The diagnosis of hypercortisolism is often delayed or missed, especially in primary care settings, leading to detrimental consequences for patients, such as unnecessary morbidity and mortality. Recent data suggest that the prevalence of hypercortisolism is far higher than previously estimated. Clinicians need to be aware of optimal approaches for identifying, diagnosing, and treating hypercortisolism. New data are emerging for hypercortisolism treatments that can improve outcomes in patients with hypercortisolism and hard-to-control type 2 diabetes.