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 ...
How do you evaluate and counsel patients on elevated SHBG levels when bioavailable free testosterone levels are normal?
If free testosterone is normal, supplementation is not required. Check for the cause of the high SHBG. Common causes include hyperthyroidism, liver disease and caloric restriction. Check the estradiol level. Many obese people have high estradiol because of the aromatase enzyme in the adipose tissue....
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 ...
How do you counsel patients on the risks and benefits of strontium supplements for osteoporosis management?
No experts whom I know prescribe Strontium for osteoporosis. It has not been shown to be efficacious to reduce fractures, although bone density will rise substantially. Also, bear in mind of very serious toxicities that have been associated with this drug. I would never use it in any of my patients....
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
Should we be measuring TBAb in all patients with hypothyroidism given recent evidence showing its ability to predict long term thyroid hormone requirements?
All patients with thyroid dysfunction should receive long-term monitoring. I don't think measuring other antibodies would change anything unless the patient requests a long-term prognosis.
Can estrogen priming therapy during IVF treatment lead to transient TSH elevation without clinical hypothyroidism?
A large number of hypothyroid women taking Levothyroxine will need to increase the dose of Levothyroxine after IVF. IVF results in extremely high levels of estrogen, which increases the thyroid-binding globulin that in terns require an dose increase of about 30%. Generally, it is recommended to incr...
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?
Overwhelming data show that acute pancreatitis is not directly due to GLP-1 use but rather the indirect effect of rapid weight loss leading to cholelithiasis and subsequent acute biliary pancreatitis in GLP-1 users. Hypertriglyceridemic pancreatitis is rare even among those with elevated TG levels (...
Do you rely on HbA1c to monitor glycemic control in a patient with diabetes and compensated cirrhosis, given that advanced liver disease can systematically lower HbA1c independent of actual glucose control?
A1C is a great test, but it has many limitations. One major one is that it depends on red cell circulation time being normal for interpretation using common standards for average glucose values. Cirrhosis will potentially shorten red cell lifespan depending on associated complications and severity. ...
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...