Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do 5HT4 agonists such as Metoclopramide actually lead to improvement in symptoms for patients with diabetes related gastroparesis?
Yes, sometimes when the gastroparesis is frequent or the symptoms are tough, I do use Reglan to help. By the time they wind up in the hospital, they are really willing to have me use anything on them that might help. I explain to every patient the side effects of Reglan, including tartive dyskinesia...
Is there a specific triglyceride level at which you discourage patients with metabolic syndrome from starting GLP-1R agonist therapy due to the risk of pancreatitis?
The usual recommended cut-off is TG > 500 mg/dl. In practical terms, this limit can be affected by lifestyle (nutritional and exercise) approaches and glycemic control, if indicated. Also, it is worth keeping in mind that concurrent gallbladder disease and cholelithiasis, more common in people with ...
How frequently would you check thyroid function in a patient who has been on amiodarone for more than one year with no prior thyroid disease and consistently normal thyroid function tests?
Amiodarone-induced thyroid dysfunction occurs in approximately 2–24% of cases. Hypothyroidism is more common than hyperthyroidism. Hypothyroidism can occur within 3 months of the beginning of Amiodarone in 10–20% of cases or may develop up to 1 year in 5–10% of cases. In some studies, the median tim...
Do you recommend prescribing methimazole to prevent iodinated contrast media-induced exacerbation of thyrotoxicosis in patients with pre-existing hyperthyroidism?
Yes. If someone has pre-existing UNTREATED hyperthyroidism and elderly, Methimazole should be started. The exact dose has not been proven but I use 5 mg daily for 2 months. Urinary iodine after a CT scan with contrast has been documented to be high at 2 weeks and 1 month but not 2 months post infusi...
In patients with MASLD, would you consider management with off-label metformin, pioglitazone (despite weight gain risk), GLP-1 RA, or simply intensify lifestyle and monitor?
In 2025, we should be assessing if patients are developing F2-F3 fibrosis especially with the use of non-invasive assessments (FIB-4 score, transient elastography, or MRI elastography), and then offering either Semaglutide or Resmetirom for these individuals w/ F2-F3, which are the only FDA approved...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
Do you recommend the use of CGM for monitoring of postbariatric hypoglycemia given recent evidence of reduced accuracy in dynamic postprandial conditions?
I have always been concerned about accurately detecting hypoglycemia in patients because of the higher MARD in the hypoglycemic range with most CGM sensors. A recent review found the MARD in hospitalized patients to be 15% in the hypoglycemic range, which is much higher than in the euglycemic or hyp...
Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?
I am not aware of a well done study in this regard, but oral contraceptives containing estrogen induce growth hormone resistance and may lower IGF-1, but the beneficial effect of estrogen on bone density would almost certainly outweigh any negative effects caused by lowering the IGF-1.
For patients on peritoneal dialysis with type 2 diabetes mellitus, do you have a preferred long- acting insulin and time of insulin administration?
Insulin management in patients on peritoneal dialysis can be tricky. In my experience, you have to be very cautious with long-acting insulin. Much of the hyperglycemia occurs during the exchanges with the dextrose solution. Therefore, using long-acting insulin can cause hypoglycemia. My suggestion i...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...