Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you recommend the use of bempedoic acid (Nexletol) for treatment of hyperlipidemia in patients with elevated baseline uric acid levels?
I would still use bempedoic acid in patients with asymptomatic hyperuricemia if they have no previous history of gout, and will clearly benefit from lipid lowering (high risk ASCVD and statin intolerance). Would monitor uric acid levels in such individuals. However if they have had recurrent gout, I...
Do you use the homeostatic model assessment (HOMA) to assess for insulin resistance and change your clinical management of patients?
No. As insulin assays are not standardized nationally, glucose measurements are surprisingly variable across methods and institutions, single measurements of fasting glucose and insulin are somewhat quixotic, and as there is a loose relationship of HOMA measures in individuals and gold-standard meas...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
How does your hospital approach the use of insulin pumps for admitted patients?
Patients using insulin pumps are only on rapid-acting insulin, so that any interruption in the use of the pump requires them to switch to a combination of basal insulin and rapid-acting insulin. This is hard to do in a controlled outpatient setting (for example, technical failure of the pump), but v...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...
Should all thyroid cancer patients have thyroglobulin levels measured pre-operatively?
Should all patients be tested? No A] Situations where TG might play a supportive role: In a rare patient with pathological bone fracture due to bone metastasis as a presenting manifestation of thyroid cancer. This is an uncommon presentation, where in TG estimation may assist in the diagnosis. Sim...
What is the recommended workup for PTH-independent hypercalcemia secondary to an elevated 1,25-dihydroxyvitamin D level?
I presume what is meant is that the PTH is suppressed, and therefore, with an elevated 1,25-dihydroxyvitamin D concentration, it is likely the primary cause? The 2 major causes for elevated 1,25-dihydroxyvitamin D when serum 25-hydroxyvitamin D is normal or sometimes low are due to either a granulom...
Do you recommend prescribing methimazole to prevent iodinated contrast media-induced exacerbation of thyrotoxicosis in patients with pre-existing hyperthyroidism?
Yes. If someone has pre-existing UNTREATED hyperthyroidism and elderly, Methimazole should be started. The exact dose has not been proven but I use 5 mg daily for 2 months. Urinary iodine after a CT scan with contrast has been documented to be high at 2 weeks and 1 month but not 2 months post infusi...
Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?
The key word in this question is "consider". GIven the lack of published clinical trials to assess efficacy (CV and CKD hard outcomes) versus safety (DKA) in this population, an answer at this time would be a qualified yes, with the qualifications being a well-motivated patient who adheres to self-g...
Can the desmopressin stimulation test be used to assess for central adrenal insufficiency?
No. Normal corticotroph cells do not respond to desmopressin. This is the point of using the test to differentiate between Cushing's disease and pseudo-Cushing.