Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
In patients with severe osteoporosis, history of retinal artery occlusion, and hypercalciuria, would you favor PTH analogue therapy or Evenity?
Assuming that PTH and vitamin D are normal, neither. Chlorthalidone is the treatment of choice in this scenario. Chlorthalidone is usually better than HCTZ, as HCTZ often must be given BID, whereas chlorthalidone can be given daily. I have seen very large improvements in BMD with thiazide therapy, o...
In adults ≥80 years with TSH 6–10 mIU/L and minimal symptoms, do you initiate levothyroxine, monitor, or avoid treatment entirely?
I tend to check free T4 in this situation. Aging is associated with some elevation in TSH value up to 10 mIU/L with normal free T4, and in those patients, levothyroxine is not needed. In some patients, I have seen it rise above 10 with normal free T4. Supplementing levothyroxine to lower serum TSH w...
Would the diagnostic yield for ABIs or peripheral arterial duplex doppler in a patient with metal rods in both legs be similar or acceptable in comparison to those tests in a patient without metal rods?
Ankle-brachial index(ABI) relies on the compression of upper and lower extremity arteries with blood pressure cuffs and measuring the ratio of blood pressure between them. While I am not aware of specific studies in those with metallic rod fixation, ABI measurements should have similar utility as lo...
Does oral Wegovy have a worse side effect profile compared to its injectable version?
From a clinical standpoint, I would say that oral semaglutide does cause more nausea and other GI side effects than injectable semaglutide for comparable doses. I am not aware of any randomized trials looking at this question, but there are single-center retrospective studies corroborating my impres...
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-...