Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
What is the optimal management of pain and loss of function due to pathologic compression fractures?
I explain to my patients if they have an acute compression fracture that they are likely to experience pain for approximately 2-3 weeks that will gradually resolve. I often give them some type of pain relief using Tylenol or ibuprofen and if severe, a more potent analgesic for a short period of time...
What triggers you to choose urgent thyroidectomy versus therapeutic plasma exchange versus continued medical management for refractory thyroid storm despite 12-24 hours of guideline-concordant therapy?
A very important factor is the comfort level of the ICU doctors and the Anesthesiologists at the institution. We usually do not recommend proceeding with urgent thyroidectomy given the increased risks, unless FT4 and TT3 are normalizing. Usually, a combination of PTU (or Methimazole), stress dose st...
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...
What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?
This is an important question to keep an eye on, given the broadening use and effectiveness of GLP-1 agonists for various conditions, especially diabetes, and for weight loss. Unfortunately, as is so often the case, major clinical trials in this area do not reflect the heterogeneity of older adults ...
When using cabergoline for prolactinoma treatment, at what dose do you counsel patients about the risk of valvular heart disease?
I always mention the possible risk of cardiac valvulopathy when prescribing cabergoline. However, I also mention that the studies showing evidence of possible harm were in patients with Parkinson's disease who were taking much higher doses than those prescribed for typical hyperprolactinemic patient...
What could cause a sudden rise in LDL cholesterol in young adults who have not changed their lifestyle or started any new medications?
Depending on the degree of the rise in LDLc noted, there are a number of reasons.Despite the person reporting that they have "not changed their lifestyle," one must consider reduced activity, or either a diet with more saturated fat - due to being less diet conscious, or due to a low carbohydrate or...
How do you monitor blood glucose levels in patients without preexisting diabetes who are starting capivasertib?
Capivasertib inhibits phosphorylation of downstream AKT substrates. By blocking AKT, an obligatory node in insulin signaling that mediates GLUT4-dependent glucose uptake in muscle and adipose tissue and suppresses hepatic glucose production, capivasertib reduces peripheral glucose uptake and increas...
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 ...
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 ...