Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How will the newer JCEM guidelines on primary aldosteronism (PA) impact your management and screening of PA?
I believe you are going to see more screening for PA and more assistance needed by healthcare providers on how to interpret the results. I also believe that perhaps this may lead to more use of steroidal MRA, which is a great thing for many patients having trouble with control of low-renin HTN.
How do you approach checking an aldosterone to renin ratio in an outpatient with hypertension and hypokalemia that is difficult to correct with oral potassium replacement?
It is well known that hypokalemia can affect the aldosterone-renin ratio (ARR). Since hypokalemia directly inhibits aldosterone production, this can lead to false negative results when using ARR to screen for primary aldosteronism. If it is difficult to correct hypokalemia with oral potassium repla...
Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?
While higher-intensity statins are associated with a slightly higher incidence of diabetes, it would not be recommended to start with low-intensity statins as there are no data to support this. Essentially, all of the CV outcomes trials with statins have been with moderate and high-intensity statins...
Do you plan to initiate combination therapy with an SGLT-2 inhibitor and finerenone, instead of an SGLT-2 inhibitor alone, when treating patients with proteinuric chronic kidney disease and type 2 diabetes in light of the CONFIDENCE trial findings?
I would start one (typically the SGLT-2 inhibitor), then add finerenone potentially later. If both are started simultaneously and there is an AE, then both may have to be stopped. I prefer to see that one is tolerated, then start another.
How do you determine the appropriateness of starting a CGM in patients aged 75 and older with type 2 diabetes on multiple daily insulin injections?
In general, the profile of T2D on MDI is a compelling indication for CGM. The wrinkle here is "age 75 and older". Though our gut instinct is that if the base case is compelling, the case should be stronger for those aged 75 and older. Specifically, avoiding hypoglycemia is critical to keep elders we...
What oral contraceptives pills do you favor for treatment of PCOS?
Oral contraceptives in women with PCOS are used for multiple indications, including pregnancy prevention, endometrial protection, menstrual irregularity, and cosmetic issues (hirsutism, acne, alopecia). Combination OCPs can accomplish all these goals. One concern with combination OCPs is that the pr...
Is inositol just as effective as metformin in treating insulin resistance associated with PCOS?
Myo-inositol (MYI) and its metabolite D-chiro inositol (DCI) are over-the-countersupplements that have been suggested to improve insulin action in patients with PCOS. Outside of the PCOS world, there doesn’t seem to be much traction to using MYI over metformin for pre-diabetes and I believe it is no...
Would you start low dose methimazole therapy in patients with positive TRAb, normal FT4 and FT3 levels but ongoing TSH suppression in a completely asymptomatic young patient?
Yes, if TSH is <0.1, I would start Methimazole. The TRAb indicate higher risk of progressing to overt hyperthyroidism.As per European Thyroid guidelines, you can consider it, but it is at clinician's discretion: "Endogenous mild or subclinical hyperthyroidism (SH) is associated with increased risk o...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?
Yes, olezarsen does lower triglycerides due to other causes of hypertriglyceridemia. It is currently in trials in patients with severe hypertriglyceridemia without Familial Chylomicronemia Syndrome (FCS).