Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you tend to avoid the use of oral weight loss stimulant medications such as phentermine in obese patients on SSRI or ADHD treatments?
I generally avoid phentermine (or similar weight management stimulant medications) in patients taking other stimulants for ADHD. I have used this class of medications together with SSRI and SNRI medications with monitoring. In theory, there may be risk for interaction including possible serotonin sy...
Is tall cell variant papillary thyroid cancer automatically categorized as intermediate risk regardless of other histopathological features and should consequently be treated with RAI?
Tall cell PTC always has a BRAFV600E mutation and should automatically make the patient an ATA intermediate Initial Risk. But not all intermediate risk patients should get RAI RX. With small tumors, no ETE, no nodes AND if the 6 week postop Tg is < 1, I would do "delayed therapy" with "watchful wait...
Do you pursue additional cardiac evaluation for patients diagnosed with Sheehan Syndrome, considering their elevated risk for atherosclerotic cardiovascular diseases?
I do not think that Sheehan has a specific coronary disease increased risk compared with other causes of early-onset hypopituitarism. Likely, the high prevalence of coronary calcifications described in the cited paper was due to long-standing untreated GH deficiency (and possibly untreated or incomp...
What is the clinical significance of positive anti-thyroid antibodies in a patient that is post-thyroidectomy?
Ordinarily, the persistence of anti thyroperoxidase antibodies (antiTPO) or antithyrogloblin (antiTG) antibodies is of no concern or clinical relevance. However, in the case of patients with differentiated thyroid cancer, in whom thyroglobulin (TG) testing is a cornerstone of follow up, persistent a...
How do you handle elevated blood calcium levels from lithium?
Lithium in the past would often show up as calcium on blood tests, leading to an artificially elevated level. I don’t know if the modern tests have fixed that. Usually, I will watch it if over time the calcium is only mildly elevated, or refer for further workup (such as parathyroid issues, bone iss...
How do the results of the ESPRIT trial, which evaluated the impact of an SBP target of <120 mmHg on preventing major cardiovascular events, influence your blood pressure management goals for hypertensive patients with diabetes or a history of stroke?
The ESPRIT trial largely validates findings from SPRINT in a Chinese population. One major difference is that 38% of ESPRIT participants had diabetes mellitus (DM). A reduction in death from a CV cause drove the significance in the primary outcome (similar to SPRINT), and BP was measured 3x after a ...
Are there instances when you would recommend against pursuing adrenal vein sampling in a patient with primary hyperaldosteronism and normal adrenal imaging?
Yes, it is not uncommon for patients to choose not to pursue an adrenalectomy. I do not get the adrenal vein sampling (AVS) until I've had a discussion about the risk/benefits of adrenalectomy. Sometimes, I'll have them visit the surgeon before attempting an AVS to get a full picture of the surgery ...
Would you consider using Evenity in an elderly patient with rate controlled atrial fibrillation without history of MI or CVA?
The cardiovascular safety profile of Evenity is complex and has been reviewed in several publications. The concern is myocardial infarction and stroke. In general, if there is a history of an MI or stroke I would personally avoid Evenity. Although I do not have access to the safety dataset, I am una...
Should metformin be used in women with PCOS for weight loss?
I would not use metformin with the goal of weight loss in PCOS. Its effects on weight loss are modest (probably a few kg at most) and inconsistent. I agree with the Endocrine Society 2013 guidelines and that recommend metformin should not be used for the treatment of PCOS unless there is coexisting ...
Can FHH present with marked hypercalcemia (e.g., >12 mg/dL)?
Although unlikely, there have been several reports of FHH with parathyroid adenoma. FHH should have a setpoint. If you have previous blood calcium levels and the calcium has risen, I would search for a parathyroid adenoma.