Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you avoid empagliflozin in patients with history of amputation?
To be clear, you can prescribe any SGLT2i to a patient with an amputation or at high risk for an amputation due to prior foot ulcers, insensate foot, peripheral vascular disease. The "warning" (not contraindication) in the canagliflozin PI is "Consider factors that may increase the risk of amputatio...
Do you use denosumab for castration-sensitive prostate cancer with osseous metastases?
This is an important question but a complex one. Several issues are critical to consider: 1) bone anti-resorptive therapies like zoledronic acid have NOT been established to improve survival or reduce skeletal events in this setting of bone metastatic HSPC as compared to waiting for mCRPC. See CALGB...
Which screening method for diabetes do you consider to be the most sensitive?
I don’t usually think about which screening method for diabetes is the most sensitive. I am more likely to consider which is most appropriate for my patient. I never order OGTT for non-pregnant patients. They are cumbersome and, compared to FPG and A1C, they don’t significantly change my recommenda...
How long do you wait before reassessing a 24 hour urine calcium level in patients with recurrent nephrolithiasis, hypercalciuria, and osteoporosis who are initiated on bisphosphonate therapy?
Thank you for your excellent question. This is a relatively common concern, and yet I am aware of very little hard data. Opinions will differ; here is mine: In this scenario, it is my practice to have the patient visit with our Stone Clinic dietitian regarding dietary recommendations for calcium, so...
Should lipid lowering therapy be started in patients with isolated elevation in lipoprotein (a) and minimal cardiovascular risk?
At the current time the answer would be "no" for someone with minimal CVD risk. There are not any currently available therapies for effectively lowering Lp(a) nor randomized trials demonstrating clinical efficacy, though this could change in the near future.
Should patients with mild subclinical hypothyroidism (TSH < 10 mIU/L) be treated with thyroid hormone replacement to improve their lipid profile?
There is a well-known association between untreated primary hypothyroidism and hypercholesterolemia with subsequent improvement of lipid profile following thyroxine replacement. However, the link between hyperlipidemia and sub-clinical hypothyroidism is less well understood. The all-important questi...
Would you treat an isolated elevated total cholesterol in a post-menopausal patient who is otherwise healthy and has no significant CV risk factors?
This is not a simple yes or no question as asked, particularly with the limited information provided. Whether I would pharmacologically treat such a patient would depend on her actual lipid values. What are her LDL, HDL and triglyceride values? On the one hand, a total cholesterol could be elevated ...
Which patient population would benefit most from cellulose and citric acid (Plenity) therapy for weight loss?
Theoretically, this could be a treatment option for patients who do not have insurance coverage for/cannot afford GLP-1RA, and who are not candidates for alternative therapy with phentermine, qsymia, or contrave (perhaps due to high blood pressure). However, the weight loss benefit of treatment with...
What is the utility of an oral calcium loading test to differentiate FHH from secondary hyperparathyroidism due to low calcium intake?
Both vitamin D deficiency and calcium deficiency can result in secondary hyperparathyroidism. Before entertaining the diagnosis of FHH, I would treat the patient with an adequate calcium intake of 1000 mg a day of elemental calcium preferably from dietary sources like dairy. Supplemental sources are...
What is the next best anti-hypertensive medication to start after mineralocorticoid receptor antagonists in patients with primary aldosteronism?
I have had a good experience with calcium channel blockers and combined alpha/beta-blockers such as carvedilol in patients with PA. They are my first and second choices after MRA. If tolerated, pushing the MRA dose to get a PRA> 1 ng/ml/hr is important. I check for proteinuria, and if present, I add...