Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you manage patients who are positive for the 21-hydroxylase antibody but have no clinical or laboratory evidence of adrenal insufficiency?
I educate the patients about the signs and symptoms of adrenal insufficiency, evaluate their HPA axis at intervals, and monitor for other autoimmune disorders.
Under what circumstances would you administer subcutaneous hydrocortisone instead of IV hydrocortisone to a patient with adrenal insufficiency?
A subcutaneous route may be used instead of intramuscular injection (preferred) at home while the patient is transferred to a medical facility for further treatment. The IV route is always used in the ER setting in a patient during an adrenal crisis.
How do you counsel younger patients regarding long-term radiologic monitoring of non-functional adrenal adenomas?
I do not think biology is so black and white. The risk of malignancy in adrenal masses according to size is a spectrum and certainly not zero just because at one point in time it is less than 5 cm (how about 4.5 cm?). Unless the radiologist can confidently diagnose a myelolipoma I think clinical jud...
Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?
If the first biopsy was AUS and the second biopsy was Bethesda II, benign, the molecular test is not warranted. It is agreed that a second biopsy of a nodule that was AUS (Bethesda III) will be benign about 40% of the time. If the first biopsy was follciular neopasm/suspicioyus for FN (Bethesda IV),...
Would you recommend the use of an ACE inhibitor to patients with Type 1 diabetes mellitus who are normotensive but have persistent moderate proteinuria?
My answer would be “yes”. ADA Standards of Care 2025 notes “ACE inhibitors and ARBs remain a mainstay of management for people with CKD with albuminuria”. Specifically, Figure 11.2 shows first-line drug therapy to be RAS inhibitor at maximum tolerated dose for treatment of albuminuria or HTN. RAS bl...
Do you recommend using intermediate-acting insulin over long-acting insulin for the management of steroid-induced hyperglycemia?
It depends on the dose of the steroids being used and whether the steroid use is for a short period or for prolonged chronic use. If the dose of the steroid is high and the use is intended for a short time, use of a short acting insulin may be preferred to combat the hyperglycemia, If the steroid us...
How do you approach therapy for severe osteoporosis after an initial 12 months of romosozumab?
After 12 months of romosozumab, most likely the patient will still need additional therapy. If you can get a bone mineral density, that can guide you into what the best next medication can be. If the patient still has significant osteoporosis or fracture during the treatment with romosozumab, I woul...
For non-functional pituitary macroadenomas, how effective has cabergoline been in reducing tumor size or preventing the need for surgery?
There is some literature suggesting that a modest effect is seen in preventing tumor regrowth in previously operated NFPA (Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists). The data on primary therapy is less convincing.Topic reviewed recently in Pharmacological Trea...
Given the new 2022 WHO classification of pituitary tumors, should we be regularly counseling our patients about the risk of malignancy for what we previously referred to as pituitary adenomas but now classified as pituitary neuroendocrine tumors (PitNETs)?
Absolutely not. Metastatic pituitary adenomas are exceedingly rare. The term PitNet is unnecessarily alarming for patients with these benign disorders and also does not provide a clinically relevant outcome classification. Accordingly, The Pituitary Society has not adopted the term PitNet and prefer...
Would you evaluate for an ectopic source in a patient with persistently elevated IGF-1 level but no clinical features of acromegaly or evidence of pituitary abnormalities?
Is this an IGF-1 drawn in the same lab? This may be falsely elevated. If so, I would repeat in a different lab or confirm/rule out acromegaly diagnosis by glucose suppression test. If the diagnosis is confirmed, measurement of GHRH to rule out a GHRH-secreting NET would be the next step.