Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you recommend cinacalcet for patients with recurrent nephrolithiasis who have hypercalciuria despite thiazide diuretic use and who also have an elevated PTH level without localizing parathyroid adenoma on imaging?
This is a tricky question with a nuanced answer. If the hyperparathyroidism is secondary, cinacalcet may have a role in treatment along with normalizing serum phosphorus and vitamin D. However, metabolically active kidney stones are unusual in advanced chronic kidney disease. If the hyperparathyroid...
In your practice, when do you opt to treat unilateral primary hyperaldosteronism medically rather than surgically?
There should be a good reason for not pursuing surgery in a patient with unilateral primary aldosteronism. The surgery is more cost-effective. Some but not all data suggest a faster decrease in cardiovascular morbidity, a lower risk of atrial fibrillation, arterial stiffness, left ventricular mass, ...
What is the optimal anti androgen dose of spironolactone when treating female hirsutism?
My experience with this issue has primarily been in treating women with PCOS who have hirsutism and so these comments are limited to that condition. First, it is important to establish normal renal function and electrolytes before starting. It is also important to know if the patient is on an ACE-I ...
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.
Have the results of the ancillary study of the VITAL trial, demonstrating that Vitamin D3 supplementation did not reduce the incident rate of fractures in generally healthy midlife and older adults, changed how you prescribe Vitamin D?
It should be appreciated that the function of vitamin D is to maintain a serum calcium concentration in a normal range to maintain neuromuscular function and most metabolic functions. It can accomplish this by increasing intestinal calcium absorption. When there is inadequate calcium in the diet, th...
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...