Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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 do you counsel patients that are positive for both stimulatory and inhibitory autoimmune thyroid markers (TRAb, TSI and TPO Ab) regarding their likelihood of flipping from hyperthyroidism to hypothyroidism?
I do not measure multiple thyroid antibodies simultaneously at the time of initial diagnosis, so this is typically not a conversation I would have at initial patient presentation. My usual practice is to check a TSI in patients with hyperthyroidism and a TPO in patients with new hypothyroidism. In p...
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...
Do you immediately discontinue sulfonylureas when initiating GLP-1 receptor agonists in patients with longstanding type 2 diabetes?
In a patient with an A1c <8% or with current issues with hypoglycemia while taking a sulfonylurea (SU), I would discontinue the sulfonylurea at the time I prescribe any highly effective medication for type 2 diabetes, including a GLP-1-based therapy. That would be with instructions to the patient to...
When should you consider adding clonidine to an antihypertensive regimen for patients with advanced CKD?
Clonidine patch is useful in severely uncontrolled hypertension. In patients with CKD, not responding to conventional medications - like calcium blockers. Though the side effect profile is not great, it is less expensive and practical.
What is your approach to the management of incidentally elevated HDL levels in isolation and is there any utility for further ASCVD risk stratification and/or genetic testing for lipid disorders?
Although the U-shaped curve for HDLC and ASCVD was a surprise (probably missed until huge population cohorts were studied), the data have been reasonably confirmed in many studies now, with some heterogeneity regarding gender as well as CVD vs total mortality. If I see a patient now with an HDL over...
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...
How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?
Phentermine has been available since 1959 and remains an affordable and effective medication option added to a full lifestyle-based weight management plan. In people who are generally healthy and without contraindications to the medication, I have had patients used in at least intermittently for sev...
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...
Would you favor the use of denosumab over bisphosphonate therapy for treatment of osteoporosis in patients who are at high risk for osteoarthritis given recent data suggesting reduced risk of developing knee OA?
Although the overall data to date concerning the impact of denosumab to reduce incident knee OA or lessen established disease remain limited, there are sufficient signals that warrant further investigation and support the need for an appropriately powered RCT with endpoints that include both patient...