Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do 5HT4 agonists such as Metoclopramide actually lead to improvement in symptoms for patients with diabetes related gastroparesis?
Yes, sometimes when the gastroparesis is frequent or the symptoms are tough, I do use Reglan to help. By the time they wind up in the hospital, they are really willing to have me use anything on them that might help. I explain to every patient the side effects of Reglan, including tartive dyskinesia...
How do you counsel younger patients regarding long-term radiologic monitoring of non-functional adrenal adenomas?
I do not think biology is so black and white. The risk of malignancy in adrenal masses according to size is a spectrum and certainly not zero just because at one point in time it is less than 5 cm (how about 4.5 cm?). Unless the radiologist can confidently diagnose a myelolipoma I think clinical jud...
Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?
If the first biopsy was AUS and the second biopsy was Bethesda II, benign, the molecular test is not warranted. It is agreed that a second biopsy of a nodule that was AUS (Bethesda III) will be benign about 40% of the time. If the first biopsy was follciular neopasm/suspicioyus for FN (Bethesda IV),...
Would you recommend the use of an ACE inhibitor to patients with Type 1 diabetes mellitus who are normotensive but have persistent moderate proteinuria?
My answer would be “yes”. ADA Standards of Care 2025 notes “ACE inhibitors and ARBs remain a mainstay of management for people with CKD with albuminuria”. Specifically, Figure 11.2 shows first-line drug therapy to be RAS inhibitor at maximum tolerated dose for treatment of albuminuria or HTN. RAS bl...
How do you approach individualizing A1c goals in patients with dementia?
This is an important question for shared decision-making. And it definitely is impacted by the severity/FAST staging of the dementia, as well as the class of medication use. As we are all aware, we do not want to use the Sulfonylurea class in older adults, especially in patients with a dementia diag...
Do you recommend using intermediate-acting insulin over long-acting insulin for the management of steroid-induced hyperglycemia?
It depends on the dose of the steroids being used and whether the steroid use is for a short period or for prolonged chronic use. If the dose of the steroid is high and the use is intended for a short time, use of a short acting insulin may be preferred to combat the hyperglycemia, If the steroid us...
What is your approach to the management of incidentally elevated HDL levels in isolation and is there any utility for further ASCVD risk stratification and/or genetic testing for lipid disorders?
Although the U-shaped curve for HDLC and ASCVD was a surprise (probably missed until huge population cohorts were studied), the data have been reasonably confirmed in many studies now, with some heterogeneity regarding gender as well as CVD vs total mortality. If I see a patient now with an HDL over...
How do you approach therapy for severe osteoporosis after an initial 12 months of romosozumab?
After 12 months of romosozumab, most likely the patient will still need additional therapy. If you can get a bone mineral density, that can guide you into what the best next medication can be. If the patient still has significant osteoporosis or fracture during the treatment with romosozumab, I woul...
Should a different weight-based dosing algorithm for levothyroxine therapy be considered in women versus men given higher incidence of iatrogenic thyrotoxicosis in women?
I do not. For the majority of my patients, my starting dose is 1.6 mcg/kg, which is in the ATA guidelines (1.6-1.8 mcg/kg has been recommended as the starting dose in many publications). There have been some studies that show using ideal body weight is a better predictor of LT4 dose, and others tha...
Would you order a repeat DEXA scan 1 year later for a kidney transplant patient who had an initial DEXA scan within the first 6 months post-transplant showing osteopenia but no history of fractures, and who has been stable on glucocorticoid-free immunosuppressive therapy?
I agree with Dr. @Dr. First Last. Bone metabolism in renal transplant is woefully shy of good data. My opinion is to monitor Vitamin D levels, provide appropriate supplementation, and monitor PTH levels, using cinacalcet as needed. My target level for PTH is 1-2x the upper limit of normal, also base...