Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you counsel cancer patients when they ask if they should avoid sugar?
“We don’t have evidence to support any specific diet that can either worsen or improve outcomes. I encourage a healthy, well-balanced diet with my top priority being you maintaining your weight during treatment.” Particularly for my head and neck patients, getting in sufficient calories is of the ut...
How would you work-up an older male patient with elevated testosterone-level-for-age?
To rule out CAH, testosterone-producing tumors, and a spurious rise due to elevated SHBG.
How often do you re-screen with autoantibody testing for type 1 diabetes if the initial test is negative in a patient with primary adrenal insufficiency?
The American Diabetes Association does not recommend periodic screening for islet cell antibodies in patients with Addison disease unless there is suspicion for autoimmune polyendocrine disorder. So the answer is not to re-screen unless there is hyperglycemia present.
What is your approach on the pursuit of bariatric surgery in a patient with advanced fibrosis?
I ensure that patients are evaluated by a multidisciplinary team with expertise in hepatology, bariatric surgery and liver transplantation. Patients with advanced hepatic fibrosis without portal hypertension may potentially undergo bariatric surgery as significant weight loss and improvement in insu...
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...