Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Can estrogen be given as hormone replacement therapy after surgical menopause to a patient with history of endometriosis ?
Risk of recurrence and transformation into malignancy is something that can deter the clinician from prescribing it in such patients.
How would you decide whether to change acromegaly therapy or intensify diabetes management in patients with acromegaly and prediabetes or diabetes starting an oral SSTR2-selective therapy if they experience worsening glycemic control?
Prediabetes or DM2 should be treated as usual but if it seems related to or worsens on SSTR2 treatment and pituitary tumor is stable, you can consider adding or changing to pegvisomant which helps hyperglycemia.
What is your preferred next therapeutic step in managing a patient with type 2 diabetes on a GLP-1 RA with a hemoglobin A1c of 8.9%?
The cited article was a retrospective study of add-on therapy for patients with T2DM on GLP1RA treatment and A1C not at goal. They found that insulin was the most likely second agent for patients with higher A1C (over 8.9%). They also felt that insulin titration by clinicians was not ideal and that ...
Outside of teplizumab, what therapies do you recommend for preserving beta cell function in patients with early stage type 1 diabetes mellitus?
Teplizumab is indicated to delay the progression of Stage 2 (hyperglycemia short of diabetes and 2 or more positive pancreatic islet cell antibodies) to Stage 3 diabetes--delayed the median time to onset of Stage 3 T1D by about 2 years longer than placebo in Stage 2 patients. I am not aware of stud...
Statistically speaking, approximately what percentage of thyroid nodule FNA biopsies are Bethesda category 1 (= nondiagnostic or unsatisfactory), and what percentage are indeterminate (Bethesda category 3 and 4)?
This is highly institution-specific, but on average: About 10% of biopsies will be nondiagnostic. About 15-30% of biopsies will be indeterminate (Bethesda 3 or 4).
Do you recommend increased screening for hypercortisolism in older patients given recent evidence that older patients do not commonly display hallmark symptoms of Cushing's Disease?
Well, the study you are referring reports that "younger patients were more likely to present with abdominal striae, acne, facial rounding, hirsutism, menstrual irregularities, and weight gain". Obviously, menstrual irregularities cannot be seen in postmenopausal women. As for the rest, I am not sure...
Is Evenity appropriate for a patient with severe osteoporosis (T-score -3.1) unresponsive to bisphosphonates and persistent primary hyperparathyroidism despite two surgeries?
Before, I would institute therapy, I would like to know what the situation is with the primary hyperparathyroidism. Is this primary or FHH? Although a 24-hour urine calcium creatinine ratio is no longer helpful, I find that the serum phosphate and 1,25-dihydroxyvitamin D, along with 25-hydroxyvitami...
Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?
I think a young male with multiple minimal trauma vert fractures and low BMD is appropriate to consider anabolic therapy. Of course, a thorough workup needs to be done to determine if there are any treatable causes of bone loss. If it is determined that he has “idiopathic osteoporosis” then treatmen...
Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?
I would offer a third year of a PTH analogue if the BMD response is less than a -2.5 T Score. I would follow quarterly serum calcium levels and a BMD for 1 year to assess the effects.
Would you consider transitioning patients older than 75 years of age with coronary disease from statins and/or other lipid-lowering agents to PCSK9 inhibitors given concerns for polypharmacy, provided their LDL levels remain at or below goal?
We do not have any data to suggest PCSK9i are better than statins, and all of the PCSK9i outcomes data are on top of statins. Data show generally that lower is better, and there isn’t a “floor” to benefit. That said, if I have someone on statin + ezetimibe who then gets LDL-C very low on a PCSK9i, I...