Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What new or emerging therapies for autoimmune gastritis are available beyond iron and vitamin B12 replacement?
Though we recognize autoimmune gastritis (AIG) as an autoimmune disease that targets antigens expressed on parietal cells of the stomach, there are currently no effective treatments to reduce gastric inflammation and to prevent parietal cell loss. Back in the 1960s, small studies looked at the role ...
What factors do you consider when deciding what type of glucagon preparation to prescribe for rescue hypoglycemia in patients with diabetes on insulin therapy?
Whatever form of ready to use glucagon is covered by insurance!
How would you approach GLP-1/GIP agonist use for MASLD management in a patient who had a prior episode of pancreatitis?
If the etiology of pancreatitis has resolved (i.e., alcohol use and the patient has achieved abstinence or status post cholecystectomy for gallstone pancreatitis), then I may consider a repeat trial of GLP-1/GIP for MASH with fibrosis when there is a need to address the extrahepatic risk factors (ob...
What further endocrine work up do you recommend for chronically elevated bone specific alkaline phosphatase levels in young asymptomatic patients with normal nuclear bone scan results and no evidence of osteomalacia?
I am sure that you are aware that the differential diagnosis for an elevated alkaline phosphatase includes Paget's disease, vitamin D deficiency, hyperparathyroidism, hyperthyroidism, occult malignancy, bone metastases, and primary bone tumors. A normal bone scan helps to eliminate many of these. Bu...
What patient factors do you consider when selecting between a small interfering RNA, like inclisiran, and PCSK9 inhibitors in patients with recent acute coronary syndrome?
Insurance coverage and out-of-pocket costs usually drive my choice. It is fairly easy to get approval for evolocumab for most of my patients. I have had a hard time getting approval for inclisiran with the exception of those with traditional Medicare + supplemental medication coverage. I usually sta...
Do you still consider propranolol first-line for sinus tachycardia in thyroid storm, or have newer perspectives on beta-blocker risks altered your management?
Yes, but...Propranolol remains the first-line option for thyroid storm, but recent evidence supports that beta-1 selective agents (metoprolol, atenolol) are equally effective and may be preferred in certain clinical contexts. The choice between propranolol and cardioselective beta-blockers should be...
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
Treatment of hyponatremia due to adrenal insufficiency with glucocorticoid therapy may result in overcorrection of serum sodium due to suppression of ADH and resultant water diuresis. Therefore, serum sodium, urinary osmolality and urinary output should be closely monitored. A brisk water diuresis w...
How do you counsel patients on the risk of hypothyroidism after radioactive ablation for hot nodules?
I tell my patients that the eventual likelihood of developing hypothyroidism after radioactive iodine treatment for autonomous thyroid nodules is dependent on the administered activity, but may be as high as 60%. Demir et al., PMID 35537668 Ceccarelli et al., PMID 15730415
Do you have a preference between RAI therapy and antithyroid medication for patients with Graves' hyperthyroidism and moderate-to-severe Graves' orbitopathy who are on glucocorticoid treatment?
I caution using RAI in Graves' disease with moderate to severe orbitopathy if I can. Surgery, if you have access to a high-volume thyroid surgeon, may be better vs long-term antithyroidal therapy. Obviously, a lot of individual patient factors can play into this decision. I would also avoid RAI for ...
What are the indications, if any, for trending ACTH and cortisol levels in patients with adrenal insufficiency on steroid replacement therapy?
The only indication is if the patient has steroid-induced adrenal insufficiency and you are planning to wean the patient off steroids. In that case, I usually measure early AM cortisol and ACTH every 8 weeks. An increase in ACTH will be the first sign of HPA axis recovery. During this process, ACTH ...