Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is the Enhanced Liver Fibrosis (ELF) test superior to the FIB-4 test in the diagnosis of MASLD?
In terms of diagnostic accuracy for advanced fibrosis in MASLD, ELF is superior to FIB-4; however, here are the caveats to consider: FIB-4 is a simple and readily available test that is best used to rule out advanced fibrosis (high negative predictive value), and ELF is best used to rule in advanced...
When starting stress dose steroids for patient with primary adrenal insufficiency, how do you decide whether to start hydrocortisone 100 mg every 8 hours versus 50 mg every 6 hours?
Stress doses of steroids in patients with primary adrenal insufficiency depend on the anticipated stress. The dose of steroids can be doubled or tripled depending on the stress. For example, in cases of maximal stress such as major surgery, the dose can be similar to the dose used for an adrenal cri...
What are some of the benefits of the newly approved Lerochol drug over traditional PCSK9 inhibitors for the treatment of familial hyperlipidemia?
Lerodalcibep was approved this past December and uses a different mechanism to inhibit PCSK9. Its potential advantages include once monthly dosing and stability at room temperature for 3 months. It appears to have similar efficacy to the PCSK9 monoclonal antibody therapies lowering LDL 55-60%. Disad...
Would you consider the use of romosozumab in men who have failed therapy with teriparatide and sustained multiple vertebral fractures?
Yes, I would consider Romosozumab for the male patient. I would check his cardiovascular status due to concern of the possible increased risk for a cardiovascular event on the medication, which could be a contraindication. However, before initiating therapy, it would be helpful to know some of the s...
What are your preferred lipid-lowering agents and target LDL reduction goal following initiation of therapy for patients with familial hyperlipidemia without underlying CAD?
It is not easy to address this question without specifics of the 'familial hyperlipidemia," but I will give examples: Monogenic familial hypercholesterolemia - since the LDL is very high from early childhood, we tend to treat adolescents with statins with a goal of a 50% reduction (20 or 40 rosuvas...
How do you counsel patients on timing of their medications when they are taking both oral semaglutide and levothyroxine?
I have no personal experience with the situation that you describe. However, it is well known that Levothyroxine should be taken on an empty stomach, because several foods such as high fiber meals, coffee, calcium, and iron supplements can bind to levothyroxine and significantly reduce its effective...
What doses of methimazole do you consider "low dose" when treating Graves' disease long-term?
"Low dose" methimazole is traditionally considered to be doses of <5-10 mg a day, but I think the definition should be 5 mg or less a day. Indeed, some patients can be controlled on 2.5 mg a day, and I have several patients with normal thyroid function who have taken 2.5 mg every other day for sever...
Would you prescribe testosterone to a post-menopausal woman for low libido and/or fatigue symptoms assuming all other work up is unremarkable?
I have never prescribed testosterone to women for decreased libido, if the other workup is normal. In addition, if you explain the side effects, such as increasing hirsutism, most women opt out of taking testosterone for this purpose.
When would you consider treating growth hormone deficiency in surgically treated acromegaly with longstanding low IGF-1 levels?
I would not treat unless there are clinical features of GHD.
Is there a maximum duration for raloxifene use?
There is relatively scant data on long-term raloxifene use in patients with osteoporosis, but generally, there are no recommendations for a drug holiday. The primary endpoint in the pivotal registration trial, MORE, was incidence of vertebral fracture, and the difference between the raloxifene and p...