Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?
The very premise on which SGLT2i is supposed to work does not exist, if the patient does not have meaningful GFR; in fact most would not use/start SGLT2i once eGFR is <20-25 range. Studies have excluded patients with advanced CKD and any benefit with low GFR seems very doubtful. Zinman et al., PMID...
Should weight loss medications be used in women who are gaining excessive weight during pregnancy?
No weight loss medications are currently known to be safe during pregnancy and should be avoided even in cases of excessive weight gain. Exercise, diet, and behavioral modifications are the mainstay of treatment for weight gain/obesity in pregnancy. Bupropion/naltrexone (Contrave) as well as GLP-1RA...
Would you consider exploratory surgery in a young patient with normocalcemic hyperparathyroidism that meets one or more criteria for parathyroidectomy but has no localized pathology on advanced neck imaging?
If the patient has any complications that could be caused by primary hyperparathyroidism surgery would be appropriate done by a highly experienced parathyroid surgeon. It is not uncommon for imaging to be negative in patients with relatively mild parathyroid problems.
Is dosimetry more important than preparation (ie rhTSH versus THW) when treating thyroid cancer with radioactive iodine therapy?
Formal dosimetry to determine radiation dose is almost never done because it is so labor intensive and only can be done with THW and not rhTSH preparation with (-131 and not I-123). >99% of therapies are done based on the extent of disease and purpose, i.e., remnant ablation 30-50 mCi, adjuvant ther...
Is there a role for Vitamin D supplementation in the treatment of Hashimoto’s thyroiditis?
Although there is some evidence that vitamin D may play a role in immune function, there is no credible evidence that vitamin D has a role in the management of autoimmune thyroid disease including Hashimoto's and Graves's disease.
What endocrine therapy would you recommend to a premenopausal female with early stage HR+ Breast cancer who is transitioning from female to male and currently on testosterone?
There is not a lot of data, and so shared decision-making is paramount, with the following considerations: Acknowledging the limited data in this setting, how would this patient feel about stopping testosterone? While many patients feel that T is critical for identity, others may not feel that way. ...
In what clinical scenarios should we use the 2-day 2mg DST instead of the 1mg overnight DST for screening of Cushing syndrome?
The 2-day low-dose DST may be of some value in patients suspected to have nonneoplastic hypercortisolism (normal cortisol <1.4-1.8 ug/dL). The Dex/CRH test performs better in such patients, but the CRH is not available.
What is your approach to determining recurrent versus RAI-refractory differentiated thyroid cancer in patients presenting with metastatic disease several years after surgery?
It sounds like you already know that there is a non-iodine avid distant disease. A brain MRI is recommended to exclude CNS disease. If insurance allows, go to a PET/CT with a diagnostic CT of the neck and chest. If insurance will not allow PET, then diagnostic CT of the neck, chest, and abdomen with...
Is there enough evidence now to use injectable semaglutide as a foundational therapy for symptomatic heart failure with preserved ejection fraction in the setting of overweight or obesity?
While the evidence for using injectable semaglutide in the setting of heart failure with preserved ejection fraction (HFpEF) and overweight/obesity is promising, it's still considered emerging! STEP-HFpEF trial: This large, well-designed study showed that semaglutide significantly improved symptoms,...
What is your protocol to starting/stopping glucocorticoid replacement in Cushing disease patients after their transsphenoidal resection surgery?
The initiation of glucocorticoid treatment post-transsphenoidal surgery in patients with Cushing's disease varies across different medical practices. Dr. Fleseriu's paper provides a comprehensive review of Cushing's disease management, offering valuable insights (Fleseriu et al., PMID 34687601). Typ...