Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Does injectable semaglutide have a higher glucose-lowering efficiency than oral semaglutide?
There is a modestly lower average exposure from 14 mg of oral semaglutide than from 1 mg of injected semaglutide. But, the important issue is that the absorption of semaglutide from the stomach is exquisitely dependent on how it is administered, and probably that is the driver of greater variability...
How would you manage new onset amenorrhea, diabetes insipidus and growth hormone deficiency without other pituitary deficiencies or excess in young females with MRI findings of pituitary mass and hypothalamic edema?
Impossible to say without seeing the images. I would however image her chest in search of sarcoidosis and obtain a skeletal survey as 2/3 of patients with LCH have bone lytic lesion. Would also consider LP to measure germ cell tumor markers and to search for possible evidence of lymphoma. DI is most...
Do you tend to avoid the use of oral weight loss stimulant medications such as phentermine in obese patients on SSRI or ADHD treatments?
I generally avoid phentermine (or similar weight management stimulant medications) in patients taking other stimulants for ADHD. I have used this class of medications together with SSRI and SNRI medications with monitoring. In theory, there may be risk for interaction including possible serotonin sy...
Is tall cell variant papillary thyroid cancer automatically categorized as intermediate risk regardless of other histopathological features and should consequently be treated with RAI?
Tall cell PTC always has a BRAFV600E mutation and should automatically make the patient an ATA intermediate Initial Risk. But not all intermediate risk patients should get RAI RX. With small tumors, no ETE, no nodes AND if the 6 week postop Tg is < 1, I would do "delayed therapy" with "watchful wait...
Do you pursue additional cardiac evaluation for patients diagnosed with Sheehan Syndrome, considering their elevated risk for atherosclerotic cardiovascular diseases?
I do not think that Sheehan has a specific coronary disease increased risk compared with other causes of early-onset hypopituitarism. Likely, the high prevalence of coronary calcifications described in the cited paper was due to long-standing untreated GH deficiency (and possibly untreated or incomp...
What is the clinical significance of positive anti-thyroid antibodies in a patient that is post-thyroidectomy?
Ordinarily, the persistence of anti thyroperoxidase antibodies (antiTPO) or antithyrogloblin (antiTG) antibodies is of no concern or clinical relevance. However, in the case of patients with differentiated thyroid cancer, in whom thyroglobulin (TG) testing is a cornerstone of follow up, persistent a...
How do you handle elevated blood calcium levels from lithium?
Lithium in the past would often show up as calcium on blood tests, leading to an artificially elevated level. I don’t know if the modern tests have fixed that. Usually, I will watch it if over time the calcium is only mildly elevated, or refer for further workup (such as parathyroid issues, bone iss...
How do the results of the ESPRIT trial, which evaluated the impact of an SBP target of <120 mmHg on preventing major cardiovascular events, influence your blood pressure management goals for hypertensive patients with diabetes or a history of stroke?
The ESPRIT trial largely validates findings from SPRINT in a Chinese population. One major difference is that 38% of ESPRIT participants had diabetes mellitus (DM). A reduction in death from a CV cause drove the significance in the primary outcome (similar to SPRINT), and BP was measured 3x after a ...
Are there instances when you would recommend against pursuing adrenal vein sampling in a patient with primary hyperaldosteronism and normal adrenal imaging?
Yes, it is not uncommon for patients to choose not to pursue an adrenalectomy. I do not get the adrenal vein sampling (AVS) until I've had a discussion about the risk/benefits of adrenalectomy. Sometimes, I'll have them visit the surgeon before attempting an AVS to get a full picture of the surgery ...
Would you consider using Evenity in an elderly patient with rate controlled atrial fibrillation without history of MI or CVA?
The cardiovascular safety profile of Evenity is complex and has been reviewed in several publications. The concern is myocardial infarction and stroke. In general, if there is a history of an MI or stroke I would personally avoid Evenity. Although I do not have access to the safety dataset, I am una...