Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should insulin be started early (prior to optimization of other anti-hyperglycemic medications) in patients with mild-to-moderate diabetes and hypertriglyceridemia refractory to statin and fibrates?
Not necessarily. The goal should be achieving optimal glucose control to improve triglyceride levels. This can be accomplished with non-insulin agents, such as GLP-1 agonists and others, that can have beneficial effects on triglycerides.
Should Orlistat be considered in the management of hypertriglyceridemia?
While there are no controlled trials addressing this issue, it is certainly a reasonable option which I have used in some patients with Familial Chylomicronemia Syndrome. It will help to reduce the generation of chylomicrons and therefore the subsequent risk for hypertriglyceridemic pancreatitis. Ma...
How should very low T scores (worse than -3) be interpreted in very thin patients (BMI < 18)?
It would be very helpful to know the age of the patients. Age is well documented to be independently inversely related to fracture risk for the same T score. Low BMI places less stress on the skeleton and in response the skeleton maintains lower bone mineral content i.e. bone mineral density. There ...
Should thyroid hormone replacement be initiated in patients with very prolonged critical illness with associated low thyroid hormone levels?
There is no evidence that LT4 is of benefit in such patients.
Should patients with asymptomatic GH deficiency be treated with GH replacement therapy if they have prior known severe CAD?
Yes, GHRT should be discussed with GHD adults independently from symptoms. There is no evidence that GHRT increases the risk of CAD, and in fact, it may be beneficial due to the lowering of total and LDL cholesterol (this is a theoretical benefit, as I am not aware of any study that showed that GHRT...
Does caution have to be used in GH replacement therapy in any and all types of cancer history?
In general, GH RT is contraindicated in patients with an ACTIVE malignancy. My practice is not to treat until I have 5 years of cancer-free interval. The situation is different with pituitary adenomas and craniopharyngiomas, as there is literature showing that GHRT does not increase the risk of recu...
Is a significant rise in cortisol post cosyntropin stimulation sufficient to rule out adrenal insufficiency in patients with low albumin?
We use the absolute cortisol (or free cortisol) values rather than the degree of the rise in cortisol as an indicator of normal adrenal function during the ACTH Stimulation Test. Is this question related to the critically ill patients?
Should a short trial of androgen therapy be used in patients with primary adrenal insufficiency suffering from persistent fatigue and hypoactive sexual desire despite sufficient glucocorticoid and mineralocorticoid replacement?
Considering that adrenal glands are an important source of androgens in women, this approach, especially in symptomatic patients, seems reasonable. I usually use DHEA supplements starting at 25 mg daily and then adjust the dose based on the DHEAS and testosterone levels. Most patients require 12.5 t...
Can osilodrostat be used indefinitely in poor surgical candidates with cushing syndrome from adrenal adenoma?
There is no restriction on the duration of therapy with osilodrostat. One of the goals is to improve the clinical condition of the patient, so the patient can become a surgical candidate.
In adult women with NCCAH, is there a benefit in using supratherapeutic doses of prednisone in addition to clomiphene to improve fertility rates?
In NC-CAH, subfertility is mild compared with the classical form. Most women with nonclassic 21-hydroxylase deficiency have normal ovulation and ability to conceive, but miscarriages occur in up to 25% of their pregnancies. In women with NC-CAH who are infertile or have a history of prior miscarriag...