Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
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?
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...
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...
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 is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
In patients with T1DM, when would you consider the use of amylin analogues for control of post prandial hyperglycemia?
Pramlintide was FDA-approved in 2005 after demonstrating modest A1C reduction, improvement in post-prandial hyperglycemia, no increase in hypoglycemia, and some weight loss. I prescribed it to several of my patients with type 1 diabetes. Unfortunately, many of them had challenges such as GI side eff...
Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...
How do you decide when to evaluate for central hypothyroidism in a patient with low-normal TSH and low free T4?
The differential in these patients is 1) mild subclinical hyperthyroidism 2) central hypothyroidism 3) normal variant related to assay detection limitations. It would be important to obtain a good history and try to identify any hypothyroid or hyperthyroid symptoms. Having said that, patients will u...
What new or emerging therapies for autoimmune gastritis are available beyond iron and vitamin B12 replacement?
Though we recognize autoimmune gastritis (AIG) as an autoimmune disease that targets antigens expressed on parietal cells of the stomach, there are currently no effective treatments to reduce gastric inflammation and to prevent parietal cell loss. Back in the 1960s, small studies looked at the role ...