Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
In patients with newly diagnosed Graves' disease who are started on methimazole therapy, when do you recommend repeating thyroid ultrasounds to monitor incidental thyroid nodules that meet FNA criteria?
I have an ultrasound in my exam room. My clinical practice is to perform an ultrasound as part of the diagnostic algorithm. I generally do not check TSI since I can make the diagnosis of Graves with the US and also exclude a concomitant nodule that needs biopsy. If you need to refer to Radiology for...
Should teprotumumab be used in patients with active, moderate Graves thyroid eye disease in the absence of proptosis?
Teprotumumab is NOT a benign therapy with multiple serious side effects and complications. In the setting of acute TED with significant disease, it has a place. For the average patient, there are multiple other treatments and other Biologics with fewer complications.
How do you approach the use of GLP-1 receptor agonists for the management of patients with metabolically healthy obesity?
I want to define my understanding of the term “metabolically healthy obesity”. Generally, this is meant to describe patients with a BMI in the obese range but without hypertension, dysglycemia or dyslipidemia. Obesity is associated with a wide range of medical conditions beyond those three such as o...
Do you start a statin concurrently with icosapent ethyl for patients with moderate hypertriglyceridemia and high ASCVD risk, or do you prefer to start a statin alone and monitor triglyceride levels?
Statin therapy can lower TGs modestly (up to 20%) and are the first line therapy for ASCVD risk reduction. Therefore I usually initiate statin therapy first and reassess lipids prior to considering use of icosapent ethyl. Additionally IPE adds pill burden (need to take 4 g a day), so I prefer to wai...
How often do you monitor pituitary adenomas once established as non-functioning?
That depends on the size and location (close to the chiasma?). Without pathology, which may help determine aggressiveness (mitotic rate, Ki67), it is impossible to predict the growth rate. For macros, I repeat an MRI in 6 months, and, if no change, I double the interval. For micros, there is recent ...
Is there any benefit to trend testosterone and DHEA-S levels in patients with PCOS to determine response to therapy?
A recent guideline for the diagnosis and management of PCOS in patients states: “Repeated androgen measures for the ongoing assessment of PCOS in adults have a limited role” (International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023). That said, I thi...
Do you offer semaglutide for weight loss management in patients with CKD?
I do, but mostly a different GLP-1, trizipitide. I think the side effect profile is cleaner and better tolerated in CKD and post-transplant patients, decreasing renal complications associated with the side effects.
Do you still consider changing atypical antipsychotics that are working well in children undergoing puberty if the prolactin levels are high but there are no symptoms of drug-induced hyperprolactinemia?
I consider the risk of osteoporosis if I believe it may be used long-term, even if asymptomatic. Typically, I warn parents of the risk but continue the medication if the prolactin is only mildly elevated. I find it rare to find an adult patient who is taking the same drugs they did in adolescence. L...
How do you manage orthostatic symptoms from autonomic neuropathy due to diabetes?
Try conservative measures such as hydration, pressure stockings, abdominal binder, exercises, and precautions prior to positional change. Addition of midodrine or other medications like flourinef and adjustment of doses of their antihypertensive medications. There are other medications that can be u...