains. The metabolic and cardiovascular effects include resistant and severe hypertension that's difficult to treat, dyslipidemia, and early cardiovascular disease leading to increased mortality risk. Physical manifestations encompass weight gain, extremity muscle wasting and weakness, distinctive skin changes like purple striae and moon face, buffalo hump formation, and osteoporosis, particularly concerning when it occurs in patients under age 50.

The neurological and psychiatric impacts significantly affect daily functioning, including neurocognitive changes such as brain fog and memory loss, mood disorders like depression and anxiety, immunosuppression leading to increased infection risk, and excessive sweating. These symptoms are often nonspecific enough that they don't immediately suggest hypercortisolism as an underlying cause, contributing to delayed diagnosis and continued deterioration in quality of life.

The CATALYST study represents a landmark investigation that fundamentally changed understanding of hypercortisolism prevalence. This prospective, 2-part, multi-enter study evaluated hypercortisolism in patients with difficult-to-control type 2 diabetes, defined as hemoglobin A_1c between 7.5% and 11.5% plus specific medication requirements (3 or more glucose-lowering medications, insulin with other medications, or multiple diabetes and blood pressure medications with complications). Using the one milligram overnight dexamethasone suppression test with appropriate exclusions for false positives, the study made remarkable discoveries. Among over 1000 participants, 23.8% had hypercortisolism—nearly a quarter of patients with difficult-to-control diabetes. Even more striking, 33.3% of participants with cardiac disorders had hypercortisolism, and 36.6% of those taking multiple antihypertensive medications tested positive. These findings challenge the traditional view that hypercortisolism is rare and suggest clinicians should consider screening more patients with treatment-resistant conditions.