Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How does a mildly elevated CBG (cortisol binding globulin) level affect the interpretation of the 1mg overnight dexamethasone suppression test results?
We usually do not measure CBG level during the 1-mg DST. If a woman is on oral estrogen, one may wait for the total cortisol level; if abnormal, repeat the test with free cortisol measurement or measure free cortisol proactively to avoid delays in test interpretation. A nice paper from the Mayo Clin...
Is there an available ASCVD risk calculator that does not exclude patients on statin therapy?
The traditional pooled ASCVD risk calculator cannot be used in patients on lipid-lowering therapy. The new PREVENT (Predicting Risk of CVD EVENTs) risk calculator, which was developed by the AHA in 2023, can be used in patients on lipid-lowering therapy. It gives an estimate of 10- and 30-year risk ...
Would you consider adding metformin to the regimen of a diabetic patient with a benign thyroid nodule to decrease its volume?
No. The evidence for this is of fairly low quality. I would, however, add it for their diabetes 100%.
Under what circumstances would you consider a bone biopsy in the workup of renal osteodystrophy?
I am always in favor of doing more diagnostic tests. The problem is that it is often practically hard to get a bone biopsy. I would suggest it anytime there a question of what is happening with the bone disease.
What is the role of metformin in treating Hashimoto's disease?
It does not currently have one. While there is limited data showing Metformin decreases antibody levels and can lower TSH, there is minimal data showing if there is any clinical benefit as a result (or what the impact on T4 or T3 is). Further research would be needed before Metformin could be consi...
What patient profiles or clinical contexts would justify the initiation of elinzanetant (Lynkuet) for postmenopausal vasomotor symptoms, considering its mechanism and current evidence base?
Elinzanetant is indicated for the treatment of moderate to severe VMS due to menopause in adult women. The VMS includes hot flashes and night sweats. This drug acts as a neurokinin 1 and neurokinin 3 receptor antagonist, thus modulating thermoregulatory pathways. The indications were supported by tw...
What is the optimal vitamin D level for pregnant women for maternal and fetal health and how should this be supplemented in pregnancy?
There is significant literature to suggest that during pregnancy maintaining a circulating concentration of 25-hydroxyvitamin D of at least 40 ng/mL can markedly reduce the risk for preeclampsia, premature births, cesarean section births, and infant dental caries. Maintaining a concentration of at l...
Would you consider treating empirically for AVP deficiency in a patient who had pituitary surgery 6 months earlier and complaints of polyuria/polydipsia with dilute urine (without performing water deprivation studies)?
In the appropriate clinical setting, like this, if you have documented inappropriately diluted urine, you can treat. The chance of resolution 6 months after surgery is very low. Always instruct the patient to have a daily polyuric phase to reduce the risk of hyponatremia.
Should GLP1 R agonists be used as first line glucose lowering agents in patients with ESKD and DM2?
This is a great question, but like all clinical questions the answer will be "it depends". A provider considering adding a new drug for DM2 in a patient with CKD5/dialysis would need to know several specifics about the patient. Let's say, the patient is not on any DM2 medication. Is this an older, t...
When should metformin be stopped before surgery and when is it considered safe to resume?
Immediate release metformin can generally be continued up until the day of surgery unless there is preoperative renal compromise such that estimated GFR drops below 30 cc/min. Extended release metformin that is taken in the evening can be held on the night prior to surgery. If the patient is well wi...