Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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 trans-sphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this ca...
Do you recommend restarting GLP-1RA after bariatric surgery if they 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 ...
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 require levothyroxine to be taken on an empty stomach in patients with stable hypothyroidism, or is dosing with breakfast acceptable with dose adjustment?
Ideally, levothyroxine should be taken on empty stomach but if a patient is taking it with breakfast and has a stable normal TSH, it is okay to continue but if TSH fluctuates change to empty stomach.
Is the risk of hypoglycemia significantly increased when using Mounjaro in combination with metformin for management of diabetes?
By itself, neither metformin or Mounjaro (Tirzepatide )is associated with a significant risk of hypoglycemia. But the question is that 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...
How do you decide when to evaluate for central hypothyroidism in a patient with low-normal TSH and low free T4?
The differential in these patients is 1)mild subclinical hyperthyroidism 2)central hypothyroidism 3)normal variant related to assay detection limitations.It would be important to obtain a good history and try to identify if any hypothyroid or hyperthyroid symptoms. Having said that patients will usu...
Do you recommend completing a 1 mg dexamethasone suppression test for an asymptomatic incidental pituitary microadenoma?
yes, if the patient has any feature of hypercortisolism such as DM, HTN, osteoporosis etc.See: Pituitary incidentaloma: a Pituitary Society international consensus guideline statement - PubMed"Screening should be performed for clinical suspicion based on features and/or comorbidities suggestive of C...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
Treatment of hyponatremia due to adrenal insufficiency with glucocorticoid therapy may result in overcorrection of serum sodium due to suppression of ADH and resultant water diuresis. Therefore, serum sodium, urinary osmolality and urinary output should be closely monitored. A brisk water diuresis w...