Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is GLP-1 therapy a viable treatment option for a patient with Type 2 Diabetes complicated by atherosclerotic heart disease and cholelithiasis?
The absolute risk difference between GLP1RAs and placebo was not remarkable (5 -27/10,000 per year for different conditions such as biliary disease, cholelithiasis, cholecystitis, cholecystectomy and biliary cancer). In addition, the risk of pancreatitis was not higher (RR 1.46 [0.59 to 3.61], P val...
How do you approach management of osteoporosis in patients post lung transplant?
Osteoporosis in patients with lung transplants is essentially glucocorticoid-induced osteoporosis. Most patients with severe lung disease have a long history of glucocorticoid exposure. Post-transplant, these patients are often on long-term glucocorticoids. The primary pathophysiology of chronic glu...
What is the likelihood of recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients who develop immunotherapy induced adrenal insufficiency?
Essentially zero. ICI-induced central adrenal insufficiency is almost always permanent.
Do you recommend combined baseline cortisol and DHEA-S testing to improve the efficiency and accuracy of adrenal insufficiency diagnosis?
Yes, especially in the absence of recent glucocorticoid exposure, which can lower DHEAS levels and make it less helpful. Han et al., PMID 39657727 recently published a comprehensive manuscript on this topic.
In patients with differentiated thyroid cancer, do you consider pathology characteristics not found in the ATA risk stratification guidelines (ie microscopic margins or multifocal cancer) when determining recurrence risk and management?
Minimal invasive carcinoma with only capsule invasion is considered low risk. Multifocal disease with a size of more than 1 cm requires completion thyroidectomy. Overall, these factors do not appear to increase recurrence risk. Details are available at jnccn.org.
Would you increase or maintain the same initial dose of methimazole for treatment of hyperthyroidism if symptoms and thyroid tests improve but are not normalized?
Starting a hyperthyroid patient on the correct dose of methimazole (MMI) is of paramount importance. According to the 2015 ATA guidelines on the management of hyperthyroidism (Ross et al., PMID 27521067), the initial methimazole dose should be based on the patient's serum free T4 level: Free T4 2-3 ...
Is there a role for cinacalcet suppression testing when evaluating patients for suspected primary hyperparathyroidism who also have recurrent calcium containing kidney stone disease?
I understand the physiology upon which the cinacalcet suppression test is based. However, I have not used it in my practice. Once I see a discordant result between a parathyroid hormone level and its main determinants: serum calcium, phosphorus, and vitamin D (or 1, 25-vitamin-D), I use a sestamibi ...
Is there a role for calcitriol in dialysis patients regardless of PTH level?
I believe the general consensus among endocrinologists is that the origin of circulating calcitriol is from the kidney and this is considered the traditional endocrine pathway of vitamin D influencing bone and intestinal mineral absorption. However, many tissues have the ability to synthesize calcit...
What is your approach to managing osteoporosis in patients with end stage kidney disease?
I don't believe you can make a diagnosis of osteoporosis in patients with ESRD. They have to be treated based on the disorders associated with CKD-MBD and not solely based on the results of a bone density scan. In some patients with documented low turnover disease and mineralization defect, some may...
Would you expect cinacalcet to lower calcium levels in a patient with Familial Hypocalciuric Hypercalcemia (FHH)?
The hypercalcemia in FHH is not primarily driven by overactive PTH secretion, so targeting the CaSR pharmacologically would not address the underlying pathophysiology. However, I suppose inducing hypoparathyroidism with Cinacalcet would induce calciuria, though at the expense of hypocalcemia.