Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is your approach to the management of incidentally elevated HDL levels in isolation and is there any utility for further ASCVD risk stratification and/or genetic testing for lipid disorders?
Although the U-shaped curve for HDLC and ASCVD was a surprise (probably missed until huge population cohorts were studied), the data have been reasonably confirmed in many studies now, with some heterogeneity regarding gender as well as CVD vs total mortality. If I see a patient now with an HDL over...
When should you consider adding clonidine to an antihypertensive regimen for patients with advanced CKD?
Clonidine patch is useful in severely uncontrolled hypertension. In patients with CKD, not responding to conventional medications - like calcium blockers. Though the side effect profile is not great, it is less expensive and practical.
How do you approach checking an aldosterone to renin ratio in an outpatient with hypertension and hypokalemia that is difficult to correct with oral potassium replacement?
It is well known that hypokalemia can affect the aldosterone-renin ratio (ARR). Since hypokalemia directly inhibits aldosterone production, this can lead to false negative results when using ARR to screen for primary aldosteronism. If it is difficult to correct hypokalemia with oral potassium repla...
In adults ≥80 years with TSH 6–10 mIU/L and minimal symptoms, do you initiate levothyroxine, monitor, or avoid treatment entirely?
I tend to check free T4 in this situation. Aging is associated with some elevation in TSH value up to 10 mIU/L with normal free T4, and in those patients, levothyroxine is not needed. In some patients, I have seen it rise above 10 with normal free T4. Supplementing levothyroxine to lower serum TSH w...
Would you consider a history of pancreatitis an indication for parathyroidectomy in patients with mild hypercalcemia secondary to primary hyperparathyroidism?
The association of pancreatitis with primary hyperparathyroidism (PHPT) has been a classic one, although an uncommon complication of PHPT. Studies vary in reporting an incidence of pancreatitis between 4-16% in patients with PHPT (usually single institution consecutive series). I think most people f...
When treating osteoporosis, does your duration of maintenance bisphosphonate therapy post anabolic therapy with PTH analogue change based on C-telopeptide levels?
I have treated many patients with teriparatide and conducted non-clinical studies on PTH/PTHrP receptors. Despite the fact that there are no PTH/PTHrP receptors on osteoclasts, when PTH stimulates osteoblast activity, the normal coupling via osteoprotegerin is intact, and about 4 weeks after one det...
How do we decide between Gallium-DOTATATE PET/CT and MIBG scans when evaluating a patient for suspected pheochromocytoma?
Mostly availability and feasibility. Gallium-DOTATATE is very sensitive.
Do you initiate a GLP-1 receptor agonist as first-line pharmacotherapy ahead of metformin in a patient with newly diagnosed type 2 diabetes and a BMI above 35?
Yes
Would the diagnostic yield for ABIs or peripheral arterial duplex doppler in a patient with metal rods in both legs be similar or acceptable in comparison to those tests in a patient without metal rods?
Ankle-brachial index(ABI) relies on the compression of upper and lower extremity arteries with blood pressure cuffs and measuring the ratio of blood pressure between them. While I am not aware of specific studies in those with metallic rod fixation, ABI measurements should have similar utility as lo...
What are the clinical prompts that lead you to consider deprescribing bisphosphonate therapy in older adults with osteoporosis?
As a Geriatrician, the essence of my practice is to determine, on regular review (reconciliation), whether an older adult’s medication is appropriate to continue or continue at the same dosing on the basis of physiology, pathology, and/or risk modification. We know well today that medications for os...