Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is it safe to use acarbose in patients with advanced chronic kidney disease?
Yes, I think so.
How do you approach vitamin D supplementation in patients with chronic kidney disease, given the findings that vitamin D2 supplementation may lead to decreased conversion of 25-hydroxyvitamin D3 to 1,25-dihydroxyvitamin D3?
In early 2000, there was a publication suggesting that ingesting vitamin D2 increases the destruction of vitamin D3 and therefore could increase the risk for vitamin D deficiency. Although I had never seen this happen in my clinic, we decided to conduct a study to evaluate what the effect of vitamin...
How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?
SGLT2-inhibitors have been known to precipitate episodes of diabetic ketoacidosis(DKA) with glucose levels far lower than are usually seen in DKA. This has been called euglycemic DKA. SGLT-2 inhibitors cause an increase in the glucagon to insulin ratio, which promotes ketosis, as well as fluid loss ...
Is the presence of ubiquitin-specific peptidase 8 (USP8) genotype helpful in determining the risk of Cushing disease recurrence?
Indeed, a recent retrospective, multicenter, international study (Zhang et al., PMID 41785910) reported that patients with USP8-variant tumors are more likely to experience recurrence of Cushing's disease in comparison with patients with microadenomas that are USP8-wildtype (37% vs. 15% at 10 years)...
What new or emerging therapies for autoimmune gastritis are available beyond iron and vitamin B12 replacement?
Though we recognize autoimmune gastritis (AIG) as an autoimmune disease that targets antigens expressed on parietal cells of the stomach, there are currently no effective treatments to reduce gastric inflammation and to prevent parietal cell loss. Back in the 1960s, small studies looked at the role ...
When do you think physicians should seriously consider prescribing PCSK9 inhibitors for the prevention of heart attack and stroke in people with ASCVD or diabetes, based on the results of the VESALIUS-CV trial?
Although I checked 'high lipoprotein (a) as a reason to go with a PCSK9 first, I would almost never do it is practice. Statins first and then add a PCSK9 if LDL is above my goal for the patient. I might use a lower dose of the statin to get 35% lowering and then add the inhibitor if the patient was ...
What factors do you consider when deciding what type of glucagon preparation to prescribe for rescue hypoglycemia in patients with diabetes on insulin therapy?
Whatever form of ready to use glucagon is covered by insurance!
How would you approach GLP-1/GIP agonist use for MASLD management in a patient who had a prior episode of pancreatitis?
If the etiology of pancreatitis has resolved (i.e., alcohol use and the patient has achieved abstinence or status post cholecystectomy for gallstone pancreatitis), then I may consider a repeat trial of GLP-1/GIP for MASH with fibrosis when there is a need to address the extrahepatic risk factors (ob...
What further endocrine work up do you recommend for chronically elevated bone specific alkaline phosphatase levels in young asymptomatic patients with normal nuclear bone scan results and no evidence of osteomalacia?
I am sure that you are aware that the differential diagnosis for an elevated alkaline phosphatase includes Paget's disease, vitamin D deficiency, hyperparathyroidism, hyperthyroidism, occult malignancy, bone metastases, and primary bone tumors. A normal bone scan helps to eliminate many of these. Bu...
What patient factors do you consider when selecting between a small interfering RNA, like inclisiran, and PCSK9 inhibitors in patients with recent acute coronary syndrome?
Insurance coverage and out-of-pocket costs usually drive my choice. It is fairly easy to get approval for evolocumab for most of my patients. I have had a hard time getting approval for inclisiran with the exception of those with traditional Medicare + supplemental medication coverage. I usually sta...