Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How should we approach the recommendation of intermittent fasting for weight loss in patients with pre-existing cardiovascular conditions, given the observed association of increased CV mortality with eating durations of less than 8 hrs?
I will admit my prejudice on this topic. I don’t understand the biologic plausibility of shortening the time during which meals are consumed to 8 consecutive hours a day with no snacking for 16 hours a day (but without calorie restriction) in order to lose weight. This would be like saying “have bru...
Do you have a preference between RAI therapy and antithyroid medication for patients with Graves' hyperthyroidism and moderate-to-severe Graves' orbitopathy who are on glucocorticoid treatment?
I caution using RAI in Graves' disease with moderate to severe orbitopathy if I can. Surgery, if you have access to a high-volume thyroid surgeon, may be better vs long-term antithyroidal therapy. Obviously, a lot of individual patient factors can play into this decision. I would also avoid RAI for ...
Have any studies shown that testosterone replacement therapy lowers the incidence of prostate cancer in hypogonadal men, or is the evidence still largely neutral?
This is a broad question to which I will give a broad answer.For men with hypogonadism (symptoms and signs of androgen deficiency, reproducibly low serum testosterone with an accurate, reliable assay) and no reversible cause, the epidemiological data overall do not show evidence of increased risk of...
How often and for how long do you monitor pituitary gland function in a patient with empty sella (radiologic finding only)?
I have never seen pituitary function showing progressive loss after an empty sella is diagnosed. Therefore, I usually assess it only once. In one study progression of hormonal deficit was seen only in 3%, and it occurred in patients who had partial ES and progressed to complete ES. Carosi et al., PM...
What are the advantages of oral octreotide acetate over its long acting injectable formulation for treatment of acromegaly?
Oral octreotide has been associated with improved patient-reported QoL measures compared with those reported for injectable lanreotide and octreotide, and a lower incidence of breakthrough symptoms. However, not all patients who are controlled by injections end up maintaining control. Usually, when ...
Should GLP-1 agonists be held during chemotherapy?
I think there are several aspects to this question. First, is there evidence that as a class GLP-1 RAs increase the risk of cancer or worsen prognosis during cancer? I could find nothing to raise concerns about outcomes. One recent report even showed a decreased risk of some cancers with GLP-1 RA co...
How do you assess and adjust treatment in patients who develops hypothyroidism after being on lithium for several years?
It depends on whether the patient is symptomatic. If not, careful monitoring is all that is needed. If there are significant symptoms, treatment with levothyroxine would be needed. Continued use of lithium is appropriate if it has been effective over time.
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.
How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?
SGLT2-inhibitors have been known to precipitate episodes of diabetic ketoacidosis(DKA) with glucose levels far lower than are usually seen in DKA. This has been called euglycemic DKA. SGLT-2 inhibitors cause an increase in the glucagon to insulin ratio, which promotes ketosis, as well as fluid loss ...
How often do you monitor pituitary adenomas once established as non-functioning?
That depends on the size and location (close to the chiasma?). Without pathology, which may help determine aggressiveness (mitotic rate, Ki67), it is impossible to predict the growth rate. For macros, I repeat an MRI in 6 months, and, if no change, I double the interval. For micros, there is recent ...