Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you decide when to treat hypocalcemia in hospitalized patients?
When I think about when to treat hypocalcemia in hospitalized patients, I anchor the decision on three things: symptoms, the absolute calcium level, and the trajectory. First, it’s important to confirm true hypocalcemia: either a serum calcium <8 mg/dL or an ionized calcium <1.1 mmol/L, and to consi...
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
Would you consider recommending parathyroidectomy for primary hyperparathyroidism patients with high calcium and PTH levels, even without traditional criteria, based on recent studies showing reduced anxiety and depression?
Let the patient decide.
In patients with hypogonadism, when do you recommend subcutaneous over intramuscular testosterone injections?
Patient's choice. Both work well when given weekly.
Can rapid weight loss following GLP1 R agonist therapy lead to postprandial hypoglycemia and if so, what are the treatment options outside of dietary modifications?
This is a very interesting question but I am not sure that there is a clear published answer. Of course, we know that this class of medications can contribute to hypoglycemia in patients on insulin or SUs and in that situation the management would involve cutting back on the insulin or SU or decreas...
For a patient with known CAD and low baseline HDL, would a PCSK9 inhibitor be a better option than a statin, given concerns for paradoxical lowering of HDL levels with statin therapy that we can encounter in the outpatient clinical setting?
Statin therapy would still be your first choice as we know that they reduce CVD related outcomes regardless of the HDL. In fact, studies show that patients with low HDL benefit even more from statin therapy.
When do you think physicians should seriously consider prescribing PCSK9 inhibitors for the prevention of heart attack and stroke in people with ASCVD or diabetes, based on the results of the VESALIUS-CV trial?
Although I checked 'high lipoprotein (a) as a reason to go with a PCSK9 first, I would almost never do it is practice. Statins first and then add a PCSK9 if LDL is above my goal for the patient. I might use a lower dose of the statin to get 35% lowering and then add the inhibitor if the patient was ...
Besides treadmill, what other exercises may be considered for post-exercise ABIs, and are their diagnostic parameters identical to standard post-exercise ABIs?
2 minutes of Toe-raises has been demonstrated to be an acceptable alternative to exercise ABI's.
Should teprotumumab be used in patients with active, moderate Graves thyroid eye disease in the absence of proptosis?
Teprotumumab has a specific role in TED, namely reversing the soft tissue expansion which manifests as proptosis, and swelling in the brow, upper, and lower lids. It does not affect "active" disease, namely, pain and pressure in the orbit, conjunctival, lid, and caruncle erythema and edema. Corticos...
How do you approach adjusting insulin pump settings in patients who have received intra-articular corticosteroid injections?
Managing steroid-induced hyperglycemia in patients with diabetes has always been a difficult problem, and guidelines are hard to come by. Glucocorticoids cause increased insulin resistance and an increased need for insulin. The steroid effect on glucose is greater in the post-prandial state than the...