Endo in a Bite

This episode reviews risk based lipoprotein targets for atherosclerotic cardiovascular disease risk reduction. It highlights LDL-C, non-HDL-C, and apolipoprotein B as key parameters, with goals stratified by overall ASCVD risk category. It emphasizes the three tier framework of 100/130/90 for low risk, 70/100/70 for intermediate risk, and 55/85/55 for high or very high risk patients. It also covers primary versus secondary prevention targets, the role of apoB in refining atherogenic burden, especially in hypertriglyceridemia, and the importance of assigning risk first before applying lipid goals in clinical practice.

This episode reviews the clinical application of lipoprotein(a) and apolipoprotein B in cardiovascular risk assessment based on AHA ACC guidance. It emphasizes the genetic determination and stability of lipoprotein(a), supporting its role as a one time measurement for risk stratification, along with the importance of cascade screening in identifying inherited risk. The discussion outlines how lipoprotein(a) levels correlate with graded increases in cardiovascular risk and contribute to atherosclerosis, thrombosis, and calcific aortic valve disease. It also highlights apolipoprotein B as a direct measure of atherogenic particle burden, providing additional risk refinement beyond traditional cholesterol metrics, particularly in patients with metabolic disease or discordant lipid profiles. Key takeaways include appropriate use of advanced lipid markers, integration with PREVENT risk estimation, recommended monitoring strategies during lipid lowering therapy, and evidence based thresholds for treatment intensification to reduce long term cardiovascular risk..

This episode reviews standard lipid measurements for cardiovascular risk assessment based on AHA/ACC guidelines. It highlights the use of non-fasting lipid testing for most patients, key indications for fasting testing, and modern LDL cholesterol calculation methods. It also covers the role of non-HDL cholesterol and the limited utility of advanced lipoprotein testing in clinical practice.

This episode reviews the importance of dyslipidemia screening across both pediatric and adult populations based on AHA ACC guidelines. It highlights the epidemiology and clinical impact of dyslipidemia, emphasizing the role of cumulative low density lipoprotein cholesterol exposure in determining lifetime cardiovascular risk. The discussion covers universal screening strategies, limitations of family history based screening, and practical approaches to identifying high risk individuals, including those with familial hypercholesterolemia. Key takeaways include recommended screening intervals, age based strategies, appropriate use of lipid testing, and the importance of early detection and intervention to reduce long term cardiovascular morbidity and mortality.

This episode reviews the clinical significance of hypoglycemia in diabetes care, including its classification into Level 1, Level 2, and Level 3 events. The discussion highlights early recognition, variability in symptom thresholds, and the importance of prompt treatment to prevent severe outcomes. Key takeaways include the use of 15 to 20 grams of fast acting carbohydrates for conscious patients, appropriate use of glucagon in severe cases, and strategies to reduce recurrence through patient education and individualized care.

This episode reviews the evolution of vitamin D management frameworks, highlighting the shift from intake based recommendations by the National Academy of Medicine to the 2011 Endocrine Society’s laboratory driven approach, and back to a modern intake focused strategy in the 2024 guideline. The discussion emphasizes when vitamin D testing is appropriate, the role of 25 hydroxyvitamin D in assessing stores, and why routine screening is no longer recommended in healthy individuals. Key clinical takeaways include evidence based supplementation for specific populations such as older adults, pregnancy, and high risk prediabetes, along with a preference for consistent daily dosing over intermittent high dose regimens.

This episode reviews clinical management of gastrointestinal symptoms associated with semaglutide therapy and strategies to maintain treatment when intolerance occurs. The discussion explains the role of delayed gastric emptying in nausea and highlights practical approaches including dietary modification, slower dose titration, and symptom directed therapy.Additional topics include pregnancy planning with the recommended 8 week washout period before conception and emerging evidence for kidney protection from the SUSTAIN 6 and FLOW trials demonstrating reduction in nephropathy progression and cardiovascular events in patients with type 2 diabetes.

This episode reviews the cardiovascular kidney metabolic (CKM) syndrome framework introduced by the American Heart Association, which describes the interconnected progression of obesity, type 2 diabetes, chronic kidney disease, and cardiovascular disease. The discussion highlights CKM staging and emphasizes early cardiometabolic risk recognition and preventive therapy including statins, blood pressure control, glucagon like peptide 1 receptor agonists, sodium glucose cotransporter 2 inhibitors, and renin angiotensin system blockade to reduce cardiovascular and kidney complications.

