Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you recommend using a 24-hour urinary cortisol/urinary creatinine ratio over a 24 hour urine cortisol to screen patients for Cushing's syndrome?
There are several tests available to look for a diagnosis of Cushing's syndrome in patients suspected to have this entity. These include AM and PM cortisol to look for altered diurnal variations. Salivary cortisol test and 24-hour Urinary cortisol. However, in my opinion, the overnight Dexamethasone...
Would you recommend HRT to treat hypogonadism in a male patient in his 80s?
If the patient is symptomatic, cautious use of a small dose can be considered with close monitoring.
Do you recommend the use of diazoxide for the management of reactive hypoglycemia in patients who have not responded to acarbose or dietary modifications?
I use uncooked starch as the next step as used with glycogen storage disorders.
In patients with confirmed hypercortisolism with a high/normal unsuppressed ACTH who have both a pituitary adenoma and adrenal adenoma identified on imaging, can you reliably use DHEA-S to determine the source of cortisol production?
There is a difference between high-normal and unsuppressed ACTH. If ACTH is high-normal, this is ACTH-dependent Cushing. However, you can have mild adrenal Cushing without fully suppressed ACTH (e.g., ACTH in the 10-20 pg/ml range and sometimes even above 20). I don't think you can rely on DHEAS in ...
Do you recommend that patients with type 2 diabetes who regularly drink artificially sweetened beverages continue their current consumption, gradually reduce their intake, or switch entirely to water in light of the SODAS trial?
Interestingly, this study showed no glycemic benefit for participants who switched from artificially sweetened drinks (ASB) to water. On the contrary, there was some deterioration of the glycemic profile on switching to water, although not clinically significant. Therefore, strictly from the glycemi...
Is the Enhanced Liver Fibrosis (ELF) test superior to the FIB-4 test in the diagnosis of MASLD?
In terms of diagnostic accuracy for advanced fibrosis in MASLD, ELF is superior to FIB-4; however, here are the caveats to consider: FIB-4 is a simple and readily available test that is best used to rule out advanced fibrosis (high negative predictive value), and ELF is best used to rule in advanced...
When starting stress dose steroids for patient with primary adrenal insufficiency, how do you decide whether to start hydrocortisone 100 mg every 8 hours versus 50 mg every 6 hours?
Stress doses of steroids in patients with primary adrenal insufficiency depend on the anticipated stress. The dose of steroids can be doubled or tripled depending on the stress. For example, in cases of maximal stress such as major surgery, the dose can be similar to the dose used for an adrenal cri...
What are some of the benefits of the newly approved Lerochol drug over traditional PCSK9 inhibitors for the treatment of familial hyperlipidemia?
Lerodalcibep was approved this past December and uses a different mechanism to inhibit PCSK9. Its potential advantages include once monthly dosing and stability at room temperature for 3 months. It appears to have similar efficacy to the PCSK9 monoclonal antibody therapies lowering LDL 55-60%. Disad...
Would you consider the use of romosozumab in men who have failed therapy with teriparatide and sustained multiple vertebral fractures?
Yes, I would consider Romosozumab for the male patient. I would check his cardiovascular status due to concern of the possible increased risk for a cardiovascular event on the medication, which could be a contraindication. However, before initiating therapy, it would be helpful to know some of the s...
How do you counsel patients on timing of their medications when they are taking both oral semaglutide and levothyroxine?
I have no personal experience with the situation that you describe. However, it is well known that Levothyroxine should be taken on an empty stomach, because several foods such as high fiber meals, coffee, calcium, and iron supplements can bind to levothyroxine and significantly reduce its effective...