Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you still consider propranolol first-line for sinus tachycardia in thyroid storm, or have newer perspectives on beta-blocker risks altered your management?
Yes, but...Propranolol remains the first-line option for thyroid storm, but recent evidence supports that beta-1 selective agents (metoprolol, atenolol) are equally effective and may be preferred in certain clinical contexts. The choice between propranolol and cardioselective beta-blockers should be...
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: Fleseriu et al., PMID 40555795"Screening should be performed for clinical suspicion based on features and/or comorbidities suggestive of Cushing disease, even in the absence of classic hypercortisolism c...
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...
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 ...
How do you counsel patients on the risk of hypothyroidism after radioactive ablation for hot nodules?
I tell my patients that the eventual likelihood of developing hypothyroidism after radioactive iodine treatment for autonomous thyroid nodules is dependent on the administered activity, but may be as high as 60%. Demir et al., PMID 35537668 Ceccarelli et al., PMID 15730415
Do you have a preference between RAI therapy and antithyroid medication for patients with Graves' hyperthyroidism and moderate-to-severe Graves' orbitopathy who are on glucocorticoid treatment?
I caution using RAI in Graves' disease with moderate to severe orbitopathy if I can. Surgery, if you have access to a high-volume thyroid surgeon, may be better vs long-term antithyroidal therapy. Obviously, a lot of individual patient factors can play into this decision. I would also avoid RAI for ...
Is there any benefit to trend testosterone and DHEA-S levels in patients with PCOS to determine response to therapy?
A recent guideline for the diagnosis and management of PCOS in patients states: “Repeated androgen measures for the ongoing assessment of PCOS in adults have a limited role” (International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023). That said, I thi...
What are the indications, if any, for trending ACTH and cortisol levels in patients with adrenal insufficiency on steroid replacement therapy?
The only indication is if the patient has steroid-induced adrenal insufficiency and you are planning to wean the patient off steroids. In that case, I usually measure early AM cortisol and ACTH every 8 weeks. An increase in ACTH will be the first sign of HPA axis recovery. During this process, ACTH ...
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.
What is the rationale behind the Anesthesiology recommendation to hold one dose of weekly GLP-RA prior to general anesthesia?
There is evidence that people treated with GLP-1 receptor agonists (GLP-1RA) more often have residual food in the stomach after an overnight fast and greater gastric volume. There is anecdotal evidence of aspiration events in people treated with GLP-1RA. The ASA statement raises a concern and provid...