Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?
Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...
Do you manage mild-to-moderate diabetic ketoacidosis with a subcutaneous rapid-acting insulin protocol rather than an IV insulin infusion?
Yes, SC rapid-acting insulin can be used in the mild cases of DKA, provided that dehydration is not severe enough to affect insulin absorption. Small, frequent doses every hour may replace the IV insulin in mild cases. A good tip is to start correcting fluid loss in the first or two hours before sta...
Would you favor the use of denosumab over bisphosphonate therapy for treatment of osteoporosis in patients who are at high risk for osteoarthritis given recent data suggesting reduced risk of developing knee OA?
Although the overall data to date concerning the impact of denosumab to reduce incident knee OA or lessen established disease remain limited, there are sufficient signals that warrant further investigation and support the need for an appropriately powered RCT with endpoints that include both patient...
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.
Is the rise in LDL and liver fat after starting tryngolza a concern?
A modest increase in LDL-C after olezarsen (Tryngolza) and plozasiran (Redemplo) have been been reported, particularly in patients with severe hypertriglyceridemia. It probably reflects the conversion of TG-rich LPs and TG-remnants to smaller lipid particles, including IDL and LDL. Notably, the non-...
Is the risk of hypoglycemia significantly increased when using Mounjaro in combination with metformin for management of diabetes?
By itself, neither metformin nor Mounjaro (Tirzepatide) is associated with a significant risk of hypoglycemia. But the question is, if they are combined, does the risk go up? I am not aware of any studies that have specifically looked at this question, but keeping in mind the mechanism of action of ...
Do you recommend completing a 1 mg dexamethasone suppression test for an asymptomatic incidental pituitary microadenoma?
In my experience, the yield of doing a 1-mg DST in an asymptomatic patient with a pituitary incidentaloma is very low. Accordingly, I only evaluate for Cushing syndrome in cases with some clinical evidence of underlying hypercortisolism. In contrast, I obtain at least one set of labs for prolactin a...
Would you consider PTH analogue in a patient with mildly elevated PTH?
This is a complicated question because there is not any substantial literature. Almost all clinical trials with teriparatide and abaloparatide excluded patients with elevated PTH levels. However, there is considerable anecdotal experience. I have surveyed many colleagues with considerable experience...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
In patients with severe osteoporosis, history of retinal artery occlusion, and hypercalciuria, would you favor PTH analogue therapy or Evenity?
Assuming that PTH and vitamin D are normal, neither. Chlorthalidone is the treatment of choice in this scenario. Chlorthalidone is usually better than HCTZ, as HCTZ often must be given BID, whereas chlorthalidone can be given daily. I have seen very large improvements in BMD with thiazide therapy, o...