Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Under what circumstances would you consider a bone biopsy in the workup of renal osteodystrophy?
I am always in favor of doing more diagnostic tests. The problem is that it is often practically hard to get a bone biopsy. I would suggest it anytime there a question of what is happening with the bone disease.
What is the role of metformin in treating Hashimoto's disease?
It does not currently have one. While there is limited data showing Metformin decreases antibody levels and can lower TSH, there is minimal data showing if there is any clinical benefit as a result (or what the impact on T4 or T3 is). Further research would be needed before Metformin could be consi...
What patient profiles or clinical contexts would justify the initiation of elinzanetant (Lynkuet) for postmenopausal vasomotor symptoms, considering its mechanism and current evidence base?
Elinzanetant is indicated for the treatment of moderate to severe VMS due to menopause in adult women. The VMS includes hot flashes and night sweats. This drug acts as a neurokinin 1 and neurokinin 3 receptor antagonist, thus modulating thermoregulatory pathways. The indications were supported by tw...
What is the optimal vitamin D level for pregnant women for maternal and fetal health and how should this be supplemented in pregnancy?
There is significant literature to suggest that during pregnancy maintaining a circulating concentration of 25-hydroxyvitamin D of at least 40 ng/mL can markedly reduce the risk for preeclampsia, premature births, cesarean section births, and infant dental caries. Maintaining a concentration of at l...
Would you consider treating empirically for AVP deficiency in a patient who had pituitary surgery 6 months earlier and complaints of polyuria/polydipsia with dilute urine (without performing water deprivation studies)?
In the appropriate clinical setting, like this, if you have documented inappropriately diluted urine, you can treat. The chance of resolution 6 months after surgery is very low. Always instruct the patient to have a daily polyuric phase to reduce the risk of hyponatremia.
Should GLP1 R agonists be used as first line glucose lowering agents in patients with ESKD and DM2?
This is a great question, but like all clinical questions the answer will be "it depends". A provider considering adding a new drug for DM2 in a patient with CKD5/dialysis would need to know several specifics about the patient. Let's say, the patient is not on any DM2 medication. Is this an older, t...
When should metformin be stopped before surgery and when is it considered safe to resume?
Immediate release metformin can generally be continued up until the day of surgery unless there is preoperative renal compromise such that estimated GFR drops below 30 cc/min. Extended release metformin that is taken in the evening can be held on the night prior to surgery. If the patient is well wi...
Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?
There doesn't seem to be any evidence that GLP-1 RA would increase the risk of CV disease. Biologically, the benefits that have been shown in patients without Diabetes (the SELECT trial) should still be applicable for patients with Diabetes Type 1.The trials that didn't show much efficacy in glucose...
When managing patients with suspected MASLD, what specific criteria or findings would prompt you to refer them to hepatology?
In patients with suspected MASLD, I consider referral to hepatology when there is evidence of fibrosis by elastography or if I don't see improvements in related parameters with weight loss and/or medical therapies (GLP1-related meds, SGLT2i, TZDs).
How often and for how long do you monitor pituitary gland function in a patient with empty sella (radiologic finding only)?
I have never seen pituitary function showing progressive loss after an empty sella is diagnosed. Therefore, I usually assess it only once. In one study progression of hormonal deficit was seen only in 3%, and it occurred in patients who had partial ES and progressed to complete ES. Carosi et al., PM...