Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How should clinicians balance the use of finerenone with other heart failure treatments like SGLT2 inhibitors, considering their glycemic benefits?
Finerenone has a different mechanism of action from SGLT2 inhibitors and may have a synergistic effect when used in combination with other GDMT medications as a replacement for eplenerone or spironolactone, with a lower risk of progressive kidney disease. Similar to other MRAs, patients should be mo...
Do you recommend the use of albumin-adjusted calcium measurement formulas to accurately assess calcium levels?
It is a reasonable approach to correct serum calcium using albumin when hypocalcemia is present, especially in a hospital setting. I believe it is less useful for evaluating hypercalcemia.Although it is reasonable to use albumin to correct serum calcium in patients with hypocalcemia it may be worthw...
During treatment of severe osteoporosis with PTH analogs (abaloparatide), would a rise in alkaline phosphatase level >200 (in the setting of normal GGT) warrant discontinuation of medication?
During treatment with PTH analogs, it is not recommended to monitor the alkaline phosphatase but only Vitamin D and calcium every three months. The alkaline phosphatase, of course, increases with PTH analog therapy, but there is no upper limit, and the concerns about osteosarcoma have been removed f...
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...