#519 Mild Autonomous Cortisol Secretion

Become a master of cortisol and learn how to identify and treat a common condition in patients with adrenal tumors! Join us as we learn about mild autonomous cortisol secretion (MACS) with Dr. Irina Bancos (@irinabancos), an internationally renowned adrenal expert!Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Advice for listeners Adrenal incidentaloma Definition (Case 1) Hormonal workup for adrenal incidentalomas Defining mild autonomous cortisol secretion (MACS) Significance and prevalence of MACS Diagnostic testing for MACS Treatment options for MACS (surgery vs. comorbidity management) Post surgical management of MACS (Case 2) Diagnostic testing for adrenal insufficiency (AI) Glucocorticoid withdrawal syndrome management Deciding when patients are able to come off of steroids after AI Outcomes after adrenalectomy in MACS Take home points CreditsWritten and produced by Paul Wurtz MD. Show notes, cover art, and infographic also created by Paul Wurtz MD. Producer, writer, show notes, and CME: Mobeen Ahmad MD Cover art and infographic: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Mobeen Ahmad MD Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Irina Bancos MD, MSc DisclosuresDr. Bancos has the following disclosures: Consulting, advisory board or safety monitoring board (all fees to institution): Recordati, Corcept, Esteve, Spruce, Sparrow, Diurnal, Neurocrine, Lufordi, Adaptyx, Crinetics, Xeris, AstraZeneca, NovoNordisc, Camurus. Research grant for investigator initiated research (to institution): Esteve, Recordati Sponsor: Panacea FinancialVisit PanaceaFinancial.com today to claim your $100 bonus and start banking built for the way you actually live and work.Sponsor: MasterClassRight now, as a listener of this show, you get at least 15% off any annual membership at MASTERCLASS.com/CURB.Sponsor: Branch Basics Use code [CURB] for 15% off the Premium Starter Kit at BranchBasics.com.

Metabolic Health, Advanced Lipidology, and Preventing ASCVDLevel up your primary prevention game. Learn when ApoB, Lp(a), and CAC actually change management, how to spot cardiometabolic risk before diabetes declares itself, and how to make smarter lipid decisions beyond the standard panel. We’re joined by Dr. Greg Katz, cardiologist and prevention expert at NYU Langone Health.Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Primary Prevention & Metabolic Syndrome (Case 1) Beyond the Standard Lipid Panel When to Order ApoB How Lp(a) Changes Management (Case 2) Using CAC/CCTA in the Gray Zone Recognizing Early Cardiometabolic Risk CGMs, Wearables, and Signal vs Noise (Case 3) How to Talk to Patients About Risk Take-Home Points CreditsWritten and produced by Paul Wurtz MD. Show notes, cover art, and infographic also created by Paul Wurtz MD. Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai S Achi MD, MBA, FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Greg Katz MD DisclosuresDr. Katz reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: DeleteMeGet 20% off your DeleteMe plan when you go to joindeleteme.com/CURB and use promocode CURB at checkout.Sponsor: Panacea Legal Visit Panacea.Legal  and use code CURB20 for 20% off contract review services.Sponsor: FIGSWe’ve teamed up with FIGS, and now Curbsiders listeners can get 15% off. Just go to WearFIGS.com and use code FIGSRX. Sponsor: Continuing Education CompanyFor Curbsiders listeners, there’s a special offer: use promo code Curb30 for 30% off all online courses and webcasts. Visit CMEmeeting.org/curbsiders to learn more.  

