Published June 20, 2026
Morning Report — Not Your Typical Medical Newsletter
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Good morning and Happy Father’s Day weekend!
Dads can diagnose a strange engine noise from 50 feet away. Their own chest pain? “Probably nothing.” The data back the stereotype, at least on the surface. In some studies, men’s physician consultation rates are roughly one-third lower than women’s, even after accounting for reproductive-related visits. Maybe it’s because many dads subscribe to a time-tested troubleshooting algorithm: Try one more thing before paying someone to look at it—a strategy better suited to lawn mowers than coronary arteries.
A New Lead for Long COVID Fatigue
COVID Quick Hits
COVID-19 may have faded from the headlines, but its shadow still falls across millions of patients. Long COVID fatigue continues to sideline patients, while effective treatments remain elusive. With hypotheses abundant but trial victories scarce, researchers turned to two old standbys: fluvoxamine, a veteran SSRI, and metformin, the workhorse diabetes drug that never seems to miss a repurposing conversation.
A case for fluvoxamine
In the REVIVE-TOGETHER trial, researchers in Brazil randomly assigned nearly 400 adults with persistent long COVID fatigue to receive fluvoxamine, metformin, or placebo for 60 days. Fluvoxamine significantly reduced fatigue and improved quality of life compared with placebo, with benefits persisting through 90 days. Metformin, for all its versatility, never separated itself from placebo.
A few caveats temper the enthusiasm. The trial lasted only three months and focused on fatigue rather than the full constellation of long COVID symptoms. Will the benefits extend to cognitive dysfunction, dyspnea, or dysautonomia, and to patients outside Brazil? Or did fluvoxamine simply ace one section of a larger exam?
Key takeaways
Long COVID remains a therapeutic desert, and randomized victories have been hard to come by. Fluvoxamine is unlikely to be the final answer, but for now, this repurposed antidepressant provides one of the field’s most credible leads—and gives clinicians something more useful than crossed fingers and mechanistic theories.
For more education on managing chronic fatigue, check out this CME podcast: Finding Energy in the Path Forward: A New Lead in Chronic Fatigue Treatment
The Cortisol Connection in Resistant Hypertension
Cardio Corner
Roughly 10% to 20% of patients receiving treatment for hypertension have resistant disease. Yet what if some cases are less resistant than misunderstood—the Wednesday Addams of hypertension? A new study suggests that excess cortisol may account for far more of these cases than previously appreciated.
Building MOMENTUM
The connection between cortisol and hypertension isn’t new, but its magnitude may be. The MOMENTUM study, the largest US investigation of its kind, assessed >1,000 patients with resistant hypertension and flagged hypercortisolism in 27% after an overnight dexamethasone suppression test. That finding disrupts the traditional view of cortisol as a less common culprit and repositions it as a frequent—and frequently missed—player in resistant hypertension. The study also linked hypercortisolism to poor kidney function and identified primary hyperaldosteronism in about 20% of patients, with a small but unlucky group checking both boxes.
Losing MOMENTUM
Still, the findings aren’t definitive. As an observational study relying on a single screening test, MOMENTUM raises important questions but doesn’t yet prove that lowering cortisol will tame resistant hypertension.
Key takeaways
Resistant hypertension may warrant a closer look at cortisol. More than one in four participants in MOMENTUM screened positive for hypercortisolism, a prevalence that pushes excess cortisol well beyond the realm of endocrine zebra. The findings serve as a reminder not to let cortisol slip too far down the differential when evaluating secondary causes of difficult-to-control blood pressure. Next, randomized trials must establish whether targeting cortisol can change the trajectory of these cases.
For more education on hypertension management, check out this CME activity: Hypertension Update: The Newest Insights
Opinion and Perspective: The Case for Caution with Routine Lipoprotein(a) Screening
Special Contributor—Frank Domino, MD
Question: Lipoprotein(a), or Lp(a), has been getting a lot of attention lately. Who should we be screening for Lp(a), how do we interpret an elevated result, and what (if anything) does it actually change in how we manage a patient today?
Answer: Lp(a) is an LDL-like particle, and an elevated level correlates with increased cardiovascular risk. It is genetically determined, and about 20% of the world’s population carry this genetic predisposition. If measured and found to be elevated (>50 mg/dL), it can place the patient at increased risk of CVD. If it is >100 mg/dL, it roughly doubles their risk.
Although many lipid and cardiovascular societies now recommend measuring Lp(a) in adults at least once, independent organizations like the USPSTF and the National Institute for Health and Care Excellence (NICE), which weigh net benefit before endorsing a screening test, have not recommended Lp(a) screening.
Lp(a) is genetically derived and, with today’s approved therapies, cannot be meaningfully lowered. And even if it could be lowered, we have no guarantee that doing so would improve patient-oriented outcomes. Moreover, knowing your Lp(a) level may come with harms. It may decrease a patient’s efforts at lifestyle modification if they feel their genes have predetermined their future. Elevated Lp(a) is not a permission slip to skip the gym, though some patients will try to read it that way. And we do not know how insurers (like life insurance) will use this information against the patient.
Should you order this test for everyone? I do not believe the data are there yet, particularly the evidence that screening improves cardiovascular risk or all-cause mortality when used for primary prevention, which is the whole point of a screening test. The best way I can envision using the Lp(a) test is if you have a patient with a PREVENT score between 7.5% and 10% who is unsure whether they want to take a statin. While an elevated Lp(a) result cannot be altered with medications or lifestyle changes at this point, it may help that person decide to optimize their other risk factors—start exercising, quit smoking, eat properly, and maybe take a statin.
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- Obesity with a normal BMI? Study suggests it’s common
- ‘Gold standard’ for mental health diagnosis may leave patients miscategorized, study finds
- Landmark cancer trial shows success against ‘undruggable’ cancer—raising hopes for future treatments
- Wonder pill shrinks tumors in a third of patients with six hard-to-treat cancers
- Hyperglycosylation is a metabolic driver of Alzheimer’s disease
Morning Report is written by:
- Alissa Scott, Author
- Aylin Madore, MD, MEd, Editor
- Margaret Oliverio, MD, Editor
- Ariel Reinish, MD, MEd, Editor
- Emily Ruge, Editor
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