Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?
The endocrine guidelines on primary aldo diagnosis (1) allow for 3 confirmatory tests: 24-hour urine, fludrocortisone suppression testing, and response to saline infusion. At UAB, we use the 24-hour urine collection. Most of our patients do not need additional salt loading during the 24-hour collect...
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...
Does ongoing methimazole requirement post radioactive iodine ablation therapy for toxic multinodular goiter suggest failure of therapy and need for repeat treatment or higher dose of radioactive iodine?
Toxic multinodular goiter may require more than one treatment with radioactive iodine (RAI) in order to achieve euthyroidism. In follow-up to RAI therapy, I recommend also looking at the free T4 and free T3 levels, as the TSH may take longer to return to normal. If the free hormone levels have impro...
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
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...
In routine practice where repeat biopsy and outcomes data are not available, what longitudinal NIT pattern (e.g., VCTE/ELF ± MRI-PDFF/ALT trajectory) do you consider sufficient to continue semaglutide specifically for MASH, and what trajectory would trigger a “futility” decision to stop or switch despite weight loss?
Aligned with clinical practice guidance that GLP-1 RAs primarily improve steatosis and inflammation rather than established fibrosis, I look for a concordant metabolic response, including ≥30% PDFF reduction with ALT improvement of ≥17 IU/L or ≥20%, alongside at least stability or modest improvement...
Do you consider adding a GLP-1 receptor agonist to insulin therapy in a patient with newly diagnosed LADA who has not yet progressed to insulin dependence?
Auto-immune diabetes is known to have identifiable stages of beta-cell dysfunction and demise and being able to intervene with a treatment to preserve or improve beta-cell function is one of the major areas of diabetes research. Latent auto-immune diabetes presenting in adults (LADA) at a time when ...
In patients with newly diagnosed Graves' disease who are started on methimazole therapy, when do you recommend repeating thyroid ultrasounds to monitor incidental thyroid nodules that meet FNA criteria?
I have an ultrasound in my exam room. My clinical practice is to perform an ultrasound as part of the diagnostic algorithm. I generally do not check TSI since I can make the diagnosis of Graves with the US and also exclude a concomitant nodule that needs biopsy. If you need to refer to Radiology for...
Do you pursue further workup for a coexisting cause of true hyperprolactinemia, or attribute the elevation to macroprolactin and observe, when PEG precipitation confirms macroprolactinemia but the post-PEG monomeric prolactin remains above the normal range?
Macroprolactinemia can coexist with real hyperprolactinemia. The post-PEG precipitation monomeric prolactin value, rather than percent recovery alone, is the most informative parameter for distinguishing isolated macroprolactinemia from coexisting true hyperprolactinemia. If monomeric prolactin is e...
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...