Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you recommend 11C-methionine PET/CT imaging for patients with persistent or recurrent Cushing’s disease after transsphenoidal surgery?
Some literature does suggest that this may be helpful in this clinical scenario. In addition to the Furnica paper you cite (Furnica et al., PMID 39873396), you may look at this review from Mark Gurnell's Cambridge group, Modern imaging in Cushing's disease.However, 11C-methionine is available only i...
How has the use of CGMs informed or improved your management of patients with pre diabetes or diabetes not on insulin?
Yes. It has led to behavior modification with diet and movement choices.
Do you recommend neuromodulation treatments with an implantable device for patients with chronic painful diabetic neuropathy who have not responded to common oral therapies such as Gabapentin and Amitriptyline?
Absolutely.I am a board-certified neurologist and pain medicine physician. By the time patients are referred to neurology, they have typically failed conservative oral or topical therapies. In this context, spinal cord stimulation represents a transformative option.Conventional oral medications usua...
Is Macrilen (macimorelin Dx) still available in the US for diagnosis of adult growth hormone deficiency (AGHD)?
No, it is not. The rights for Macrilen were returned from Novonordisk to Areterna Zentaris almost 1 year ago (May 2023), and as of now, no company is selling it. Although they communicated an anticipated re-launch with an alternate commercialization partner, I am not aware that that was accomplished...
What factors do you consider when deciding between RFA and surgery for a patient with a benign thyroid nodule causing dysphagia?
I primarily examine the risk of anesthesia/surgery and size of the biopsy-proven benign nodule when using ablation (thermal: RFA or microwave). We are still in a period where insurance companies just got a ICD9 for the procedure (RFA only) and it is not clear whether all insurance company will pay. ...
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
No. Stopping denosumab leads to rebound bone resorption and loss of all gains. The hypocalcemia indicates insufficient calcium and/or calcitriol. Calcium intake should be 1,000-1,200 mg daily from food and/or supplements in divided doses with food.
Do you recommend repeat TSH testing after a patient switches from brand-name to generic levothyroxine?
Yes. Because the FDA allows for variability in generics and the fact that some patients are very sensitive to small changes in their levothyroxine dose, I do repeat TSH after a patient switches levothyroxine formulations.
For patients with adrenal insufficiency who are on hydrocortisone replacement, would you recommend stress doses to cover for minor procedures such as dental work or thyroid fine-needle aspiration biopsies?
It is reasonable to tell patients to double their usual replacement dose on the day of minor procedures such as those involving local anesthesia. Here is a recent review: Vaidya et al., PMID 40522647.
Is a target TSH closer to the mid normal range justified in older individuals (age 70 or above) without any known cardiac ischemia or dysrhythmia or osteoporosis?
There are observational data showing decreased mortality rates and improved measures of well-being in elderly persons with TSH levels that are above the traditional reference range for the general population. Therefore, having a target TSH range of about 7 is more appropriate for elderly persons. Th...
Would you consider starting short-term metformin in an otherwise healthy patient who is beginning high-dose glucocorticoids to prevent glucocorticoid-induced insulin resistance?
Sustained use of glucocorticoid therapy is well recognized for causing hyperglycemia in patients without known dysglycemia. Rates of 15-25% have been reported depending on the clinical situations and the doses and duration of steroid use. A safe, effective, and cost-friendly approach to prevent this...