Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
For patients on T4/T3 combination therapy for management of hypothyroidism is there an indication for monitoring T3 levels and if so, what is the appropriate timing (trough versus peak) given the pharmacokinetics of liothyronine?
For patients taking a combination of T4 and T3, in my opinion, there is no need to monitor T3 levels. The aim is to keep the TSH in the desired range. One may want to keep the TSH level somewhat higher in the older patients compared to the younger patients.
How do you counsel patients on the likelihood of resolution of their hypertension post adrenalectomy for primary hyperaldosteronism?
Primary hyperaldosteronism is a curable cause of hypertension. Removal of an Aldosterone producing adenoma results in correction of biochemical abnormalities in almost all patients. Hypertension also improves but not in all patients. Studies have shown that "cure" of hypertension occurs in about 27-...
What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?
From the 2025 ADA Standards of Care, section 10 discusses Cardiovascular Disease and Risk Management. With proper blood pressure technique, the recommended blood pressure treatment goal is less than 130/80 mmHg if this can be achieved safely. Several randomized controlled trials are referenced with ...
Would you recommend 11C-methionine PET/CT imaging for patients with persistent or recurrent Cushing’s disease after transsphenoidal surgery?
Some literature does suggest that this may be helpful in this clinical scenario. In addition to the Furnica paper you cite (Furnica et al., PMID 39873396), you may look at this review from Mark Gurnell's Cambridge group, Modern imaging in Cushing's disease.However, 11C-methionine is available only i...
How has the use of CGMs informed or improved your management of patients with pre diabetes or diabetes not on insulin?
Yes. It has led to behavior modification with diet and movement choices.
Do you recommend neuromodulation treatments with an implantable device for patients with chronic painful diabetic neuropathy who have not responded to common oral therapies such as Gabapentin and Amitriptyline?
Absolutely.I am a board-certified neurologist and pain medicine physician. By the time patients are referred to neurology, they have typically failed conservative oral or topical therapies. In this context, spinal cord stimulation represents a transformative option.Conventional oral medications usua...
Is Macrilen (macimorelin Dx) still available in the US for diagnosis of adult growth hormone deficiency (AGHD)?
No, it is not. The rights for Macrilen were returned from Novonordisk to Areterna Zentaris almost 1 year ago (May 2023), and as of now, no company is selling it. Although they communicated an anticipated re-launch with an alternate commercialization partner, I am not aware that that was accomplished...
In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?
If LDL levels are already below 70, I don’t target a lower goal. The SPARCL trial showed that reducing LDL to this range has an NNT of about 45 to prevent one stroke, which I find to be modest at best. From my perspective, lowering LDL further (<30-50 range) shifts the focus to treating a number rat...
Does the degree of TSH suppression significantly impact the risk of differentiated thyroid carcinoma recurrence?
This is a very timely question. The new 2025 Guidelines for thyroid cancer was just published. They cite studies that recurrence and cancer dead for low and low/ intermediate risk thyroid cancer patients are not affected by TSH suppression. The recommended TSH is normal and less than 4 uU/ml. It is ...
Is there a role for cinacalcet in the management of PTHrP-mediated hypercalcemia?
Cinacalcet is a calcimimetic, meaning that it mimics calcium and interacts with the calcium sensor in the parathyroid glands, which is a signal to decrease the production of PTH. Cinacalcet will not decrease the production of PTHRP in cancer cells. However, cinacalcet will decrease the production of...