Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How long does it take the hypothalamic-pituitary-gonadal axis to recover from secondary amenorrhea in the setting early onset and chronic use of oral combined contraceptive pills?
About 6 months after cessation of OCs.
Do you recommend the use of automated insulin delivery systems (such as Control IQ with Tandem insulin pumps) for managing gestational diabetes?
Currently, none of the current FDA-approved AID systems have algorithms set to achieve pregnancy-specific glucose goals. So using the manual mode with overnight target 90 along with appropriate bolus settings to keep PPG at goal is the most efficient.
Should thyroxine hormone be started in women having fertility concerns with high-normal TSH and negative TPO antibody?
This landmark NEJM trial showed no benefit in women with TPO antibodies and a TSH > 2.5 of starting levothyroxine. However, most IVF centers start low-dose levothyroxine since subclinical hypothyroidism is associated with an increased risk of miscarriages especially if TSH > 5 or TSH > 2.5 with posi...
Do progesterone only oral contraceptive pills affect cortisol binding globulin?
I do not recall any recent publications, but I am sure old studies have examined this question. Based on my clinical experience, there is no significant effect on total cortisol levels.
What 60 minute cortisol threshold value do you use for diagnosis of adrenal insufficiency after ACTH stimulation?
It depends on the assay. Different assays measure different things. Mass spectrometry is the most accurate available assay at present, and it measures ONLY cortisol. Immunoassays also detect other related compounds, and vary from assay to assay as to which ones. Discussed in PMID 25877990.
Should GLP-1 agonists be weaned in patients who have achieved goal weight loss and glycemic control?
This is a good question that comes up often. The short answer is no -- GLP-1 receptor agonists should not be weaned after achieving goals. There are several trials where GLP-1RA has been discontinued after 6 or more months of therapy and weight regain is substantial on average and the loss of glycem...
What is the goal of estradiol levels on ovarian suppression and AI for breast cancer?
This is a sneaky difficult question. We've known since George Beatson that estrogen was important for breast cancer, and the Early Breast Cancer Trialists Collaborative Group helped get Tamoxifen approved in 1978. I've heard it said that we've had more trials looking at estrogen therapy for breast c...
Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?
As reviewed recently by Dr. Teblick et al., PMID 35358303, this is still a controversial and complex issue. Based on many studies, it would be preferable to avoid ACTH stimulation unless there is rapid availability of free cortisol. Random total cortisol is probably the better alternative.
Which patients would benefit most from teplizumab therapy to delay the onset of T1DM?
First, for full disclosure, I am an adult endocrinologist and I have not prescribed teplizumab so what I will say is what I have distilled from reading the literature and discussing this topic with colleagues.Teplizumab was approved for use in a very narrow category of patients with a relatively sma...
Do you recommend the use of GLP 1 R agonist therapy for obese women with PCOS who are actively trying to conceive?
This is a very relevant question. GLP 1 RA therapy is recommended by the recently published International Consensus Guideline in Management of PCOS for assistance with weight loss in combination with lifestyle modification (Teede et al., PMID 37580314). The guideline states that this should be done ...