#519 Mild Autonomous Cortisol Secretion

The Curbsiders Internal Medicine Podcast

Education, Health & Fitness, Higher Education, Medicine, Science

4.8 • 3.3K Ratings

🗓️ 30 March 2026

⏱️ 74 minutes

🔗️ Recording | iTunes | RSS

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Summary

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!

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

Credits

Written 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

Disclosures

Dr. 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

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Transcript

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0:00.0	It's 2026 and we're about to have our three-year anniversary of our Patreon at patreon.com
0:05.9	slash curbsiders. So to celebrate, we're offering the first 1,000 members who sign up free
0:11.6	house officer privileges for one month. That lets you get access to 70 plus bonus episodes
0:17.6	where Paul and I recap high-yield pearls, answer listener questions, and give our picks of the week.
0:23.2	It's a lot of fun, so check us out at patreon.com slash curbsiders, or you can click the link in the episode description to sign up.
0:33.7	Paul, why did the adrenal gland break up with the pituitary?
0:38.9	Oh, my God.
0:40.8	A topical one.
0:41.8	Wait, why did the adrenalin retitory?
0:45.7	Shoot.
0:46.4	I feel like this one I could puzzle out, but I feel, I sense your impatience.
0:49.5	Tell me.
0:50.8	It felt like it was being controlled.
0:53.3	I would not have gotten there. Great stuff. The curbsiders podcast is for entertainment, education, and information purposes only, and the topics discussed should not be used solely to diagnose, treat, cure, or prevent any diseases or conditions. For the more of the views and statements expressed on this podcast are solely those of the host and should not be interpreted to reflect official policy or position of any entity, aside from possibly cash like more a hospital and affiliate outreach programs. If indeed, there are any.
1:11.5	In fact, there are none.
1:12.4	Pretty much, we aren't responsible if you screw up.
1:13.5	You should always do your own homework and let us know when we're wrong.
1:22.3	Welcome back to the curbsiders.
1:23.7	I'm Dr. Matthew Francoato here with my great friend in America's primary care physician,
1:29.2	probably the primary care physician, Dr. Paul Nelson Williams. Hey, Paul. Yeah, probably. Hey, Matt.
1:35.8	How are you? I'm doing well, Paul. This was some really new territory for me tonight. Mild
1:41.3	autonomous cortisol secretion with Dr. Arena Bancos. And you know, Paul, we've done a bunch of adrenal episodes. I feel like this fits right in there and we're just really like upping our adrenal game like every time, aren't we? We need to be doing more a dex-metazone suppression test. Like they just, I feel like everybody should be getting them at this point now. So I'm glad we could preach the gospel about that at least. Yeah. I think in primary care,
	...

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