Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When performing adrenal vein sampling, is calculating selectivity index using androstenedione superior to using cortisol alone for determining successful catheterization?
In our experience, the measurement of androstenedione is particularly beneficial when the AVS is done without Cosyntropin stimulation. While the cortisol gradient may be <2 in such cases, we see a several-fold increase in Androstenedione gradients confirming successful catheterization.
Does biotin interfere with the measurement of other metabolites of the Vitamin D pathway outside of the 25-hydroxy Vitamin D assay?
Biotin interferes with chemiluminescent assays. Assays using LCMS to measure 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D are not affected.
Would you consider GLP1 R agonist therapy in a patient with a history of severe gallstone pancreatitis that is now post cholecystectomy?
In the context of shared decision-making, I would consider prescribing an GLP-1RA on someone with a history of severe gallstone pancreatitis post cholecystectomy. The critical issue is for the patient to understand the uncertainty about the safety of the approach and be willing to take on that risk....
What is your approach to progressive calvarial hyperostosis found in an elderly adult not caused by Pagets, acromegaly or hypercalcemia?
Does your patient have meningioma? Is the osteosclerosis generalized or localized? Localized osteosclerosis can arise from tumors (either benign or malignant) that secrete osteogenic proteins. I have had such a patient, with the unresectable meningioma secreting endothelin. Endothelin is also secret...
What specific clinical factors would drive you to recommend surgical intervention for patients with small, nonfunctional pituitary adenomas who exhibit no neurological symptoms?
I don't think there is any indication for surgery in such a case.
When and how do you taper off cabergoline therapy for treatment of microprolactinoma?
If patient does not desire fertility and microprolactinoma is stable or smaller, cabergoline can be tapered off.
Do patients with an elevated IGF-1 level and features of acromegaly need to have confirmatory growth hormone suppression testing with OGTT?
OGTT is not always needed. In the presence of clinical features of acromegaly, a frankly elevated IGF-1, and a pituitary adenoma visible by MRI glucose suppression test is not necessary.
Does preoperative use of somatostatin receptor ligand improve remission rates after surgery for acromegaly?
This is still an open question. Two well-known papers (one from Norway and one from China) addressed this and suggested that a 4-6 month treatment increased the chance of surgical cure for GH-secreting macroadenomas, but both papers had methodological issues. I have done this occasionally for macros...
Should patients with non-functional pituitary macroadenomas with persistent, but tolerable, headaches be recommended for surgery?
It depends on the size of the adenoma and stability of the imaging. It is sometimes difficult to know if the headaches are related. In a younger patient, I would consider surgery.
Are you offering GLP-1 agonists to patients with CKD and diabetes mellitus?
According to KDIGO 2022, GLP-1RA are second line DM Rx (see fig 3: Rossing et al., PMID 36272755); this class of medications still awaiting a CKD-dedicated RCT such as FLOW (Rossing et al., PMID 36651820). However, secondary outcomes of CVOT show kidney protective effects for some GLP-1RAs (non-exen...