Join us as we review and appraise recent practice-changing articles. In this episode, we cover the latest in GLP-1s and GIP agonists for CVD, Type 2 Diabetes, and Obesity, valacyclovir to treat Alzheimer’s, weight regain patterns after medication-induced weight loss, and a deep dive into the data behind deprescribing – and behavioral science to increase deprescribing behavior.  Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Alex Chaitoff (@alexchaitoff), Nora Taranto (@norataranto), & Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Nora Taranto MD, MSCE; Alexander Chaitoff MD, MPH; Paul Williams, MD, FACP,, & Matthew Watto MD, FACP Cover Art: Nora Taranto MD, MSCE Reviewer: Sai S Achi MD, MBA, FACP Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer GLP-1 + GIPs vs GLP-1s for patients with T2DM and Obesity – SURPASS-CVOT  Weight Regain after Weight loss  VALAD – Valacyclovir in patients with early Alzheimer’s  Nudges to increase Deprescribing  Outro Sponsor: MedStudy Qbank Study less. Remember more. Pass confidently.Medstudy.com/CurbsidersCURB15 for 15% offSponsor: FIGSWe’ve teamed up with FIGS, and now Curbsiders listeners can get 15% off at Wearfigs.com with code FIGSRX. Sponsor: QuinceRight now, go to Quince.com/curb for free shipping and 365-day returns. Sponsor: A Dangerous DiagnosisTo get 20% off use DIAGNOSIS20 at www.penguinrandomhouse.com/books/808848/a-dangerous-diagnosis-by-shantanu-rai/paperback/

We have a classic episode for you. Conquer prediabetes and diabetes prevention! We’re joined by Dr. Scott Isaacs, who provides essential pearls on navigating  screening tests for diabetes and prediabetes, identifying atypical cases of prediabetes, and individualizing management of prediabetes with lifestyle changes and medications.Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Case from Kashlak Why screen for prediabetes and diabetes? Who to screen for prediabetes and diabetes How to screen for prediabetes and diabetes Role of the physical exam Explaining a diagnosis of prediabetes to patients Atypical types of prediabetes Management of prediabetes: lifestyle changes Management of prediabetes: medications Outro Credits Producer, Writer, and Show Notes: Malini Gandhi MD Infographic and Cover Art: Zoya Surani Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai Achi MD,MBA,FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Scott Isaacs MD DisclosuresDr. Isaacs reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: BabbelGet up to 60% off at Babbel.com/CURB. Sponsor: MedStudy QbankStudy less. Remember more. Pass confidently. Medstudy.com/Curbsiders CURB15 for 15% offSponsor: University of Pennsylvania Graduate School of EducationLearn about our Medical Education master’s program, explore our certificate option, and sign up for an application fee waiver code. Take the next step in advancing medical education—visit www.gse.upenn.edu/curbsiders. Sponsor: LocumstoryWhether you’re simply curious or seriously considering a change, pop by Locumstory.com to see if it’s something that makes sense for you

Stop getting TICK’ed off by LymeMaster Lyme disease — from recognizing erythema migrans and avoiding unnecessary testing to managing disseminated Lyme and post-exposure prophylaxis. Learn practical, evidence-based strategies you can use in the clinic. We’re joined by Dr. Sophie Woolston MD, infectious diseases expert and clinician-educator. (MaineHealth)Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Case 1 Lyme Basics Stages of Lyme Lyme Testing and Interpretation Coinfection Lyme Treatment Tick Prevention and Removal Post-Treatment Lyme Disease Syndrome Outro Credits Written and Produced by: Beth Gasperlin MD Show Notes, Infographics, and Cover Art by: Zoya Surani Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Gasperlin MD   Reviewer: Leah Witt MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Sophie Woolston MD DisclosuresDr. Woolston reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: Continuing Education CompanyFor Curbsiders listeners, there’s a special offer: use promo code Curb30 for 30% off all online courses and webcasts.  Visit CMEmeeting.org/curbsiders to learn more.  Sponsor: Mint MobileShop plans at MINTMOBILE.com/CURB.Sponsor: FIGSWe’ve teamed up with FIGS, and now Curbsiders listeners can get 15% off. Just go to WearFIGS.com and use code FIGSRX.Sponsor: FreedUse code FREED50 for fifty dollars off your first month at Freed.ai

