Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?
I am not aware of a well done study in this regard, but oral contraceptives containing estrogen induce growth hormone resistance and may lower IGF-1, but the beneficial effect of estrogen on bone density would almost certainly outweigh any negative effects caused by lowering the IGF-1.
For patients on peritoneal dialysis with type 2 diabetes mellitus, do you have a preferred long- acting insulin and time of insulin administration?
Insulin management in patients on peritoneal dialysis can be tricky. In my experience, you have to be very cautious with long-acting insulin. Much of the hyperglycemia occurs during the exchanges with the dextrose solution. Therefore, using long-acting insulin can cause hypoglycemia. My suggestion i...
What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?
From the 2025 ADA Standards of Care, section 10 discusses Cardiovascular Disease and Risk Management. With proper blood pressure technique, the recommended blood pressure treatment goal is less than 130/80 mmHg if this can be achieved safely. Several randomized controlled trials are referenced with ...
Do patients with central adrenal insufficiency on maintenance hydrocortisone therapy require doubling of their corticosteroid during chemotherapy cycles?
I would follow the same sick day rules. If the patient is not feeling well with nausea, diarrhea, or worsening fatigue, the same rules of doubling the GC dose would apply. In cases of severe vomiting and not being able to keep the double dose of GC, parenteral GC injection and going to the ED for fl...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
Which anti-hypertensives do you hold and for how long when screening for hyperaldosteronism in a patient with resistant hypertension and initial screening with unsuppressed renin but elevated aldosterone >20 while on anti-hypertensive therapy?
Only spironolactone for 2-3 weeks. Suppressed renin is the most sensitive test to diagnose primary hyperaldosteronism.
Do you initiate a dopamine agonist empirically in a patient with a pituitary microadenoma and a mildly elevated prolactin between 30 and 100 ng/mL, or do you pursue further workup to distinguish a true microprolactinoma from stalk effect before committing to treatment?
In a patient with a microadenoma, mild hyperprolactinemia (30-100 ng/mL) can be caused by tumorous secretion of prolactin, but stalk effect is also possible. In addition, co-secreting tumors (prolactin and either growth hormone or, rarely, ACTH) should be considered. I would first evaluate for hormo...
What is your process of discontinuing testosterone you prescribe to a patient?
First of all, it’s really rare that I discontinue. Proper counseling is critical, as starting TRT will result in loss of the natural ability to produce testosterone—when many men hear this, they will decide either not to start or to consider SERM therapy with clomiphene/enclomiphene. And that’s also...
Would you add romosozumab to denosumab for a year or switch to romosozumab for a year in a patient who fractures on long term denosumab therapy?
My preference, if insurance were not an obstacle, would be to add romosozumab (Romo) rather than switch. The data are limited, and certainly this is "off-label," but the rationale is reasonable. Denosumab (Dmab) treatment leads to increased sclerostin levels which would be targeted by the addition ...
Do you have safety concerns when prescribing GLP-1 medications in patients on corticosteroids or immunosuppressive therapy?
I think we need to be particularly careful when co-prescribing with systemic corticosteroids because of the risk of sarcopenia. We know that rapid weight loss is accompanied not only by a loss of fat tissue but also of muscle. Corticosteroids can also have myotoxicity and cause muscle atrophy. I the...