Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When interpreting bone density reports, are T-scores adjusted for different age brackets?
T-scores are standardized to a "young normal" population, and do not change with age. Z-scores are standardized to an age and sex-matched population, and do change with age. When assessing BMD over time, one should compare the actual measurement, not the T-score or Z-score and related to the measure...
Would you consider changing a non-diabetic patient with obesity and a history of CAD who is on semaglutide to tirzepatide if they have not achieved their weight loss goals?
For now, I would NOT switch a patient with any atherosclerotic cardiovascular disease from semaglutide to tirzepatide, assuming that they had a substantial response to semaglutide and was tolerating semaglutide well. The rationale is that cardiovascular event prevention would be the primary goal of ...
Can estrogen be given as hormone replacement therapy after surgical menopause to a patient with history of endometriosis ?
Risk of recurrence and transformation into malignancy is something that can deter the clinician from prescribing it in such patients.
How would you decide whether to change acromegaly therapy or intensify diabetes management in patients with acromegaly and prediabetes or diabetes starting an oral SSTR2-selective therapy if they experience worsening glycemic control?
Prediabetes or DM2 should be treated as usual but if it seems related to or worsens on SSTR2 treatment and pituitary tumor is stable, you can consider adding or changing to pegvisomant which helps hyperglycemia.
What is your preferred next therapeutic step in managing a patient with type 2 diabetes on a GLP-1 RA with a hemoglobin A1c of 8.9%?
The cited article was a retrospective study of add-on therapy for patients with T2DM on GLP1RA treatment and A1C not at goal. They found that insulin was the most likely second agent for patients with higher A1C (over 8.9%). They also felt that insulin titration by clinicians was not ideal and that ...
Outside of teplizumab, what therapies do you recommend for preserving beta cell function in patients with early stage type 1 diabetes mellitus?
Teplizumab is indicated to delay the progression of Stage 2 (hyperglycemia short of diabetes and 2 or more positive pancreatic islet cell antibodies) to Stage 3 diabetes--delayed the median time to onset of Stage 3 T1D by about 2 years longer than placebo in Stage 2 patients. I am not aware of stud...
Statistically speaking, approximately what percentage of thyroid nodule FNA biopsies are Bethesda category 1 (= nondiagnostic or unsatisfactory), and what percentage are indeterminate (Bethesda category 3 and 4)?
This is highly institution-specific, but on average: About 10% of biopsies will be nondiagnostic. About 15-30% of biopsies will be indeterminate (Bethesda 3 or 4).
Do you recommend increased screening for hypercortisolism in older patients given recent evidence that older patients do not commonly display hallmark symptoms of Cushing's Disease?
Well, the study you are referring reports that "younger patients were more likely to present with abdominal striae, acne, facial rounding, hirsutism, menstrual irregularities, and weight gain". Obviously, menstrual irregularities cannot be seen in postmenopausal women. As for the rest, I am not sure...
Would you consider PCSK9 inhibitors for patients with elevated coronary calcium score or coronary calcification for primary prevention in lieu of statins/ezetimibe and/or bempedoic acid?
Absolutely! The VESALIUS trial confirms that lower is better even in people without a prior event. I wouldn’t use a PCSK9i in lieu of a statin, though. I would add it to the statin if someone’s LDL-C is still elevated. If someone has a high CAC score, I target an LDL-C and apoB <55 mg/dL. Ezetimibe ...
Is Evenity appropriate for a patient with severe osteoporosis (T-score -3.1) unresponsive to bisphosphonates and persistent primary hyperparathyroidism despite two surgeries?
Before, I would institute therapy, I would like to know what the situation is with the primary hyperparathyroidism. Is this primary or FHH? Although a 24-hour urine calcium creatinine ratio is no longer helpful, I find that the serum phosphate and 1,25-dihydroxyvitamin D, along with 25-hydroxyvitami...