Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is adequate BP control sufficient enough when titrating spironolactone therapy for primary hyperaldosteronism treatment?
Good blood pressure control is one of the three major goals of medical treatment of primary aldosteronism. Titrating spironolactone (or eplerenone) to an adequate blood pressure (often with reduction or cessation of other anti-hypertensives) is often the first goal met with dose adjustment. The seco...
How many days prior to elective major surgery do you recommend holding oral GLP 1 R agonist therapy?
Zero. Or, I suppose, if you're having surgery early in the morning, one.This has gone back and forth, but the most recent guidance from the ASA (with other societies concurring) has been that most patients can continue their GLP medications as normal preoperatively, with higher-risk people being rec...
After what time frame off GLP-1 RA therapy should you restart at the lowest starting dose?
When a patient has stopped an incretin agonist for more than 2 weeks, I suggest at least restarting at a reduced dose. After 3-4 weeks, I would suggest restarting at the lowest or next to lowest dose. Restarting at a higher dose with anti-nausea medication such as ondansetron may be an option for so...
Do you recommend using a 24-hour urinary cortisol/urinary creatinine ratio over a 24 hour urine cortisol to screen patients for Cushing's syndrome?
There are several tests available to look for a diagnosis of Cushing's syndrome in patients suspected to have this entity. These include AM and PM cortisol to look for altered diurnal variations. Salivary cortisol test and 24-hour Urinary cortisol. However, in my opinion, the overnight Dexamethasone...
What hormonal workup is recommended for a male with abnormally high serum testosterone not on supplements or hormone replacement therapy?
First, one has to make a distinction between a high serum total testosterone and a high serum free testosterone concentrations measured by an accurate methodology. A high total serum testosterone with a normal serum free testosterone occurs with patients with high concentrations of proteins that bin...
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
Would you recommend HRT to treat hypogonadism in a male patient in his 80s?
If the patient is symptomatic, cautious use of a small dose can be considered with close monitoring.
Do you recommend the use of diazoxide for the management of reactive hypoglycemia in patients who have not responded to acarbose or dietary modifications?
I use uncooked starch as the next step as used with glycogen storage disorders.
In patients with confirmed hypercortisolism with a high/normal unsuppressed ACTH who have both a pituitary adenoma and adrenal adenoma identified on imaging, can you reliably use DHEA-S to determine the source of cortisol production?
There is a difference between high-normal and unsuppressed ACTH. If ACTH is high-normal, this is ACTH-dependent Cushing. However, you can have mild adrenal Cushing without fully suppressed ACTH (e.g., ACTH in the 10-20 pg/ml range and sometimes even above 20). I don't think you can rely on DHEAS in ...
Do you recommend that patients with type 2 diabetes who regularly drink artificially sweetened beverages continue their current consumption, gradually reduce their intake, or switch entirely to water in light of the SODAS trial?
Interestingly, this study showed no glycemic benefit for participants who switched from artificially sweetened drinks (ASB) to water. On the contrary, there was some deterioration of the glycemic profile on switching to water, although not clinically significant. Therefore, strictly from the glycemi...