Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
Do you consider adding a GLP-1 receptor agonist to insulin therapy in a patient with newly diagnosed LADA who has not yet progressed to insulin dependence?
Auto-immune diabetes is known to have identifiable stages of beta-cell dysfunction and demise and being able to intervene with a treatment to preserve or improve beta-cell function is one of the major areas of diabetes research. Latent auto-immune diabetes presenting in adults (LADA) at a time when ...
How long after a DKA episode do you anticipate patients with ketosis prone diabetes mellitus to be able to discontinue insulin therapy?
If the patient is antibody negative with beta cell function, they can usually discontinue insulin 1 to 2 months after the initial diabetic ketoacidosis (DKA) event (I typically order the antibodies and C-peptide at their first follow-up visit and then will start to pull off insulin once I have the r...
For a patient with a large pheochromocytoma, how would you evaluate for possible autonomous cortisol co-secretion prior to adrenalectomy to assess need for risk of glucocorticoid withdrawal postoperatively?
From a practical standpoint, and given that this is rare, it is reasonable to check a postoperative day 1 (POD1) AM cortisol and decide then whether cortisol replacement is needed. You can also check ACTH, AM and PM cortisol to assess diurnal variation, and DHEAS pre-op to get some idea.
Does your LDL goal change in elderly patients with diabetes and hyperlipidemia who are on statin therapy?
First, what is an elderly? I will be 81 next month, and I don't consider that young, but also not too elderly to try to protect myself from an event. This patient is a high/very high risk, and if he is at a good goal on a statin, why would anyone want to change the dose? I tell my patients that surv...
What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?
The endocrine guidelines on primary aldo diagnosis (1) allow for 3 confirmatory tests: 24-hour urine, fludrocortisone suppression testing, and response to saline infusion. At UAB, we use the 24-hour urine collection. Most of our patients do not need additional salt loading during the 24-hour collect...
Do you measure plasma metanephrines in an asymptomatic, normotensive patient with an adrenal incidentaloma below 10 Hounsfield units on non-contrast CT, given that a small proportion of pheochromocytomas can appear lipid-rich on imaging?
The probability of a positive result would be very low unless the patient is hypertensive or has suggestive symptoms.
How do you decide between repeat resection and radiosurgery when MRI imaging suggests limited residual tumor in the cavernous sinus in patients treated for acromegaly?
If residual tumor is not surgically curable, another surgery is not advisable. Given available pharmacological treatments, I do not consider XRT until I run out of medical options, particularly in young patients with intact pituitary function. Even if a patient does not respond to SRL, including pas...
Do you pursue further workup for a coexisting cause of true hyperprolactinemia, or attribute the elevation to macroprolactin and observe, when PEG precipitation confirms macroprolactinemia but the post-PEG monomeric prolactin remains above the normal range?
Macroprolactin is usually biologically in active so if the patient has symptoms of hyperprolactinemia, further work up may be needed.
In patients with MASLD, would you consider management with off-label metformin, pioglitazone (despite weight gain risk), GLP-1 RA, or simply intensify lifestyle and monitor?
In 2025, we should be assessing if patients are developing F2-F3 fibrosis especially with the use of non-invasive assessments (FIB-4 score, transient elastography, or MRI elastography), and then offering either Semaglutide or Resmetirom for these individuals w/ F2-F3, which are the only FDA approved...