Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?
There doesn't seem to be any evidence that GLP-1 RA would increase the risk of CV disease. Biologically, the benefits that have been shown in patients without Diabetes (the SELECT trial) should still be applicable for patients with Diabetes Type 1.The trials that didn't show much efficacy in glucose...
When managing patients with suspected MASLD, what specific criteria or findings would prompt you to refer them to hepatology?
In patients with suspected MASLD, I consider referral to hepatology when there is evidence of fibrosis by elastography or if I don't see improvements in related parameters with weight loss and/or medical therapies (GLP1-related meds, SGLT2i, TZDs).
What are the advantages of oral octreotide acetate over its long acting injectable formulation for treatment of acromegaly?
Oral octreotide has been associated with improved patient-reported QoL measures compared with those reported for injectable lanreotide and octreotide, and a lower incidence of breakthrough symptoms. However, not all patients who are controlled by injections end up maintaining control. Usually, when ...
Do you recommend using anastrazole in men developing gynecomastia while on testosterone replacement treatment for hypogonadism depending on pre-treatment estradiol level?
There is no role for aromatase inhibitors (e.g., anastrozole) for the prevention of gynecomastia. A randomized trial of anastrozole for the treatment of gynecomastia demonstrated no benefit compared to placebo.There is no reason to administer prophylactic therapy prior to the initiation of testoster...
For hypothyroid patients on dual replacement therapy (levothyroxine & liothyronine), do you recommend monitoring TSH while holding off on the morning T3 dose?
No, I do not withhold the morning dose of T3. Older studies have shown no effect of an oral dose of T3 on serum TSH levels (Saberi & Utiger, PMID 4422006).
Do you recommend initiating zoledronic acid for osteoporosis at the time of hospitalization for a fracture?
I did not institute bisphosphonate therapy during hospitalization for a fracture. It would have been helpful to have known bone remodeling markers if the patient had been followed for osteoporosis. It is reasonable to institute antiresorptive therapy in patients with high bone turnover. However, I d...
Do you recommend the use of albumin-adjusted calcium measurement formulas to accurately assess calcium levels?
It is a reasonable approach to correct serum calcium using albumin when hypocalcemia is present, especially in a hospital setting. I believe it is less useful for evaluating hypercalcemia.Although it is reasonable to use albumin to correct serum calcium in patients with hypocalcemia it may be worthw...
During treatment of severe osteoporosis with PTH analogs (abaloparatide), would a rise in alkaline phosphatase level >200 (in the setting of normal GGT) warrant discontinuation of medication?
During treatment with PTH analogs, it is not recommended to monitor the alkaline phosphatase but only Vitamin D and calcium every three months. The alkaline phosphatase, of course, increases with PTH analog therapy, but there is no upper limit, and the concerns about osteosarcoma have been removed f...
For patients on T4/T3 combination therapy for management of hypothyroidism is there an indication for monitoring T3 levels and if so, what is the appropriate timing (trough versus peak) given the pharmacokinetics of liothyronine?
For patients taking a combination of T4 and T3, in my opinion, there is no need to monitor T3 levels. The aim is to keep the TSH in the desired range. One may want to keep the TSH level somewhat higher in the older patients compared to the younger patients.
How do you counsel patients on the likelihood of resolution of their hypertension post adrenalectomy for primary hyperaldosteronism?
Primary hyperaldosteronism is a curable cause of hypertension. Removal of an Aldosterone producing adenoma results in correction of biochemical abnormalities in almost all patients. Hypertension also improves but not in all patients. Studies have shown that "cure" of hypertension occurs in about 27-...