Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you determine the appropriateness of starting a CGM in patients aged 75 and older with type 2 diabetes on multiple daily insulin injections?
In general, the profile of T2D on MDI is a compelling indication for CGM. The wrinkle here is "age 75 and older". Though our gut instinct is that if the base case is compelling, the case should be stronger for those aged 75 and older. Specifically, avoiding hypoglycemia is critical to keep elders we...
How do you approach persistent fatigue in a patient after thyroidectomy whose TSH is within the target range, given that fatigue affects the majority of thyroidectomy patients yet its underlying mechanisms remain poorly understood?
I tend to assess fatigue in the 6-12 months post-thyroidectomy, as the initial 4-8 weeks post-op visit can skew results, especially after larger surgeries or not always optimal TSH levels. If the TSH is in the normal range, I also look at other causes of fatigue, like iron deficiency, OSA, etc. If t...
In patients with a history of retinal vein occlusion, how should the risk of recurrent thromboembolic events influence the selection of osteoporosis therapies?
The FDA-approved prescribing information for raloxifene explicitly lists retinal vein thrombosis alongside deep vein thrombosis and pulmonary embolism as contraindications.
How do you distinguish between andropause versus pathological hypogonadism in older male patients?
The American Urological Association (AUA) guidelines state: "Men with sustained elevated prolactin levels, very low total testosterone (T) levels (<150 ng/dL) and unexplained failure to produce luteinizing hormone (LH)/follicle-stimulating hormone (FSH) warrant a pituitary magnetic resonance imaging...
How do you counsel patients with diabetes regarding the risks of cannabis use?
Cannabis use is becoming increasingly more common among patients with diabetes, with 10% recording use in the past month in a survey from 2022 (Han et al., PMID 39037352). Severe medical problems have been associated with cannabis use, including addiction(CUD), increased cardiovascular events, and a...
Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?
Yes, olezarsen does lower triglycerides due to other causes of hypertriglyceridemia. It is currently in trials in patients with severe hypertriglyceridemia without Familial Chylomicronemia Syndrome (FCS).
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
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...
Would you use a parathyroid hormone analog for treatment of osteoporosis in a patient with mildly elevated AlkPhos of unclear etiology?
I would be hesitant to administer an anabolic in this setting without first delineating the reason for an elevated AlkPase. I would suggest starting with sorting out the source of the AlkPase (i.e., bone, liver, or gut with measuring bone-specific AlkPase, G-GGT levels, and possibly a liver ultrasou...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...