Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you start a GLP-1 receptor agonist for the treatment of type 2 diabetes in patients with remote family history of medullary thyroid cancer without genetic testing?
No, I would not start a GLP-1 RA in a patient with a family history of MTC. What do you even mean by remote?
Do you routinely check morning cortisol before discharging a patient who received more than 3 days of high-dose corticosteroids during a hospitalization for an acute illness?
No. In general, persistent HPA suppression does not occur when a single steroid treatment is shorter than 2 weeks.
Can cinacalcet be used in primary hyperparathyroidism to determine if mild/moderate hypercalcemia is responsible for non-specific complaints?
Cinacalcet is primarily used in patients with hyperparathyroidism who are less-than-optimal surgical candidates. However, it is effective in about 80% of patients with hyperparathyroidism to normalize their serum calcium and reduce their PTH levels. The main issue with using cinacalcet for the deter...
Is anabolic therapy for treatment of severe osteoporosis less effective when not taken continuously for the 12 to 24 month duration of therapy?
I have had experience with Forteo. When it was first introduced and was very expensive and not always covered by insurance, I would use it intermittently with good success. In some cases, I would use it twice a week and follow the bone remodeling markers, which were a good indicator of its effective...
How do you counsel patients on ways to boost their HDL cholesterol levels while on lipid lowering therapy?
I don't set high-density lipoprotein (HDL) cholesterol goals for my patients per se, nor do I spend a lot of time counseling them on ways to boost their HDL. Having said that, I recommend a heart-healthy dietary pattern and increased physical activity as ways to improve their overall health, which w...
Do you routinely recommend delaying dental extractions in patients who have recently received intravenous bisphosphonate therapy for osteoporosis treatment?
I don't because the risk of osteonecrosis of the jaw (ONJ) is very low.
When do you consider scheduled or more frequent POC blood glucose checks in hospitalized patients who are either not eating or otherwise at high risk for hypoglycemia?
Standard q6h (before meals + bedtime) monitoring is insufficient for patients who are NPO or at high risk for hypoglycemia. Evidence supports more frequent or scheduled monitoring in the following scenarios: 1. NPO/not eating Every 4–6 hours is recommended for NPO patients on basal insulin alone (E...
What patient factors are most important when considering who needs a broader workup for osteoporosis prior to starting therapy?
A workup to rule out secondary causes must be done prior to starting therapy for osteoporosis. A good history and exam are recommended to look for any clues for modifiable factors. At a minimum, one should do CMP, 25-OH vitamin D, TSH, and a 24-hour urinary calcium or calcium/creatinine ratio should...
Do you discontinue statin therapy when patients reach LDL levels way below their target goal with PCSK9 inhibitor therapy?
I will not routinely adjust statin dosing in patients on PCSK9 inhibitors unless their LDL levels fall below 15-25 mg/dl. In which case, I will reduce statin dosing to allow the LDL to rise above 15-25 mg/dl.
Under what clinical circumstances, if any, would you prescribe fenofibrate along with statin therapy?
Yes, I do sometimes combine fibrates and statins. Usually, it’s in the setting of needing to treat severe hypertriglyceridemia with the fibrate in a patient who also has hypercholesterolemia and an indication for a statin. If a patient is on a statin and still has mild to moderate hypertriglyceridem...