Helping you diagnose a common cause of hypertension!Hypertension is a growing disease globally, affecting millions of individuals and increasing the risk of heart disease and stroke. Along with the expert help of Dr. Vaidya (Brigham and Women’s Hospital), we help reimagine the approach of clinicians in terms of hypertension and help them navigate common diagnostic dilemmas! @AnandVaidya17 (Bluesky) @AnandVaidya17 (X)Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Introduction and Personal Interests Advice and Wisdom in Medicine  Case 1 Defining Primary Aldosteronism Screening for Primary Aldosteronism How common is Primary Aldosteronism Challenges in Diagnosis and Testing Medication Management and Testing Protocols Managing indeterminate cases Aldosterone Suppression Testing and its role Discussing treatment options with patients Case 2 Considering genetic causes of Primary Aldosteronism The need for AVS for lateralization Upcoming imaging modalities for Primary Aldosteronism Case 3 Medical Management of Primary Aldosteronism Future Directions in Treatment Credits Producer, Writer, Show Notes:Mobeen Ahmad MBBS  Infographic:Kate Grant MBChB MRCGP Cover Art:Kate Grant MBChB MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest:  Anand Vaidya MD, MMSc DisclosuresDr. Vaidya has disclosed the following: Financial Relationships: Astra Zeneca-Consulting Fee and Corcept-Consulting Fee, relationships have not ended. The Curbsiders report no relevant financial disclosures. Sponsor: The Sanford GuideCurbsiders listeners can get 20% off the already very moderately priced yearly subscriptions directly at sanfordguide.com. Go to sanfordguide.com and use the code, CURB at checkout.Sponsor: MedStudy PodcastMedStudy Qbank - Study less. Remember more. Pass confidently. Medstudy.com/Curbsiders CURB15 for 15% offSponsor: Panacea Legal Visit Panacea.Legal and use code CURB20 for 20% off contract review services.Sponsor: DeleteMeGet 20% off your DeleteMe plan when you go to joindeleteme.com/CURB and use promo code CURB at checkout.

Join us as we review and appraise recent practice-changing articles on oral semaglutide for obesity, fish oil in ESRD, IV iron during infection, the new US Dietary Guidelines, & anticoagulation after ablation in AFib. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Josh Gilman, & Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Joshua Gilman, MD, & Matthew Watto MD, FACP Cover Art: Rahul Ganatra, MD MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Oral Semaglutide for obesity Fish Oil for CV risk reduction in hemodialysis patients IV Iron for iron deficiency anemia during infection New USA Dietary Guidelines Anticoagulation after catheter ablation for AF Outro Sponsor: FIGSCheck out the limited-edition Team USA collection, and get 15 percent off your first order at Wearfigs.com with code FIGSRX. Sponsor: Continuing Education CompanyVisit CMEmeeting.org/curbsiders and use promo code Curb30 for 30% off all online courses and webcasts.  Sponsor: GustoTry Gusto today at gusto.com/CURB, and get three months free when you run your first payroll.Sponsor: MDProgress For our listeners, enjoy your first month free at mdprogress.ca/promo/curbsiders

We have another classic episode for you. Master inpatient heart failure management! Learn key tips for initiating guideline-directed medical therapy, diuretic therapy pearls, and ensuring smooth transitions of care. We are joined by Dr. Gurusher Panjrath @PanjrathG (GW School of Medicine and Health Sciences-Dr. Panjrath)Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Rapid Fire Questions/Picks of the Week Case Aliquot 1 Defining Heart Failure POCUS in Heart Failure Timing/Indications for Echocardiography Initiating Diuretic Therapy Adjusting Diuretic Therapy/Drip vs Bolus Adjunct Diuretic Therapy Afterload Reduction Monitoring Diuretic Response Inpatient Sodium and Fluid Restriction Case Aliquot 2 Classifying Heart Failure Pharmacotherapy for HFrEF Pharmacotherapy for HFpEF Ischemic Evaluation Interval Summary/Highlights Case Aliquot 3 Considerations for Initial Care of Cardiogenic Shock Choosing Inotrope/Vasopressor Right Heart Catheterization Case Aliquot 4 Discharge Medications for Heart Failure Titration of Goal Directed Medical Therapy Post Discharge Follow Up Washout Period for ACEi/ARB Cost/Barriers of ARNI Patient Education Take Home Points Outro Credits Writer, Producer, and Show Notes by: Reaford Blackburn, Jr., MD Infographic & Cover Art: Caroline Coleman MD Hosts: Monee Amin, MD and Meredith Trubitt, MD    Reviewer: Rahul Ganatra MD Technical Production: PodPaste Guest: Gurusher Panjrath, MD Sponsor: MDProgressEnjoy your first month free at mdprogress.ca/promo/curbsidersSponsor: QuinceGo to Quince.com/curb for free shipping on your order and 365-day returns. Now available in Canada, too.Sponsor: Sanford Guide Curbsiders listeners can get 20% off the already very moderately priced yearly subscriptions directly at sanfordguide.com.Sponsor: Babbel  Here's a special, (limited time) deal for our listeners. Right now get up to 55% off your Babbel subscription – at Babbel.com/CURB.

