Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What are your preferred lipid-lowering agents and target LDL reduction goal following initiation of therapy for patients with familial hyperlipidemia without underlying CAD?
It is not easy to address this question without specifics of the 'familial hyperlipidemia," but I will give examples: Monogenic familial hypercholesterolemia - since the LDL is very high from early childhood, we tend to treat adolescents with statins with a goal of a 50% reduction (20 or 40 rosuvas...
Would you order a repeat DEXA scan 1 year later for a kidney transplant patient who had an initial DEXA scan within the first 6 months post-transplant showing osteopenia but no history of fractures, and who has been stable on glucocorticoid-free immunosuppressive therapy?
I agree with Dr. @Dr. First Last. Bone metabolism in renal transplant is woefully shy of good data. My opinion is to monitor Vitamin D levels, provide appropriate supplementation, and monitor PTH levels, using cinacalcet as needed. My target level for PTH is 1-2x the upper limit of normal, also base...
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...
In patients with iron deficiency due to history of gastric bypass or IBD, would you consider oral iron therapy if the iron deficiency anemia is mild?
Oral iron can often be effective in iron deficiency, as long as absorption is intact. If you are concerned about absorption, performing an oral iron challenge can be useful in allowing you to avoid long trials of oral iron that will be ineffective. Simply check an iron panel at baseline, then admini...
Do you recommend restarting a GLP-1RA after bariatric surgery if the patient tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...
Do you escalate to 7.2 mg semaglutide in a patient with obesity who has not achieved their weight loss goal on the 2.4 mg dose despite the increased risk of dysesthesia at the higher dose?
This question is raised because of a recent report (Wharton et al., PMID 40961952) looking at weight loss in obese patients titrated up to 7.2 mg/week of semaglutide compared to the usual dose of 2.4 mg/week. The study was funded by Novo Nordisk, and the authors have strong financial ties to the com...
When starting GLP-1 R agonist therapy for weight loss purposes, how do you counsel patients on duration of treatment therapy?
I counsel people that I expect this to be lifelong therapy (similar to how we don't stop blood pressure medications when blood pressure comes down to normal on them because it will go back up, we don't stop GLP1RA when we get to our weight goals, as our weight will go back up when they are stopped)....
How do you counsel patients on semaglutide or tirzepatide in light of potential cancer risks?
Use of GLP 1 RAs has sky-rocketed in recent years due to what seems to be a positive class effect on T2DM, weight loss, renal outcomes, cardiac outcomes and hepatic outcomes. I am not aware of any signals of increased malignancy risk. A brief literature review found meta-analyses showing possible be...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
Does your LDL goal change in elderly patients with diabetes and hyperlipidemia who are on statin therapy?
First, what is an elderly? I will be 81 next month, and I don't consider that young, but also not too elderly to try to protect myself from an event. This patient is a high/very high risk, and if he is at a good goal on a statin, why would anyone want to change the dose? I tell my patients that surv...