Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you approach a patient with Paget’s disease of bone with elevated alkaline phosphatase and history of chronic kidney disease?
You can give Zol IV, which is clearly the optimal treatment for active Paget's. Those in the field that treat many such patients just administer this very slowly over 1-2 hours and assure good hydration concomitantly. I have treated a number of patients like this, with this scenario, without any pro...
Do you offer semaglutide for weight loss management in patients with CKD?
Type your answer here...I do, but mostly a different GLP-1, trizipitide. I think the side effect profile is cleaner and better tolerated in CKD and post-transplant patients, decreasing renal complications associated with the side effects. Some tips for high quality answersDirectly answer the questio...
For which patients with type 1 diabetes on insulin pump therapy do you consider transitioning from rapid acting to ultra-rapid acting insulin?
When might faster-acting insulin analogs be considered for use in an insulin pump?Insulin pump use has rapidly become the standard of care for patients with type 1 diabetes mellitus (T1DM). Insulin pumps are generally paired with continuous glucose monitoring (CGM) and automatically adjust insulin d...
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...
Will you give a trial of tirzepatide in patients with PsA and obesity who have a partial response to bDMARD rather than switching their immunosuppressive regimen?
I don't believe the data on the magnitude of the benefit of GLP-1 agonists in arthritis symptoms is sufficient to suggest that adding one of these agents would be preferable to changing DMARDs in a patient with inadequate response.
What is your approach to treating concomitant hypernatremia and hyperglycemia in patients with encephalopathy?
The risk-benefit assessment begins by identifying the primary physiologic problem. In patients with concomitant hypernatremia and hyperglycemia, the dominant abnormality is usually a profound free water deficit from osmotic diuresis. My goal is to restore normal physiology by replacing that free wat...
In patients with osteoporosis at high fracture risk, what factors most influence your decision to prescribe teriparatide versus abaloparatide?
Both abaloparatide and teriparatide are very effective anabolic agents to reduce vertebral and nonvertebral fracture risk in patients with osteoporosis (although clinical trials did not demonstrate reduction of hip fracture risk). The two agents are more similar than different and both induce an an...
What are your top takeaways from ADA 2026?
Lots of drugs in pipeline.Amylin receptor agonists may provide better tolerability and reasonable efficacy and become the first-line nutrient-stimulated hormone (NuSH) therapy with time.Do not follow titration in the prescribing information (PI) of glucagon-like peptide-1 receptor agonist (GLP-1 RA)...
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?
Radioactive iodine (RAI) ablation will have its primary effect usually within 6 months of therapy. If thyroid function tests (TFTs) are subclinically hyperthyroid with Graves' disease, I would wait up to a year, as the concomitant chronic thyroiditis may spontaneously decrease TFTs to normal. If the...
What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?
The biggest difference between osteoporosis and CKD-MBD has to do with the underlying bone mineral laboratories. Generally, with osteoporosis, bone chemistries are relatively normal; there may be a decrease in Vit D. However, with CKD-MBD, there is usually an increase in PTH, potentially abnormaliti...