Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you manage orthostatic symptoms from autonomic neuropathy due to diabetes?
Try conservative measures such as hydration, pressure stockings, abdominal binder, exercises, and precautions prior to positional change. Addition of midodrine or other medications like flourinef and adjustment of doses of their antihypertensive medications. There are other medications that can be u...
When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?
My practice has been that after 2-3 years of denosumab, I wait 6 months and then start zoledronic acid.
What hormonal workup is recommended for a male with abnormally high serum testosterone not on supplements or hormone replacement therapy?
First, one has to make a distinction between a high serum total testosterone and a high serum free testosterone concentrations measured by an accurate methodology. A high total serum testosterone with a normal serum free testosterone occurs with patients with high concentrations of proteins that bin...
What therapies do you offer to patients with hypophosphatasia and low bone density who do not qualify for enzyme replacement therapy?
I have seen several patients like this. I recommend vitamin D to maintain 25-hydroxyvitamin D of 40-60 ng/mL, which usually requires 3000-5000 IUs daily. A good source of dietary calcium; my preference is 1000 mg from dairy sources, which not only provides a good source of bioavailable calcium but a...
Do you consider adding a GLP-1 receptor agonist to insulin therapy in a patient with newly diagnosed LADA who has not yet progressed to insulin dependence?
Auto-immune diabetes is known to have identifiable stages of beta-cell dysfunction and demise and being able to intervene with a treatment to preserve or improve beta-cell function is one of the major areas of diabetes research. Latent auto-immune diabetes presenting in adults (LADA) at a time when ...
How long after a DKA episode do you anticipate patients with ketosis prone diabetes mellitus to be able to discontinue insulin therapy?
If the patient is antibody negative with beta cell function, they can usually discontinue insulin 1 to 2 months after the initial diabetic ketoacidosis (DKA) event (I typically order the antibodies and C-peptide at their first follow-up visit and then will start to pull off insulin once I have the r...
For a patient with a large pheochromocytoma, how would you evaluate for possible autonomous cortisol co-secretion prior to adrenalectomy to assess need for risk of glucocorticoid withdrawal postoperatively?
From a practical standpoint, and given that this is rare, it is reasonable to check a postoperative day 1 (POD1) AM cortisol and decide then whether cortisol replacement is needed. You can also check ACTH, AM and PM cortisol to assess diurnal variation, and DHEAS pre-op to get some idea.
Does your LDL goal change in elderly patients with diabetes and hyperlipidemia who are on statin therapy?
First, what is an elderly? I will be 81 next month, and I don't consider that young, but also not too elderly to try to protect myself from an event. This patient is a high/very high risk, and if he is at a good goal on a statin, why would anyone want to change the dose? I tell my patients that surv...
What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?
The endocrine guidelines on primary aldo diagnosis (1) allow for 3 confirmatory tests: 24-hour urine, fludrocortisone suppression testing, and response to saline infusion. At UAB, we use the 24-hour urine collection. Most of our patients do not need additional salt loading during the 24-hour collect...
Do you measure plasma metanephrines in an asymptomatic, normotensive patient with an adrenal incidentaloma below 10 Hounsfield units on non-contrast CT, given that a small proportion of pheochromocytomas can appear lipid-rich on imaging?
The probability of a positive result would be very low unless the patient is hypertensive or has suggestive symptoms.