Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...
In patients with low alkaline phosphatase and high Vitamin B6 levels, does negative genetic testing for ALPL mutation rule out hypophosphatasia?
In general, the answer is no. The technical details of how the genetic testing was conducted are critically important and impact the kinds of genetic variation that can be detected. Prior knowledge about the patient and prior testing in related individuals are important factors in deciding how to ch...
How many statins do you try before considering alternative therapies like PCSK9 inhibitors or inclisiran to lower LDL levels?
In earlier years, I would try changing statins 3 to 4 times. More recently (and I use rosuvastatin almost all the time), I try to halve the dose (only lose 5 to 10% effect), and if that does not work, I try going to rosuvastatin 10 mg 1 to 2 times per week, and that gets about 25% reduction, to whic...
For which patients with type 1 diabetes on insulin pump therapy do you consider transitioning from rapid acting to ultra-rapid acting insulin?
When might faster-acting insulin analogs be considered for use in an insulin pump?Insulin pump use has rapidly become the standard of care for patients with type 1 diabetes mellitus (T1DM). Insulin pumps are generally paired with continuous glucose monitoring (CGM) and automatically adjust insulin d...
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic transsphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this cas...
Will you give a trial of tirzepatide in patients with PsA and obesity who have a partial response to bDMARD rather than switching their immunosuppressive regimen?
I don't believe the data on the magnitude of the benefit of GLP-1 agonists in arthritis symptoms is sufficient to suggest that adding one of these agents would be preferable to changing DMARDs in a patient with inadequate response.
What are your top takeaways from ADA 2026?
Lots of drugs in pipeline.Amylin receptor agonists may provide better tolerability and reasonable efficacy and become the first-line nutrient-stimulated hormone (NuSH) therapy with time.Do not follow titration in the prescribing information (PI) of glucagon-like peptide-1 receptor agonist (GLP-1 RA)...
Does ongoing methimazole requirement post radioactive iodine ablation therapy for toxic multinodular goiter suggest failure of therapy and need for repeat treatment or higher dose of radioactive iodine?
Toxic multinodular goiter may require more than one treatment with radioactive iodine (RAI) in order to achieve euthyroidism. In follow-up to RAI therapy, I recommend also looking at the free T4 and free T3 levels, as the TSH may take longer to return to normal. If the free hormone levels have impro...
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
How do you assess and adjust treatment in patients who develops hypothyroidism after being on lithium for several years?
It depends on whether the patient is symptomatic. If not, careful monitoring is all that is needed. If there are significant symptoms, treatment with levothyroxine would be needed. Continued use of lithium is appropriate if it has been effective over time.