This episode reviews the American Heart Association PREVENT™ cardiovascular risk calculator and its role in modern primary prevention. The discussion highlights the shift from the pooled cohorts equation to contemporary risk prediction models that incorporate kidney function, cardiometabolic risk staging, and updated population data. Emphasis is placed on risk refinement strategies including coronary artery calcium scoring and lipid biomarkers such as apolipoprotein B and lipoprotein(a). These tools help identify hidden cardiovascular risk and guide preventive lipid lowering therapy before clinical cardiovascular disease develops.

This episode reviews the 2025 ACE consensus framework for individualized obesity pharmacotherapy, moving beyond standardized algorithms toward condition based medication selection. Emphasis is placed on comorbidities, organ specific risk stratification, safety monitoring, and long term therapeutic benefit to support precision management of adiposity based chronic disease.

This episode reviews the 2025 ACE consensus approach to cost conscious obesity pharmacotherapy, emphasizing access driven treatment sequencing, payer mandated step therapy, and stage based medication selection for adiposity based chronic disease. Focus is placed on balancing clinical efficacy, affordability, and long term sustainability, with escalation and override strategies guided by therapeutic response and the presence of obesity related complications.

This episode reviews the 2025 ACE consensus on complication centric obesity management, with a focus on organ system based medication prioritization. Topics include pharmacologic selection across cardiometabolic, renal, hepatic, cardiovascular, and biomechanical complications, emphasizing outcome driven therapy rather than weight alone in adiposity based chronic disease (ABCD).

This episode reviews the 2025 ACE consensus on biologically informed lifestyle therapy for obesity and adiposity based chronic disease (ABCD), including personalized nutrition strategies to achieve and sustain an energy deficit, protein and micronutrient requirements to preserve lean mass and metabolic health, physical activity and resistance training targets for weight maintenance, the role of sleep and circadian regulation in energy balance, and the importance of addressing weight bias, stigma, and psychological comorbidities in long term obesity management.

This episode reviews the 2025 ACE consensus on therapeutic weight loss response, threshold based outcomes, early pharmacologic response assessment, and how to align intervention intensity with disease severity in adiposity based chronic disease (ABCD).

This episode reviews the clinical component of the 2025 ACE consensus, shifting from identifying excess adiposity to staging adiposity based chronic disease (ABCD). It explains how clinicians assess obesity related complications, apply disease staging independent of BMI, and account for contributing factors such as medications, endocrine causes, genetics, psychological influences, and social determinants. The episode then connects staging to individualized treatment planning and long term management within a chronic disease framework.

This episode examines the anthropometric component of the 2025 ACE consensus on obesity, emphasizing the role of BMI as a screening tool rather than a diagnostic endpoint. It outlines population specific BMI thresholds, the clinical need for assessing abdominal adiposity, and the importance of standardized waist circumference and waist to height ratio measurements in evaluating cardiometabolic risk. The discussion reinforces why body fat distribution, rather than total body weight, drives disease risk and explains when body composition testing is indicated to clarify clinical ambiguity. The episode situates these measurements within the broader ACE framework for adiposity based chronic disease (ABCD), supporting more accurate risk stratification and individualized management.

This episode introduces the 2025 ACE consensus framework for obesity, reframing the condition as adiposity based chronic disease (ABCD) rather than a numeric weight diagnosis. It reviews the shift toward person centered, complication centric care, emphasizing the role of both anthropometric and clinical assessment in diagnosis and staging. The discussion highlights obesity related complications as the primary driver of disease severity, the limitations of body mass index as an endpoint, and the importance of shared decision making and longitudinal management using lifestyle, pharmacologic, and surgical therapies to improve health outcomes and quality of life.

This episode reviews the management of dyslipidemia in special populations using an individualized, risk based framework. It emphasizes ASCVD risk assessment in older adults, patients receiving gender affirming hormone therapy, individuals living with HIV, those with chronic inflammatory or autoimmune diseases, adult survivors of childhood cancer, and solid organ transplant recipients. The discussion highlights statin selection, drug drug interactions, use of non statin therapies, and the limitations of traditional risk calculators, underscoring the importance of shared decision making and tailored lipid lowering strategies in populations with complex and often underestimated cardiovascular risk.

This episode reviews guideline directed statin therapy and LDL lowering strategies using ASCVD risk based statin benefit groups. It emphasizes selection of statin intensity, LDL C treatment targets, and appropriate escalation to non statin therapies, including ezetimibe, PCSK9 inhibitors, and bempedoic acid. The episode also addresses statin associated muscle symptoms, CK based management thresholds, and evidence based approaches to true statin intolerance with shared decision making for optimal cardiovascular risk reduction.

