Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should we be less cautious with the use of GLP 1 R agonist therapy for patients with osteoporosis and obesity given recent data suggesting significantly lower fall and fracture risk?
The interaction of GLP-1 R agonist therapy and fracture risk is complicated, and I would not assume a decrease in risk of fracture for most patients. However, there were three recent retrospective studies that all showed decreased fracture risk following use of either semaglutide or tirzepatide when...
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?
Potassium iodide (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 follows: Lugol's solution (8 mg iodide/drop): 5-7 drops Saturated solution of potassium iodide (SSKI) (50 mg iodide/drop): 1-2 drops Minor calculated ...
How do you manage an implanted insulin pump or continuous glucose monitoring device during radiation?
We do not have an official written policy yet, but honestly, we probably should develop one, since these devices are becoming more prevalent. For CGMs, we ask the patient to place the device far from the treatment site while under treatment and to verify function with finger stick glucose measuremen...
How do you manage dose titration and nutrition to avoid sarcopenia when prescribing a GLP-1 receptor agonist in a frail older adult with MASLD?
GLP-1 and GLP-1/GIP receptor agonists as a class have been found to be effective in improving MASLD (Loomba et al., PMID 38856224) in patients with and without diabetes. This large class of drugs(more are on the way) also causes significant weight loss, and newer iterations may lower BMI into the no...
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...
Do you recommend continuous glucose monitoring for patients with Type 2 diabetes who are not on insulin?
When CGM technology was first commercialized, the sensors were bulky, uncomfortable, not very accurate, expensive, and required calibration with a blood glucose meter. Now they are quite small, comfortable, much more accurate, much cheaper, and no longer require calibration. It is a matter of time b...
How do you counsel patients on the use of peptides like tesamorelin for weight management?
There is little to no efficacy or safety data for these peptides. As such, I do not recommend these to my patients and, in fact, try to persuade patients who are interested in them or are taking them not to take them. We need more research!
Do you start a GLP-1 receptor agonist to reduce decompensation risk in an older adult with MASLD and compensated cirrhosis?
If they have an approved indication and can get coverage, I would. Need to follow a bit more closely to ensure not rapid weight loss and protein focused with resistance exercise to avoid worse lean mass loss.
For transgender females taking estrogen therapy, what is the approach to assessing the need for breast cancer screening with mammography?
Breast tissue grown with the use of hormone therapy in trans women is histologically the same as the breast tissue of cisgender women. For a trans woman of average risk, it is recommended to start screening with an annual mammogram 5 years after beginning hormone therapy, at age 40. There is not muc...
What is your approach to IV fluid management for the treatment of hypercalcemia of malignancy?
At this point, I believe one can use either saline or lactated Ringer's. There is some evidence that low-chloride-containing solutions have advantages in general, which may well be the case, but we need more data on that. The amount of calcium in LR is very small and should not make a difference (1....