Dr. Fleseriu schools us on managing the unexpectedBecome a master of pituitary incidentalomas. Learn about the hormonal workup and management of pituitary microadenomas, macroadenomas and empty sella syndrome and when surgery may be needed. We’re joined by Dr. Maria Fleseriu, @MariaFleseriu (Oregon Health and Science University)Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Rapid fire questions/Picks of the Week Case 1 Defining Pituitary Incidentalomas What is the difference between micro adenoma, macroadenoma and functional vs non-functional adenomas Hormonal workup of microadenoma (assessing for hypopituitarism and hormonal excess) Decided when to reimage patients and long term follow up of microadenomas Case 2 Hormonal workup for pituitary macroadenoma Deciding when surgery should be considered Discussing the role of visual field testing Case 3 Defining empty sella syndrome Discussing hormonal assessment of empty sella syndrome Treatment options for hyperprolactinemia caused by empty sella syndrome Outro Credits Producer, writer, show notes, and CME: Mobeen Ahmad MD Infographic and cover art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Dr. Maria Fleseriu DisclosuresDr. Fleseriu reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: Continuing Education CompanyCurbsiders listeners, there’s a special offer: use promo code Curb30 for 30% off all online courses and webcasts. Visit CMEmeeting.org/curbsiders to learn more.Sponsor: Mint MobileNew customers can make the switch today and for a limited time, get unlimited premium wireless for just $15 per month. Switch now at mintmobile.com/CURBSponsor: LocumstoryLocumstory.com is literally just a free, unbiased resource dedicated to educating physicians about locums.Sponsor: FIGSCheck out the limited-edition Team USA collection, and get 15 percent off your first order at Wearfigs.com with code FIGSRX. 

We have a classic episode for you. Master male hypogonadism diagnosis and management. Discover when and how to test, how to tackle confounding conditions, and why lifestyle changes may be more effective than testosterone therapy in certain patients. We are joined by Dr. Brad Anawalt, an expert in endocrine care, to guide us through the essentials.Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMEShow Segments Intro Case 1 History and Physical  Laboratory Testing  Effect of Lifestyle on Testosterone Case 2 Prostate and Cardiovascular risk Treatment Options and Considerations Secondary Causes of Hypogonadism Case 3 Testicular Size and Klinefelter Syndrome hCG and Clomiphene Monitoring and Follow-Up Take-Home Points Outro Credits Written and produced by Paul Wurtz MD. Show notes, cover art, and infographic also created by Paul Wurtz MD.  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai S Achi MD, MBA, FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Bradley D. Anawalt MD Sponsor: GustoTry Gusto today at gusto.com/CURB, and get three months free when you run your first payroll.Sponsor: LocumstoryLocumstory.com is literally just a free, unbiased resource dedicated to educating physicians about locums.  Sponsor: MedStudyMedStudy Qbank+ Study less. Remember more. Pass confidently. Medstudy.com/Curbsiders CURB15 for 15% offSponsor: The Sanford GuideCurbsiders listeners can get 20% off the already very moderately priced yearly subscriptions directly at sanfordguide.com. Go to sanfordguide.com and use the code, CURB at checkout.