This episode reviews the management of hypertriglyceridemia in pregnancy using a triglyceride level guided framework. It emphasizes risk stratification for maternal ASCVD versus pancreatitis, identification of secondary and genetic dyslipidemias, and implementation of lifestyle, dietary, and pharmacologic interventions with multidisciplinary oversight throughout gestation and lactation.

This episode reviews the evaluation and management of adult hypertriglyceridemia using a triglyceride level driven framework. Emphasis is placed on risk stratification to distinguish ASCVD risk reduction from pancreatitis prevention, identification and treatment of secondary and genetic contributors, and implementation of evidence based lifestyle and dietary interventions to guide therapy.

This episode breaks down hypertriglyceridemia in adults, covering classification by level, etiology, particle type, and clinical risk orientation.

This episode reviews the evaluation of adults with severe hypertriglyceridemia, according to the 2025 AACE Algorithm.• Severe Hypertriglyceridemia: Understand impaired triglyceride clearance, chylomicron accumulation, and increased pancreatitis risk, including multifactorial causes.• Familial Chylomicronemia Syndrome: Recognize this rare, early onset disorder with persistent hypertriglyceridemia despite low fat intake.• Dysbetalipoproteinemia (APOE E2/E2): Learn about equal elevations of TG and cholesterol, tuberous xanthomas, low Apo B, and excellent response to fibrates.

This episode reviews how to evaluate and manage adults with extremely low or extremely high HDL cholesterol according to the 2025 AACE Algorithm.• Identifies secondary causes of abnormal HDL, such as renal disease, low estrogen states, hyperandrogenism, medications (fibrates, TZDs, niacin, anti epileptics), alcohol excess, estrogen therapy, or pesticide exposure.• Explains key genetic disorders linked to HDL extremes, including ABCA1 (Tangier disease), LCAT (fish eye disease), APOA1 deficiency, CETP deficiency, SCARB1 deficiency, LIPC deficiency, LIPG deficiency, and APOC3 variants.• Summarizes diagnostic clues and next steps, such as examination for corneal clouding, orange tonsils, xanthomas, neuropathy, kidney evaluation, fasting lipid profile confirmation, and targeted genetic or family screening.

This episode reviews how to evaluate and manage adults with very low LDL cholesterol (<40 mg/dL) according to the 2025 AACE Algorithm.• Identifies secondary causes such as lipid lowering therapy, malnutrition, malabsorption, and chronic diseases.• Explains key genetic disorders linked to low LDL. Including MTTP, APOB, PCSK9, ANGPTL3, and SAR1B mutations.• Summarizes diagnostic clues and next steps, such as liver ultrasound, vitamin level assessment, and genetic or family screening.

This episode explores the next step in the 2025 AACE Dyslipidemia Management Algorithm, focusing on adults with LDL cholesterol levels of 190 mg/dL or higher.• Discusses how to evaluate for Familial Hypercholesterolemia and rule out secondary causes.• Reviews diagnostic tools such as the Dutch Lipid Clinic Network, Simon Broome, and Welsh criteria.• Outlines a stepwise approach to assessment, genetic testing, and family screening for early prevention 

This episode serves as the introduction to the series on the 2025 AACE Dyslipidemia Management Algorithm, focusing on patient centered risk assessment and lifestyle based prevention strategies.• Covers ASCVD and pancreatitis risk evaluation, lifestyle modification, and shared decision making.• Introduces ASCVD risk classification, validated risk calculators, and integrated cardiometabolic management.• Highlights the importance of equity, medication access, and long term adherence.

In this episode, we review recommendations 73 to 84 from the 2025 American Thyroid Association guidelines on managing radioiodine refractory differentiated thyroid cancer and survivorship care.Key topics include:• Use of immunotherapy, redifferentiation therapy, and local or systemic treatments for advanced disease.• Pregnancy management, including timing of surgery, imaging considerations, and TSH goals.• Long term follow up focusing on side effect monitoring, financial counseling, and psychosocial support.

