Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
Which anti-hypertensives do you hold and for how long when screening for hyperaldosteronism in a patient with resistant hypertension and initial screening with unsuppressed renin but elevated aldosterone >20 while on anti-hypertensive therapy?
Only spironolactone for 2-3 weeks. Suppressed renin is the most sensitive test to diagnose primary hyperaldosteronism.
Do you initiate a dopamine agonist empirically in a patient with a pituitary microadenoma and a mildly elevated prolactin between 30 and 100 ng/mL, or do you pursue further workup to distinguish a true microprolactinoma from stalk effect before committing to treatment?
In a patient with a microadenoma, mild hyperprolactinemia (30-100 ng/mL) can be caused by tumorous secretion of prolactin, but stalk effect is also possible. In addition, co-secreting tumors (prolactin and either growth hormone or, rarely, ACTH) should be considered. I would first evaluate for hormo...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
What is your process of discontinuing testosterone you prescribe to a patient?
First of all, it’s really rare that I discontinue. Proper counseling is critical, as starting TRT will result in loss of the natural ability to produce testosterone—when many men hear this, they will decide either not to start or to consider SERM therapy with clomiphene/enclomiphene. And that’s also...
Do you consent patients for diabetes insipidus following SRS or fractionated radiation for pituitary tumors?
This, and more broadly hypopituitarism of any type, is an important consideration and likely under-addressed topic in consent.Untreated hypopituitarism in adult life is associated with reduced all-cause life expectancy, and by one study 2x mortality rate compared with age/sex matched controls. [1]Th...
Would you add romosozumab to denosumab for a year or switch to romosozumab for a year in a patient who fractures on long term denosumab therapy?
My preference, if insurance were not an obstacle, would be to add romosozumab (Romo) rather than switch. The data are limited, and certainly this is "off-label," but the rationale is reasonable. Denosumab (Dmab) treatment leads to increased sclerostin levels which would be targeted by the addition ...
How do you counsel patients with metabolic syndrome who decline statin therapy and have low coronary calcium scores regarding their long-term CVD risk?
This is a great question with many ramifications, and I can only give an incomplete answer that includes personal opinion. First, what is the risk? The MESA Risk Score Calculator (check it out) gives a CAC percentile score as well as a 10-year risk. The 10-year risk may be low, but a high percentile...
Do you have safety concerns when prescribing GLP-1 medications in patients on corticosteroids or immunosuppressive therapy?
I think we need to be particularly careful when co-prescribing with systemic corticosteroids because of the risk of sarcopenia. We know that rapid weight loss is accompanied not only by a loss of fat tissue but also of muscle. Corticosteroids can also have myotoxicity and cause muscle atrophy. I the...