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Should these patients receive a primary prophylactic ICD to prevent SCD
Tests may include early morning serum cortisol, 24-hour urinary free cortisol, late-night salivary cortisol, or dynamic tests such as the dexamethasone suppression test and short Synacthen (ACTH stimulation) test for suspected adrenal insufficiency
Significant improvements in fasting glucose or weight may justify more conservative escalation, while absence of improvement may prompt discussion of dose timing or medication adherence
A 2025 radiographic study found an average 7% reduction in midfacial volume for every 10 kilograms of total weight lost, with most of the change occurring in superficial facial fat pads
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