Metabolic Insights for APPs

Thank you to Madrigal for sponsoring this podcast episode.This educational discussion explores why fibrosis—not steatosis—is the key prognostic driver in metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction–associated steatohepatitis (MASH). Physician assistants Kelsey Gaid, PA-C from the University of Utah Health and Andrew Garza, MPAS, PA-C review how fibrosis stage predicts liver-related outcomes, including progression to cirrhosis and hepatocellular carcinoma. The conversation highlights the importance of non-invasive assessment tools such as FibroScan, the role of patient education, and why identifying fibrosis early is critical for risk stratification and management.The discussion also covers practical treatment strategies for MASLD and MASH, including lifestyle interventions, the impact of achieving ≥10% weight loss, and the growing role of pharmacologic therapies. The speakers review how GLP-1 receptor agonists support weight loss and metabolic health, as well as the emerging role of resmetirom (Rezdiffra), a thyroid hormone receptor-β agonist, in improving liver fibrosis. This video provides clinicians and advanced practice providers with key insights into modern MASLD/MASH management, fibrosis monitoring, and combination therapy approaches.

Thank you to Madrigal for sponsoring this Medication Review Video Module.In this educational video, Andrew Garza, MPAS, PA-C, provides a comprehensive clinical overview of safety monitoring, adverse events, and drug–drug interactions associated with Resmetirom, the first FDA-approved therapy for metabolic dysfunction–associated steatohepatitis (MASH) with F2–F3 fibrosis. Drawing from both clinical experience and data from the MAESTRO-NASH trial, Andrew reviews the most common side effects observed with resmetirom, including diarrhea, nausea, pruritus, vomiting, constipation, abdominal pain, and dizziness. He explains that gastrointestinal symptoms—particularly diarrhea and nausea—are the most frequent causes of discontinuation, though they are typically mild, self-limited, and most common within the first 12 weeks of therapy. The discussion also covers transient liver enzyme elevations, rare hepatotoxicity considerations, and recommended liver function monitoring intervals at 3, 6, and 12 months. In addition, this video outlines clinically important drug interactions, including CYP2C8 and OATP1B1/1B3 inhibitors (such as gemfibrozil, cyclosporine, and clopidogrel), weight-based dosing adjustments, and maximum statin dose recommendations when co-administered with resmetirom. This practical, evidence-based review is essential for endocrinology, hepatology, and primary care providers managing patients with MASH and advanced fibrosis who are initiating resmetirom therapy.

Thank you to Corcept for sponsoring this FAQ Video Module. In this educational endocrinology update, Amy Burmesh, PA-C, from the Medical College of Wisconsin shares a practical, step-by-step approach to screening for hypercortisolism and Cushing syndrome in clinical practice. She reviews the three primary screening tests for cortisol excess: the 24-hour urine free cortisol, late-night salivary cortisol (two samples), and the 1 mg overnight dexamethasone suppression test. The discussion highlights the strengths and limitations of each test, including sensitivity and specificity, patient compliance challenges, and when each option is most appropriate. Learn why the dexamethasone suppression test offers the highest diagnostic accuracy, when late-night salivary cortisol may be unreliable (such as in shift workers), and why oral estrogen therapy can interfere with interpretation of serum cortisol results. This episode also explains the role of ACTH and DHEAS levels in differentiating ACTH-dependent vs ACTH-independent hypercortisolism and identifying adrenal sources of cortisol excess. Designed for advanced practice providers, endocrinology clinicians, and primary care professionals, this practical overview provides clear guidance on evaluating suspected Cushing syndrome and selecting the right screening strategy for your patients.

Thank you to Madrigal for sponsoring this Medication Review Video Module.In this video, Jessica Bartholomew, MSN, APRN, FNP-C, reviews the mechanism of action of resmetirom, the first FDA-approved liver-directed therapy for non-cirrhotic metabolic dysfunction–associated steatohepatitis (MASH) in patients with stage F2–F3 fibrosis. The discussion explains how selective activation of thyroid hormone receptor beta in the liver targets impaired hepatic lipid metabolism seen in MASH, helping reduce liver fat, inflammation, and fibrosis progression while minimizing systemic thyroid effects. Clinical outcomes from the MAESTRO-NASH trial and the significance of FDA accelerated approval are also reviewed, highlighting a new disease-directed approach to MASH management.

