Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
For which patients with type 2 diabetes mellitus would you consider switching to once-weekly basal insulin (Awiqli)?
Once weekly basal insulin is an advance in diabetes pharmacology, but it will not be optimal for everyone. I would suggest it for people with a very stable eating and activity schedule week to week, and may have problems with adherence to or reluctance to daily basal insulin. This may work well for ...
In patients with MASLD/MASH, do you perform any cardiac testing to create a patient's risk profile, given that cardiac complications are the top cause of morbidity and mortality in this patient population (especially those with advanced fibrosis)?
This is a very important question, particularly because the new ACC guidelines suggest the use of more advanced lipid markers, like Apolipoprotein B and Lipoprotein (a), in individuals who are deemed "high risk" for cardiac disease. Unfortunately, they didn't specifically mention MASLD/MASH as a ris...
Is it a good practice to prescribe clonidine to take as needed for occasional severe blood pressure elevations?
Prescribing as needed clonidine is not part of my routine BP management. If the BP is uncontrolled consistently then long-acting medications can be uptitrated or dose adjusted. As needed clonidine may be helpful in the initial evaluation period or when making medications changes. It is important for...
How do you approach the frequency of DEXA scan monitoring for older adults on bisphosphonate therapy during the course of therapy?
Depends who you read. ACP: Recommendation 4: ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence) [1] Monitoring wasn't addressed in the 2023 update. ACR: For adults continuing...
What is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?
I have successfully treated several patients with bisphosphonate-induced subtrochanteric femoral fractures with Forteo. However, before initiating another antiresorptive therapy, I first want to be sure that the Forteo at the desired effect on bone remodeling by increasing both bone formation and bo...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
Do you recommend the use of crinecerfont in patients with congenital adrenal hyperplasia to reduce corticosteroid requirements?
Data looks good but I have not treated any patients with it.
Which anti-hypertensives do you hold and for how long when screening for hyperaldosteronism in a patient with resistant hypertension and initial screening with unsuppressed renin but elevated aldosterone >20 while on anti-hypertensive therapy?
Only spironolactone for 2-3 weeks. Suppressed renin is the most sensitive test to diagnose primary hyperaldosteronism.
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...