Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is there a specific triglyceride level at which you discourage patients with metabolic syndrome from starting GLP-1R agonist therapy due to the risk of pancreatitis?
Overwhelming data show that acute pancreatitis is not directly due to GLP-1 use but rather the indirect effect of rapid weight loss leading to cholelithiasis and subsequent acute biliary pancreatitis in GLP-1 users. Hypertriglyceridemic pancreatitis is rare even among those with elevated TG levels (...
How often and for how long do you monitor pituitary gland function in a patient with empty sella (radiologic finding only)?
I have never seen pituitary function showing progressive loss after an empty sella is diagnosed. Therefore, I usually assess it only once. In one study progression of hormonal deficit was seen only in 3%, and it occurred in patients who had partial ES and progressed to complete ES. Carosi et al., PM...
In middle-aged adults with TSH 5–10 mIU/L and no symptoms, would you start levothyroxine or monitor, and does your threshold change with cardiovascular risk factors?
In a middle-aged patient with a TSH between 5-10 and no symptoms, I would initially monitor their thyroid levels. I would consider checking a TPO antibody titer; if positive, the rate of transition to overt hypothyroidism is greater. I would also screen for other medical issues that could be impacte...
How do you counsel patients on the risks and benefits of strontium supplements for osteoporosis management?
No experts whom I know prescribe Strontium for osteoporosis. It has not been shown to be efficacious to reduce fractures, although bone density will rise substantially. Also, bear in mind of very serious toxicities that have been associated with this drug. I would never use it in any of my patients....
Should we be measuring TBAb in all patients with hypothyroidism given recent evidence showing its ability to predict long term thyroid hormone requirements?
All patients with thyroid dysfunction should receive long-term monitoring. I don't think measuring other antibodies would change anything unless the patient requests a long-term prognosis.
Do you rely on HbA1c to monitor glycemic control in a patient with diabetes and compensated cirrhosis, given that advanced liver disease can systematically lower HbA1c independent of actual glucose control?
A1C is a great test, but it has many limitations. One major one is that it depends on red cell circulation time being normal for interpretation using common standards for average glucose values. Cirrhosis will potentially shorten red cell lifespan depending on associated complications and severity. ...
In patients with MASLD and F2–F3 fibrosis, would you initiate Resmetirom even if they are not making active lifestyle changes?
Yes, many patients had an underlying metabolic disorder that is difficult/impossible to address with lifestyle interventions alone and will go on to progress in their liver disease if left alone. Now with the approval of Semaglutide in August 2025 by the FDA and the approval of Resmetirom, we have t...
Would you recommend statin initiation in a young adult patient (age < 40) with type 1 diabetes mellitus and LDL cholesterol levels greater than 100 without any cardiovascular risk factors?
The recommendations are to start statins in young adults with type 1 DM if duration of diabetes is over 20 years.
What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?
The biggest difference between osteoporosis and CKD-MBD has to do with the underlying bone mineral laboratories. Generally, with osteoporosis, bone chemistries are relatively normal; there may be a decrease in Vit D. However, with CKD-MBD, there is usually an increase in PTH, potentially abnormaliti...
What is the preferred first-line non-insulin agent in patients with ketosis-prone diabetes during "remission" and evidence of preserved beta cell function?
Ketosis-prone diabetes (KPD) is an atypical form of diabetes that has been found in various racial and ethnic groups (Asian Indian, South American, West African, African American and others). People with KPD may present with DKA without the autoimmune findings of Type 1 diabetes. After the DKA episo...