Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What are the main differences between TRYNGOLZA and Redemplo?
Tryngolza (olesarsen) and Redemplo (plozasiran) both work to reduce apoC-III production a known inhibitor of LPL activity thus leading to significant triglyceride lowering. Olezarsen is an antisense oligonucleotide and plozasirin is an siRNA. Both lower triglycerides by 40-60% and both are FDA appro...
What is the correct dose of Lugol's iodine solution and duration of therapy for preparing a thyrotoxic patient for surgery and minimizing the risk of thyroid storm?
KI can be given 3 times per day in a full glass of water or juice (bitter) for 10 days before Graves' hyperthyroidism surgery as Lugol's solution (8 mg iodide/drop) 5-7 drops SSKI (50 mg iodide/drop) 1-2 drops Minor calculated differences in dose described for these 2 types of KI are insignificant s...
Do you manage mild-to-moderate diabetic ketoacidosis with a subcutaneous rapid-acting insulin protocol rather than an IV insulin infusion?
Yes, SC rapid-acting insulin can be used in the mild cases of DKA, provided that dehydration is not severe enough to affect insulin absorption. Small, frequent doses every hour may replace the IV insulin in mild cases. A good tip is to start correcting fluid loss in the first or two hours before sta...
Would you favor the use of denosumab over bisphosphonate therapy for treatment of osteoporosis in patients who are at high risk for osteoarthritis given recent data suggesting reduced risk of developing knee OA?
Although the overall data to date concerning the impact of denosumab to reduce incident knee OA or lessen established disease remain limited, there are sufficient signals that warrant further investigation and support the need for an appropriately powered RCT with endpoints that include both patient...
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.
Is the rise in LDL and liver fat after starting tryngolza a concern?
A modest increase in LDL-C after olezarsen (Tryngolza) and plozasiran (Redemplo) have been been reported, particularly in patients with severe hypertriglyceridemia. It probably reflects the conversion of TG-rich LPs and TG-remnants to smaller lipid particles, including IDL and LDL. Notably, the non-...
What therapies do you offer patients who have osteoporosis and CKD and have had adverse reactions to several oral bisphosphonate therapies and denosumab?
Without further details as to the severity of CKD, the severity of the osteoporosis, and the specific intolerance issues with denosumab (and/or BPs), this is a very difficult question to provide specific advice. Some general comments can be offered: CKD stage 4-5 is essentially without fracture data...
Is the risk of hypoglycemia significantly increased when using Mounjaro in combination with metformin for management of diabetes?
By itself, neither metformin nor Mounjaro (Tirzepatide) is associated with a significant risk of hypoglycemia. But the question is, if they are combined, does the risk go up? I am not aware of any studies that have specifically looked at this question, but keeping in mind the mechanism of action of ...
Do you recommend completing a 1 mg dexamethasone suppression test for an asymptomatic incidental pituitary microadenoma?
In my experience, the yield of doing a 1-mg DST in an asymptomatic patient with a pituitary incidentaloma is very low. Accordingly, I only evaluate for Cushing syndrome in cases with some clinical evidence of underlying hypercortisolism. In contrast, I obtain at least one set of labs for prolactin a...
Would you consider PTH analogue in a patient with mildly elevated PTH?
This is a complicated question because there is not any substantial literature. Almost all clinical trials with teriparatide and abaloparatide excluded patients with elevated PTH levels. However, there is considerable anecdotal experience. I have surveyed many colleagues with considerable experience...