Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic transsphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this cas...
How do you approach the frequency of DEXA scan monitoring for older adults on bisphosphonate therapy during the course of therapy?
Depends who you read. ACP: Recommendation 4: ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence) [1] Monitoring wasn't addressed in the 2023 update. ACR: For adults continuing...
In patients with iron deficiency due to history of gastric bypass or IBD, would you consider oral iron therapy if the iron deficiency anemia is mild?
Oral iron can often be effective in iron deficiency, as long as absorption is intact. If you are concerned about absorption, performing an oral iron challenge can be useful in allowing you to avoid long trials of oral iron that will be ineffective. Simply check an iron panel at baseline, then admini...
How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?
Phentermine has been available since 1959 and remains an affordable and effective medication option added to a full lifestyle-based weight management plan. In people who are generally healthy and without contraindications to the medication, I have had patients used in at least intermittently for sev...
Is it safe to use acarbose in patients with advanced chronic kidney disease?
Yes, I think so.
Do you immediately discontinue sulfonylureas when initiating GLP-1 receptor agonists in patients with longstanding type 2 diabetes?
In a patient with an A1c <8% or with current issues with hypoglycemia while taking a sulfonylurea (SU), I would discontinue the sulfonylurea at the time I prescribe any highly effective medication for type 2 diabetes, including a GLP-1-based therapy. That would be with instructions to the patient to...
Do you discontinue statin therapy when patients reach LDL levels way below their target goal with PCSK9 inhibitor therapy?
I will not routinely adjust statin dosing in patients on PCSK9 inhibitors unless their LDL levels fall below 15-25 mg/dl. In which case, I will reduce statin dosing to allow the LDL to rise above 15-25 mg/dl.
With the advent of GLP-1 receptor agonist therapy, when (if ever) do you consider adding pioglitazone to patients' diabetes regimen?
Yes, I do still use pioglitazone, which I believe is underused. I like to consider pioglitazone in patients who have central obesity with leaner legs/arms, i.e., who have a potential mild form of lipodystrophy, and who have hypertriglyceridemia, MASLD/MASH, and insulin resistance. I find that these ...
How do you recommend mitigating the risks of using beta blocker and clonidine therapy in combination for management of hypertension?
Beta blockers vary in lipophilicity, which affects blood-brain barrier permeability. Propranolol and metoprolol readily cross the blood-brain barrier, while other beta-blockers like nebivolol do not. The CNS side effects of fatigue, depression, and insomnia are more likely to worsen if using a lipop...
Do you recommend restarting a GLP-1RA after bariatric surgery if the patient tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...