Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you approach therapy for severe osteoporosis after an initial 12 months of romosozumab?
After 12 months of romosozumab, most likely the patient will still need additional therapy. If you can get a bone mineral density, that can guide you into what the best next medication can be. If the patient still has significant osteoporosis or fracture during the treatment with romosozumab, I woul...
For non-functional pituitary macroadenomas, how effective has cabergoline been in reducing tumor size or preventing the need for surgery?
There is some literature suggesting that a modest effect is seen in preventing tumor regrowth in previously operated NFPA (Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists). The data on primary therapy is less convincing.Topic reviewed recently in Pharmacological Trea...
Given the new 2022 WHO classification of pituitary tumors, should we be regularly counseling our patients about the risk of malignancy for what we previously referred to as pituitary adenomas but now classified as pituitary neuroendocrine tumors (PitNETs)?
Absolutely not. Metastatic pituitary adenomas are exceedingly rare. The term PitNet is unnecessarily alarming for patients with these benign disorders and also does not provide a clinically relevant outcome classification. Accordingly, The Pituitary Society has not adopted the term PitNet and prefer...
Would you evaluate for an ectopic source in a patient with persistently elevated IGF-1 level but no clinical features of acromegaly or evidence of pituitary abnormalities?
Is this an IGF-1 drawn in the same lab? This may be falsely elevated. If so, I would repeat in a different lab or confirm/rule out acromegaly diagnosis by glucose suppression test. If the diagnosis is confirmed, measurement of GHRH to rule out a GHRH-secreting NET would be the next step.
Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?
In short, no. I think the recent studies tell me two things: We need to better discriminate correction rates based on the risk of osmotic demyelination (ODS). Perhaps, do not worry so much about over-correction. They do not tell me to start rapidly correcting patients, and I guess I will summarize m...
When do you recommend screening patients with T2DM for heart failure?
Heart failure is increasingly being recognized as a complication of diabetes. Heart failure is classified in 4 stages. Stage A is “at risk” because of diabetes, stage B is asymptomatic for the patient but with detectable cardiac abnormalities and then stage C and D are symptomatic stages of heart fa...
Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?
Interesting, I have just received a message from a patient in this very same situation. I am not aware of any specific literature on this. In absence of such data, I usually recommend remaining on the same desmopressin dose and obeying to thirst, as I worry about hyponatremia that may be caused by a...
Is azilsartan superior to other angiotension receptor blockers in regard to cardiorenal outcome data?
In short, there are no data. There are very few head-to-head comparisons of ARBs on hard outcomes. Azilsartan was used in SPRINT (alongside losartan and valsartan), though the secondary analyses focused on class effect as opposed to specific med-to-med comparisons within a class (DeCarolis et al., P...
Is the accuracy of continuous glucose monitors (DEXCOM or Libre) lower in patients undergoing dialysis?
The question of the accuracy of CGM in dialysis patients is an important one and has been debated for some time. CGM is a superior method for glucose management over fingersticks in most clinical settings. Patients with ESRD on dialysis in particular, can have very difficult-to-control diabetes. A r...
Do you routinely check vitamin K levels in post-bariatric surgery patients?
Vitamin K levels are not checked routinely in post-bariatric surgery patients. Deficiency of this vitamin is very uncommon in patients who have undergone a sleeve gastrectomy and even with Roux-en-Y gastric bypass. There is more potential for deficiency in patients who have had biliopancreatic diver...