Thank you to Madrigal for sponsoring this FAQ Video Module.In this episode, Tammy Harper, NP-C, a transplant hepatology nurse practitioner at Keck Medicine of USC, shares real-world insights on managing statin therapy in patients with MASH and MASLD. Drawing from extensive experience in internal medicine and liver transplantation, she discusses when statins can be safely continued in cirrhosis, when dose adjustments may be appropriate, and how to monitor patients with compromised liver and kidney function. The discussion highlights collaboration with cardiology, practical lab monitoring strategies, and considerations before and after liver transplant, offering valuable guidance for clinicians managing cardiovascular risk in patients with advanced liver disease.

Thank you to Madrigal for sponsoring this FAQ Video Module.In this FAQ video, Kelsey Gaid, PA-C, from the University of Utah Health reviews the role of combining GLP-1 receptor agonists with resmetirom for the treatment of MASH with stage 2–3 fibrosis. This video explains why lifestyle changes and GLP-1 therapy alone may be insufficient for fibrosis regression, highlights data from the MAESTRO-NASH trial, and explores how resmetirom targets intrahepatic thyroid beta signaling to reduce liver fat and improve fibrosis independent of weight loss. A practical discussion for clinicians managing MASLD/MASH in patients with diabetes or prediabetes.

Thank you to Corcept Therapeutics for sponsoring this podcast episode.In this episode, Natalie Bellini, CNP, and Davida Kruger, MSN, APN-BC, BC-ADM, explore why elevated cortisol is an underrecognized driver of difficult-to-control type 2 diabetes and hypertension. This episode breaks down how hypercortisolism differs from classic Cushing syndrome, reviews data showing a high prevalence in patients not meeting glycemic or blood pressure targets, and explains why excess cortisol increases cardiovascular risk and mortality. The discussion also walks through simple screening with the overnight dexamethasone suppression test and highlights when referral to endocrinology is warranted.A must-watch for clinicians managing complex diabetes, hypertension, and cardiometabolic risk.

Thank you to Corcept Therapeutics for sponsoring this FAQ Video Module.In this FAQ video, Benny Lopez, BC-ADM, DMSc, PA-C, discusses what to do when patients with type 2 diabetes remain uncontrolled despite following ADA guidelines. He explains why clinicians should look beyond glycemic control and consider underlying causes such as hypercortisolism. The video reviews when to screen uncontrolled patients, the rationale for using the 1 mg dexamethasone suppression test (DST), and how this simple evaluation can help identify patients who may benefit from further workup rather than continued medication intensification.

Thank you to Corcept Therapeutics for sponsoring this FAQ Video Module.In this FAQ video, Amy Burmesch, PA-C, discusses which patients with type 2 diabetes should be screened for hypercortisolism. She outlines key high-risk subgroups, including younger patients without a family history of diabetes, individuals with difficult-to-control diabetes despite multiple therapies, and patients with low bone density or unusual fragility fractures. This practical overview helps clinicians narrow screening decisions and identify underlying cortisol excess that may be driving insulin resistance and poor glycemic control.

Thank you to Corcept Therapeutics for sponsoring this FAQ Video Module.In this FAQ video, endocrinology David Doriguzzi, PA-C, breaks down how to screen for hypercortisolism using the 1 mg dexamethasone suppression test (DST). He explains the physiology behind cortisol suppression, how to correctly interpret post-dexamethasone cortisol levels, and why results that appear “low” on lab reports may actually be abnormal. The discussion also reviews the value of measuring dexamethasone levels, ACTH, and DHEAS to help differentiate adrenal versus pituitary causes of cortisol excess. Designed for APPs and clinicians managing patients with difficult-to-treat type 2 diabetes and suspected hypercortisolism.

Thank you to Corcept Therapeutics for sponsoring this FAQ Video Module.This FAQ video features endocrinology David Doriguzzi, PA-C, discussing emerging data showing that cortisol excess frequently goes unrecognized in patients with insulin resistance, refractory hypertension, and unexplained weight gain. Drawing on recent clinical trial evidence, he explains why nearly one in four patients with treatment-resistant diabetes may have underlying hypercortisolism and how expanding our understanding beyond classic Cushing syndrome features can support earlier recognition and more effective treatment. Designed for APPs and clinicians managing complex metabolic disease.