How Common Is Hypercortisolism in Patients With Hypertension? Risk Factors, Epidemiology, and Making a Diagnosis

Endogenous hypercortisolism (EHC) is an underrecognised and clinically significant contributor to hypertension, particularly resistant hypertension. Once viewed as a rare entity, EHC is now understood as a spectrum of cortisol excess associated with adverse cardiometabolic outcomes and target-organ damage. Recent large-scale studies demonstrate a much higher prevalence of EHC among patients with resistant hypertension and difficult-to-control diabetes, often in the absence of classic Cushingoid features. This review synthesises recent large-scale epidemiological data pertaining to EHC in hypertension, and discusses the various diagnostic modalities, highlighting the need for systematic screening, which may improve outcomes in resistant hypertension.