Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you approach adjusting insulin pump settings in patients who have received intra-articular corticosteroid injections?
Managing steroid-induced hyperglycemia in patients with diabetes has always been a difficult problem, and guidelines are hard to come by. Glucocorticoids cause increased insulin resistance and an increased need for insulin. The steroid effect on glucose is greater in the post-prandial state than the...
Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?
Hypocalcemia can be prevented by providing adequate calcium, 1,200-1,500 mg in divided doses daily, and adequate calcitriol to absorb it. Good results also occur when the patient has tertiary hyperparathyroidism with hypercalcemia.
Do you change your pre-operative insulin dosing when patients are NPO for surgery, but also just recovering from newly resolved DKA?
For patients immediately recovered from DKA (e.g., within 72 hours), my first priority would be to delay any non-emergent surgery until the etiology of DKA has been evaluated and (if possible) addressed and the DKA has been definitively resolved with conversion off of continuous insulin and resumpti...
What empiric dose change, if any, do you make for patients already taking liquid or softgel levothyroxine preconception upon confirmation of a positive pregnancy test?
Based on the Alexander et al., PMID 15254282, it is recommended to increase Levothryoxine from 7 to 9 tablets/week and check TSH and Free T4 when possible. Repeat TFT should be checked every 4 weeks until after 20 weeks of gestation with T4 adjustment to keep TSH.
How do you counsel cancer patients when they ask if they should avoid sugar?
“We don’t have evidence to support any specific diet that can either worsen or improve outcomes. I encourage a healthy, well-balanced diet with my top priority being you maintaining your weight during treatment.” Particularly for my head and neck patients, getting in sufficient calories is of the ut...
Is there an evidence-based consensus on CT-derived Hounsfield unit thresholds for opportunistic assessment of osteoporosis, and how should such measurements be applied when DXA results are inconclusive or do not meet diagnostic criteria?
Per the International Society for Clinical Densitometry's official positions: "Opportunistic CT-based attenuation using Hounsfield Units (HU) can be used to estimate the likelihood of osteoporosis (L1 HU < 100) and normal (L1 HU > 150) bone density to support decisions regarding bone health assessm...
How would you work-up an older male patient with elevated testosterone-level-for-age?
To rule out CAH, testosterone-producing tumors, and a spurious rise due to elevated SHBG.
How often do you re-screen with autoantibody testing for type 1 diabetes if the initial test is negative in a patient with primary adrenal insufficiency?
The American Diabetes Association does not recommend periodic screening for islet cell antibodies in patients with Addison disease unless there is suspicion for autoimmune polyendocrine disorder. So the answer is not to re-screen unless there is hyperglycemia present.
When can we consider deferring an insulin drip in patients with hypertriglyceridemia-induced pancreatitis?
Serum triglyceride levels >500 mg/dL (5.6 mmol/L) are required for hypertriglyceridemia to be considered the underlying etiology of acute pancreatitis (UpToDate).For patients with severe hypertriglyceridemic pancreatitis, such as those serum triglyceride levels >1000 mg/dL plus lipase >3 times the u...
What is your approach on the pursuit of bariatric surgery in a patient with advanced fibrosis?
I ensure that patients are evaluated by a multidisciplinary team with expertise in hepatology, bariatric surgery and liver transplantation. Patients with advanced hepatic fibrosis without portal hypertension may potentially undergo bariatric surgery as significant weight loss and improvement in insu...