In this episode, we review recommendations 57 to 72 from the 2025 American Thyroid Association guidelines on the management of radioiodine avid and radioiodine refractory differentiated thyroid cancer.Key topics include:• The role of RAI therapy for iodine avid bone metastases and rising thyroglobulin levels• Criteria and management strategies for RAIR disease• Monitoring and follow up of stable or progressive RAIR metastatic DTC• Indications for molecular testing and tissue based biomarker assessment• Recommended systemic therapies including multikinase inhibitors (lenvatinib, sorafenib, cabozantinib)• Targeted therapies for NTRK, RET, ALK, and BRAFV600E mutations• Dose management, adverse event monitoring, and strategies for treatment sequencing• The importance of tumor biopsy and next-generation sequencing to guide therapy for resistant disease

In this episode, we review recommendations 51 to 56 from the 2025 American Thyroid Association guidelines on long term management of differentiated thyroid cancer. Key topics include:• The role of ongoing (dynamic) risk stratification in individualized patient management• Decision making for reoperative neck surgery and alternative local therapies such as ethanol and RFA• Indications for additional RAI therapy for cervical lymph node metastases• The role of EBRT in unresectable locoregional recurrences• Radioactive iodine dosing strategies and preparation methods, including dosimetry and TSH stimulation• Management of metastatic disease with RAI, including treatment of pulmonary micrometastases and macronodular metastases

In this episode, we review recommendations 45 to 50 from the 2025 American Thyroid Association guidelines on long term management of differentiated thyroid cancer. Key topics include:• Individualization of TSH suppression strategy• Long term considerations for TSH suppression in low and intermediate risk patients• Monitoring serum thyroglobulin and Tg antibodies as markers of disease status• Follow up protocols for low risk differentiated thyroid cancer, including when to discontinue ultrasound and biochemical monitoring• The role of radioiodine whole body scintigraphy in follow up care•Indications for advanced imaging with fluorodeoxyglucose PET/CT in high risk patients

In this episode, we break down recommendations 41 to 44 from the 2025 American Thyroid Association guidelines on differentiated thyroid cancer management. Key topics include:• Patient counseling on the small risk of second primary malignancy after RAI• Baseline labs: complete blood count and kidney function before RAI therapy• Reproductive considerations: pregnancy precautions, nursing patient guidance, and fertility counseling• Adjuvant external beam radiotherapy (EBRT) for high risk cases, balancing locoregional control with potential toxicity

In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surveillance and radioactive iodine management for adult patients with differentiated thyroid cancer. • Surveillance: Ultrasound as first line follow up; 6 to12 month intervals; FNA for nodes ≥10 mm; CT or PET for rising thyroglobulin without visible disease • Radioactive Iodine: Not routine in low risk; recommended for high risk and metastatic cases; role in oncocytic thyroid carcinoma still uncertain • Preparation for RAI Therapy: Recombinant TSH preferred; TSH goal greater than 30 mIU/L; low iodine diet before treatment • Imaging: Pre and post therapy scans are essential• Safety: Oral and written radiation precautions for patients and families • Adverse Effects: Salivary gland dysfunction, xerostomia, and lacrimal duct problems, with hydration and preventive dental care recommended • Takeaway: Ultrasound and thyroglobulin trends guide surveillance, RAI therapy should be tailored to patient risk, and careful preparation along with safety measures are critical for long term management

In this episode, we break down recommendations 21 to 30 from the 2025 American Thyroid Association guidelines on differentiated thyroid cancer management. Key topics include:• Preoperative discussion of surgical risks, including nerve and parathyroid injury• Preoperative and postoperative voice assessment and laryngeal examination• Intraoperative nerve identification and monitoring strategies• Parathyroid preservation and autotransplantation, with calcium and vitamin D supplementation• Avoidance of routine thyroidectomy drains• Pathology reporting beyond AJCC staging, including vascular invasion, nodal status, and histologic subtypes• Updated 2025 risk stratification and ATA response criteria• Postoperative thyroglobulin measurement for guiding further management

In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surgical management for adult patients with differentiated thyroid cancer.• Surgery by tumor size: lobectomy for small, low risk tumors; total thyroidectomy for larger or advanced tumors• Thyroglossal duct carcinoma: Sistrunk procedure and thyroidectomy for higher risk cases• Central and lateral neck lymph node surgery: therapeutic vs. prophylactic approaches• General surgical principles: avoid overtreatment, preserve thyroid function, and maximize oncologic control• Numbers to remember: tumor sizes, surgical approaches, and key risk based strategies

This bonus summary episode distills the Endocrine Society’s 2025 guideline updates on primary aldosteronism into high yield pearls for clinical practice and board preparation. Key topics include:• Broad screening for hypertensive patients regardless of potassium status• Diagnostic evaluation with the aldosterone to renin ratio• Selective use of suppression testing and updated terminology• Adrenal vein sampling (AVS) as the gold standard for lateralization• Surgical vs. medical management based on disease laterality• Mineralocorticoid receptor antagonist therapy, titration, and renin response• Cortisol cosecretion testing and its role in surgical planning• Individualized treatment strategies to improve cardiovascular and metabolic outcomes

