Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you use bone turnover markers to assess medical adherence in patients treated for osteoporosis?
I find the bone remodeling markers very helpful. First and foremost, I want to be sure that if I am going to put a patient on an antiresorptive medication that the patient has evidence for high bone turnover over i.e., increased osteoclastic activity. If the bone remodeling markers for both bone for...
How do you approach adjusting insulin pump settings in patients who have received intra-articular corticosteroid injections?
Managing steroid-induced hyperglycemia in patients with diabetes has always been a difficult problem, and guidelines are hard to come by. Glucocorticoids cause increased insulin resistance and an increased need for insulin. The steroid effect on glucose is greater in the post-prandial state than the...
With the advent of GLP-1 receptor agonist therapy, when (if ever) do you consider adding pioglitazone to patients' diabetes regimen?
Yes, I do still use pioglitazone, which I believe is underused. I like to consider pioglitazone in patients who have central obesity with leaner legs/arms, i.e., who have a potential mild form of lipodystrophy, and who have hypertriglyceridemia, MASLD/MASH, and insulin resistance. I find that these ...
What is the clinical significance of a low C-peptide and insulin level when glucose levels are normal?
The real readout of the adequacy of insulin secretion is always glycemia. Thus, if the glucose level is normal, whatever the insulin level is "normal," and beta-cell function is likely normal. You can double down on that if the glucose tolerance test is normal. Normal glucose with low insulin or C-p...
What are some advantages of Veligrotug over Tepezza for the treatment of thyroid eye disease?
Tepezza is FDA-approved and currently in use. Veligrotug is being reviewed by the FDA. While the early released data suggest it is safe and improves thyroid eye disease (TED), before answering this question, we need to wait until the data are fully available and published. It is currently under FDA ...
How do you manage pregnancy associated osteoporosis in post-partum patients with vertebral fractures?
I would make certain that the patient is getting adequate calcium and vitamin D and maintaining a serum 25-hydroxy vitamin D of at least 30 ng/mL. If the patient is breastfeeding, I would not give a bone active medication until breastfeeding has been halted. I would like a lot more information about...
How do you screen (imaging, modality) for bone density changes following oncologic treatment in childhood cancer survivors?
Certain survivors of childhood cancer are at risk for reduced bone mineral density, especially those exposed to extensive corticosteroids or radiation, hypogonadism, growth hormone deficiency, and those who have had reduced weight-bearing/mobility for an extended period of time. It is important to s...
What is the clinical significance of a paradoxical decrease in HDL cholesterol after starting statin therapy?
Whether HDL goes up, goes down or stay stable on statin therapy is honestly not of much concern to me. I do not think it is of any clinical significance since we know that statin therapy improves outcomes. In fact, studies show that the clinical benefit of statins is even stronger in individuals wit...
When and how should we be stopping GLP-1 Receptor Agonist/Dual Agonist therapy?
I usually continue for 3-4 years, the tapering down slowly over 1 year period, buy then the set point for energy expenditure and appetite likely is changed.
Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?
The secondary stroke prevention trial showed that high/moderate-intensity statin therapy combined with ezetimibe and titrated to achieve LDLc <70 were equally effective (compared to goal LDLc <100). Overall, the most important determinant of risk reduction is the achieved LDLc, and so moderate inten...