Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is the presence of ubiquitin-specific peptidase 8 (USP8) genotype helpful in determining the risk of Cushing disease recurrence?
Indeed, a recent retrospective, multicenter, international study (published in Lancet DM) reported that patients with USP8-variant tumors are more likely to experience recurrence of Cushing's disease in comparison with patients with microadenomas that are USP8-wildtype (37% vs. 15% at 10 yr). On the...
Do you immediately discontinue sulfonylureas when initiating GLP-1 receptor agonists in patients with longstanding type 2 diabetes?
In a patient with an A1c <8% or with current issues with hypoglycemia while taking a sulfonylurea (SU), I would discontinue the sulfonylurea at the time I prescribe any highly effective medication for type 2 diabetes, including a GLP-1-based therapy. That would be with instructions to the patient to...
What patient factors do you consider when selecting between a small interfering RNA, like inclisiran, and PCSK9 inhibitors in patients with recent acute coronary syndrome?
Insurance coverage and out-of-pocket costs usually drive my choice. It is fairly easy to get approval for evolocumab for most of my patients. I have had a hard time getting approval for inclisiran with the exception of those with traditional Medicare + supplemental medication coverage. I usually sta...
What is your approach to the management of incidentally elevated HDL levels in isolation and is there any utility for further ASCVD risk stratification and/or genetic testing for lipid disorders?
Although the U-shaped curve for HDLC and ASCVD was a surprise (probably missed until huge population cohorts were studied), the data have been reasonably confirmed in many studies now, with some heterogeneity regarding gender as well as CVD vs total mortality. If I see a patient now with an HDL over...
When should you consider adding clonidine to an antihypertensive regimen for patients with advanced CKD?
Clonidine patch is useful in severely uncontrolled hypertension. In patients with CKD, not responding to conventional medications - like calcium blockers. Though the side effect profile is not great, it is less expensive and practical.
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...
Do you still consider propranolol first-line for sinus tachycardia in thyroid storm, or have newer perspectives on beta-blocker risks altered your management?
Yes, but...Propranolol remains the first-line option for thyroid storm, but recent evidence supports that beta-1 selective agents (metoprolol, atenolol) are equally effective and may be preferred in certain clinical contexts. The choice between propranolol and cardioselective beta-blockers should be...
What further endocrine work up do you recommend for chronically elevated bone specific alkaline phosphatase levels in young asymptomatic patients with normal nuclear bone scan results and no evidence of osteomalacia?
I am sure that you are aware that the differential diagnosis for an elevated alkaline phosphatase includes Paget's disease, vitamin D deficiency, hyperparathyroidism, hyperthyroidism, occult malignancy, bone metastases, and primary bone tumors. A normal bone scan helps to eliminate many of these. Bu...
Do you recommend completing a 1 mg dexamethasone suppression test for an asymptomatic incidental pituitary microadenoma?
Yes, if the patient has any feature of hypercortisolism, such as DM, HTN, osteoporosis, etc.See: Fleseriu et al., PMID 40555795"Screening should be performed for clinical suspicion based on features and/or comorbidities suggestive of Cushing disease, even in the absence of classic hypercortisolism c...
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
Treatment of hyponatremia due to adrenal insufficiency with glucocorticoid therapy may result in overcorrection of serum sodium due to suppression of ADH and resultant water diuresis. Therefore, serum sodium, urinary osmolality and urinary output should be closely monitored. A brisk water diuresis w...