In this episode, we review key updates from the 2025 ATA guidelines on surgical referral, imaging, and risk based management for adult patients with differentiated thyroid cancer.• Referral to high volume thyroid surgeons (≥25 to 50/year) for better outcomes• Comprehensive neck ultrasound; FNA for suspicious nodes ≥8 to 10 mm • Use CT or MRI if ultrasound is insufficient for invasive or bulky disease • Avoid routine preoperative thyroglobulin, antibody testing, and genomic profiling unless it informs surgical planning • Active surveillance for very low risk papillary thyroid cancers (≤1 cm, intrathyroidal) • Percutaneous ablation as an alternative for select low risk patients • Indications for surgery: tumor growth ≥3 mm, nodal metastases, extrathyroidal extension, or patient preference

This episode reviews the Endocrine Society’s 2025 guideline updates on managing primary aldosteronism after initial screening.• When suppression testing is indicated or unnecessary• Cortisol cosecretion in adrenal adenomas and surgical planning• Role of adrenal vein sampling (AVS) in determining laterality, with rare exceptions• Treatment strategies for unilateral vs bilateral disease• MRA therapy, titration approach, and importance of renin response

In this episode, we review the ATA 2025 thyroid cancer guideline updates on tumors of uncertain malignant potential and when germline genetic testing is appropriate. Topics include:• NIFTP and related tumors with strict pathologic criteria and low malignant risk• Management pearls and pitfalls of overtreatment• Indications for germline testing (PTEN, DICER1, APC, Carney complex, Werner syndrome)• Why non-syndromic familial thyroid cancer does not justify routine testing• Screening approaches for relatives and risks of overdiagnosis• Interpreting tumor sequencing results and confirming germline variants

This episode reviews medications and hormonal therapies that can falsely raise the Aldosterone-to-Renin Ratio (ARR), creating false-positive results in primary aldosteronism screening. • Covers centrally acting alpha-2 agonists, beta blockers, NSAIDs, and combined estrogen-progestin therapy. • Explains mechanisms for PAC and renin changes, highlighting discordance between PRA vs DRC assays. • Reviews practical withdrawal timelines (minimal vs full) to reduce confounding before ARR testing.

This episode reviews my key notes on medications and factors that can falsely lower the Aldosterone-to-Renin Ratio (ARR), leading to missed cases of primary aldosteronism.• Organized into strong, intermediate, and weak confounders for quick clinical reference.• Includes the most important non-medication factor to correct before testing: hypokalemia.

• Four-part series highlighting my personal notes and key clinical insights from the newly released 2025 Endocrine Society guidelines on Primary Aldosteronism• Each episode translates complex recommendations into practical, board-focused guidance you can apply immediately• Episode 1 features two ready-to-use tools:  • Clear patient instructions to follow before lab testing   • Detailed instruction sheet for lab technicians

This high-yield episode breaks down exactly why Lp(a) is gaining attention as a critical cardiovascular risk factor. It's genetically determined, stable for life, and not modified by lifestyle. Dr. Beg reviews who needs testing, when to test, and how Lp(a) contributes to atherosclerosis, inflammation, and calcific aortic valve disease.We’ll also dive into current and emerging treatment options including PCSK9 inhibitors and promising RNA-based therapies like Pelacarsen and Olpasiran and clarify when Lp(a) testing is essential for your board prep, LKA, or everyday patient care.Perfect for:• Internal medicine & endocrine board review• LKA prep• Clinicians managing lipid disorders or ASCVD riskWant detailed episode notes? Subscribe at ezendoprep.com

Ready to master MASLD and MASH for your boards and daily practice? This episode cuts straight to the chase, delivering crucial, latest pearls on this evolving liver disease. We cover everything from new terminology and risk factors (including PCOS), to statin use, screening essentials (FIB-4, FibroScan), and the latest treatments including FDA-approved Resmetirom. Get sharp on diagnosis, management, and referral. Perfect for board prep, LKA, and refining your patient care. Want episode notes? Subscribe at ezendoprep.com.

Are you staying sharp for boards or brushing up on practical diabetes care? This quick episode covers the most up to date vaccine guidelines for patients with diabetes…straight from board review content. Learn how to apply CDC recommendations on Hepatitis B, Pneumococcal, Influenza, RSV, COVID-19, and Shingles. Discover smart memory tricks and practical clinical decision points to keep you board ready and real world sharp.Want the notes from today’s episode? Subscribe to the newsletter at ezendoprep.com.