Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When do you consider scheduled or more frequent POC blood glucose checks in hospitalized patients who are either not eating or otherwise at high risk for hypoglycemia?
Standard q6h (before meals + bedtime) monitoring is insufficient for patients who are NPO or at high risk for hypoglycemia. Evidence supports more frequent or scheduled monitoring in the following scenarios: 1. NPO/not eating Every 4–6 hours is recommended for NPO patients on basal insulin alone (E...
How do you counsel patients on ways to boost their HDL cholesterol levels while on lipid lowering therapy?
I don't set HDL-cholesterol goals for my patients per se, nor do I spend a lot of time counseling them on ways to boost their HDL. Having said that, I recommend a heart healthy dietary pattern and increased physical activity as ways to improve their overall health which will also generally lead to a...
Do you routinely recommend delaying dental extractions in patients who have recently received intravenous bisphosphonate therapy for osteoporosis treatment?
I don’t because the risk of ONJ is very low.
Do you routinely check morning cortisol before discharging a patient who received more than 3 days of high-dose corticosteroids during a hospitalization for an acute illness?
No. In general persistent HPA suppression does not occur when a single steroid treatment is shorter than 2 weeks.
Would you start romosozumab in an active smoker?
This is not simple! But we are good at assessment of risk vs benefit (or benefit vs risk!)First I would reassess fracture risk, prior treatments, reason to consider romo. Then I would do a deep dive into risk assessment for cardiovascular disease: how much do they smoke, prior cardiovascular disease...
When stopping denosumab and transitioning to PO bisphosphonate, do you wait for 6 months after the last denosumab injection to start PO bisphosphonate?
Some background: In patients discontinuing denosumab without subsequent antiresorptive therapy, BMD rapidly reverts back to baseline with an elevation in vertebral fracture risk (with an enhanced risk of multiple vertebral fractures). Thus, sequential treatment regimens following denosumab have been...
Is anabolic therapy for treatment of severe osteoporosis less effective when not taken continuously for the 12 to 24 month duration of therapy?
I have had experience with Forteo. When it was first introduced and was very expensive and not always covered by insurance, I would use it intermittently with good success. In some cases, I would use it twice a week and follow the bone remodeling markers, which were a good indicator of its effective...
Do you recommend starting a statin in youth (greater than 10 years old) with Type 1 diabetes mellitus and LDL cholesterol levels greater than 130?
In general, I probably would not consider starting a statin in a youth with T1D unless they had T1D AND Familial Hypercholesterolemia and/or an LDL >190 mg/dL or significant microvascular complications already. Recommendations are to consider statin therapy in individuals with diabetes of long durat...
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 ...
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...