Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you order MODY genetic testing to discontinue unnecessary treatments such as insulin or metformin in patients misdiagnosed as either Type 1 diabetes or Type 2 diabetes?
First, I like the term Monogenic Diabetes better than MODY because it captures the concept of a single-gene mutation to distinguish it from the multi-gene/environmental factors in T1DM and T2DM. I think screening for monogenic diabetes should be considered in patients with atypical features of T1DM ...
In compensated MASH cirrhosis with frailty/sarcopenia, how do you use GLP-1 receptor agonists safely—what lean-mass or functional monitoring strategy (and stopping/adjustment thresholds) do you use to prevent harmful weight-loss–associated muscle loss while pursuing cardiometabolic benefit?
In compensated MASH cirrhosis with frailty or sarcopenia, I use GLP-1 receptor agonists cautiously (and for non-MASH indications) and pair them with structured resistance exercise 2 days a week, adequate protein intake (1.2-1.5 g/kg/day), and baseline functional assessment rather than focusing on we...
Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?
If the first biopsy was AUS and the second biopsy was Bethesda II, benign, the molecular test is not warranted. It is agreed that a second biopsy of a nodule that was AUS (Bethesda III) will be benign about 40% of the time. If the first biopsy was follciular neopasm/suspicioyus for FN (Bethesda IV),...
Do you forgo adrenal imaging in a patient with primary hyperaldosteronism who has decided against surgery?
Yes. It would be a waste of time and money. Can go straight to using spironolactone or other mineralocorticoid blocker.
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
This is a complicated question because while denosumab is a biologic therapeutic that has immunomodulatory effects on innate and adaptive immunity its association with serious infections complications appears modest. An increased rate of background infections and some increase in serious infections ...
Do you have safety concerns when prescribing GLP-1 medications in patients on corticosteroids or immunosuppressive therapy?
I think we need to be particularly careful when co-prescribing with systemic corticosteroids because of the risk of sarcopenia. We know that rapid weight loss is accompanied not only by a loss of fat tissue but also of muscle. Corticosteroids can also have myotoxicity and cause muscle atrophy. I the...
When would you consider switching from standard calcium replacement therapy to the newly approved Encaleret therapy for treatment of hypocalcemia secondary to hypoparathyroidism?
Encaleret at this time is not used to treat other hypocalcemic disorders other than autosomal dominant hypocalcemia type I (ADH 1). This genetic disorder is caused by a specific genetic gain-of-function mutation in the CASR gene that tricks the body into sensing that calcium levels are too high, eve...
How frequently would you check thyroid function in a patient who has been on amiodarone for more than one year with no prior thyroid disease and consistently normal thyroid function tests?
Amiodarone-induced thyroid dysfunction occurs in approximately 2–24% of cases. Hypothyroidism is more common than hyperthyroidism. Hypothyroidism can occur within 3 months of the beginning of Amiodarone in 10–20% of cases or may develop up to 1 year in 5–10% of cases. In some studies, the median tim...
When using cabergoline for prolactinoma treatment, at what dose do you counsel patients about the risk of valvular heart disease?
I always mention the possible risk of cardiac valvulopathy when prescribing cabergoline. However, I also mention that the studies showing evidence of possible harm were in patients with Parkinson's disease who were taking much higher doses than those prescribed for typical hyperprolactinemic patient...
What factors would lead you to extend the duration of antithyroid drug therapy in a patient with Graves' disease who is clinically euthyroid at 12 months but has risk factors for recurrence?
One should never discontinue methimazole after an arbitrary period of time without checking anti-TSH receptor antibody levels. If they are positive or even “normal” but not undetectable, the patient will inevitably have a recurrence of their hyperthyroidism relatively quickly (Laurberg et al., PMID ...