Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is a history of provoked DVT a contraindication to starting testosterone replacement therapy in a middle aged man with symptomatic hypogonadism who is on anti-coagulation?
The data on testosterone replacement and thromboembolic disease is not so clear but there is likely a link and should be noted in patients at high risk (e.g smoking, prior event, erythrocytosis). It’s important to discuss the risk benefits with the patient but as long as they are on anticoagulation,...
Can anabolic agents be used in a patient with history of radioactive iodine treatment for hyperthyroidism?
This is an interesting question. When PTH was approved it had a black box warning for patients who had a history of radiation to the skeleton due to risk of potential osteosarcomas. The black box has been removed for the duration of use. Since we have another anabolic agent without that black box, I...
For patients on desiccated bovine thyroid hormone therapy, how do you approach transitioning to synthetic thyroid hormone derivatives?
The US Pharmacopoeia specifies that a1 grain (65 mg) dose of desiccated thyroid have approximately 38 mcg of T4 and 9 mcg of T3 (Blumberg et al., PMID 3598896). If T3 is approximately 3-4 times as metabolically potent as T4, then 65 mg of desiccated thyroid has about 38 + (4 x 9) = approximately 75 ...
Do you recommend switching from a GLP-1 agonist to insulin in female patients with type 2 diabetes who are planning to become pregnant?
Animal studies have indicated a potential for reproductive toxicity at maternally toxic doses of Semaglutide, Dulaglutide and Exenatide.Due to the paucity of data with Semaglutide and Human pregnancy, the manufacturer advises stopping the drug 2 months before conception.However, in a multicentric st...
Is Metformin contraindicated in patients using long term oxygen therapy at home?
If a patient is stable at home without hypoxia on oxygen and eGFR is over 30 cc/min, I would be comfortable with prescribing metformin at a dose appropriate to the eGFR. Metformin should be stopped for any pulmonary decompensation or hospital admission.
Would you start octreotide in a patient with suspected sulfonyurea overdose but without frank hypoglycemia?
The data in the literature supports treating with Octreotide once hypoglycemia is present. Otherwise, a watchful, waiting period would be employed. It is reasonable to have a low threshold for its use once indicated, given how prolonged and profound the hypoglycemia can be in this situation.
How do you recommend adjusting insulin pump settings when transitioning from U-100 to U-200 Humalog insulin?
For U-200 or U-500 concentrated insulins in an insulin pump, the basal and bolus settings need to be adjusted to take the concentration of the insulin and pharmacology into account. For a switch from U-100 to U-200, the basal rate would be reduced by 50% such that 1 unit per hour of U-100 would beco...
How should diabetic retinopathy surveillance be adjusted for patients starting GLP-1 agonists?
As with traditional anti-hyperglycemic medications, GLP-1 agonists may cause transient worsening of diabetic retinopathy due to the initial rapid control of blood glucose. Therefore, if a patient has existing retinopathy and is about to start GLP-1 agonist therapy, I recommend closer monitoring. For...
Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?
The challenge with hypovolemic hyponatremia lies in the fact that, upon correcting volume depletion, the kidney's capacity to excrete dilute urine returns, potentially leading to a rapid excretion of large volumes of dilute urine. In the case of an asymptomatic patient with a sodium level of 120 mEq...
How frequently do you monitor for hypocalcemia in patients on romosozumab?
I do not know the clinical safety data well. In my own practice, I never saw anybody get hypocalcemia. I assume the potential cause of hypocalcemia is the anti-resorptive effect of the drug. Before any osteoporosis drug. I get a good chemistry panel, PTH level, vitamin D level, and when appropriate ...