Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
When would you consider treating growth hormone deficiency in surgically treated acromegaly with longstanding low IGF-1 levels?
I would not treat unless there are clinical features of GHD.
Is there a maximum duration for raloxifene use?
There is relatively scant data on long-term raloxifene use in patients with osteoporosis, but generally, there are no recommendations for a drug holiday. The primary endpoint in the pivotal registration trial, MORE, was incidence of vertebral fracture, and the difference between the raloxifene and p...
Would you use a parathyroid hormone analog for treatment of osteoporosis in a patient with mildly elevated AlkPhos of unclear etiology?
I would be hesitant to administer an anabolic in this setting without first delineating the reason for an elevated AlkPase. I would suggest starting with sorting out the source of the AlkPase (i.e., bone, liver, or gut with measuring bone-specific AlkPase, G-GGT levels, and possibly a liver ultrasou...
Can estradiol patches be prescribed once weekly instead of twice weekly for the treatment of postmenopausal symptoms?
It depends on the formulation of the patch but it can be hard to have patches stay on for a week, leading to symptoms if they fall off.
Do you recommend routinely monitoring pancreatic markers such as amylase and lipase while receiving GLP1 R agonist or dual agonist therapies to determine their risk of pancreatitis?
Absolutely not. We know that changes in amylase and lipase levels on these drugs are very common. For example, if you look at the supplementary data across the SUSTAIN series of phase 3 trials with subcutaneous semaglutide, the average person had about a 15-30% rise in their amylase/lipase. Further,...
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...
Should long-acting subcutaneous insulin be started upfront in addition to regular insulin infusion for patients with diabetic ketoacidosis?
Current ADA guidelines suggest patients with uncomplicated mild or moderate DKA may be treated with subcutaneous rapid-acting insulin analogs every 1-2 hours as an effective alternative to IV insulin, but still only recommend IV short-acting insulin by continuous infusion for moderate-severe DKA. Ho...
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
Would you consider recommending parathyroidectomy for primary hyperparathyroidism patients with high calcium and PTH levels, even without traditional criteria, based on recent studies showing reduced anxiety and depression?
Let the patient decide.