Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you recommend using intermediate-acting insulin over long-acting insulin for the management of steroid-induced hyperglycemia?
It depends on the dose of the steroids being used and whether the steroid use is for a short period or for prolonged chronic use. If the dose of the steroid is high and the use is intended for a short time, use of a short acting insulin may be preferred to combat the hyperglycemia, If the steroid us...
How do you approach therapy for severe osteoporosis after an initial 12 months of romosozumab?
After 12 months of romosozumab, most likely the patient will still need additional therapy. If you can get a bone mineral density, that can guide you into what the best next medication can be. If the patient still has significant osteoporosis or fracture during the treatment with romosozumab, I woul...
Should a different weight-based dosing algorithm for levothyroxine therapy be considered in women versus men given higher incidence of iatrogenic thyrotoxicosis in women?
I do not. For the majority of my patients, my starting dose is 1.6 mcg/kg, which is in the ATA guidelines (1.6-1.8 mcg/kg has been recommended as the starting dose in many publications). There have been some studies that show using ideal body weight is a better predictor of LT4 dose, and others tha...
For non-functional pituitary macroadenomas, how effective has cabergoline been in reducing tumor size or preventing the need for surgery?
There is some literature suggesting that a modest effect is seen in preventing tumor regrowth in previously operated NFPA (Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists). The data on primary therapy is less convincing.Topic reviewed recently in Pharmacological Trea...
Given the new 2022 WHO classification of pituitary tumors, should we be regularly counseling our patients about the risk of malignancy for what we previously referred to as pituitary adenomas but now classified as pituitary neuroendocrine tumors (PitNETs)?
Absolutely not. Metastatic pituitary adenomas are exceedingly rare. The term PitNet is unnecessarily alarming for patients with these benign disorders and also does not provide a clinically relevant outcome classification. Accordingly, The Pituitary Society has not adopted the term PitNet and prefer...
Would you evaluate for an ectopic source in a patient with persistently elevated IGF-1 level but no clinical features of acromegaly or evidence of pituitary abnormalities?
Is this an IGF-1 drawn in the same lab? This may be falsely elevated. If so, I would repeat in a different lab or confirm/rule out acromegaly diagnosis by glucose suppression test. If the diagnosis is confirmed, measurement of GHRH to rule out a GHRH-secreting NET would be the next step.
Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?
In short, no. I think the recent studies tell me two things: We need to better discriminate correction rates based on the risk of osmotic demyelination (ODS). Perhaps, do not worry so much about over-correction. They do not tell me to start rapidly correcting patients, and I guess I will summarize m...
Do you start a statin concurrently with icosapent ethyl for patients with moderate hypertriglyceridemia and high ASCVD risk, or do you prefer to start a statin alone and monitor triglyceride levels?
Statin therapy can lower TGs modestly (up to 20%) and are the first line therapy for ASCVD risk reduction. Therefore I usually initiate statin therapy first and reassess lipids prior to considering use of icosapent ethyl. Additionally IPE adds pill burden (need to take 4 g a day), so I prefer to wai...
How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?
I would first determine if there are other medications the patient is on that reduce the blood glucose. Hypoglycemia with SGLT-2 inhibitors is usually due to something else. Another medication is most likely. Could be very poor dietary intake. Could lower the dose if not on the lowest available dose...
When do you recommend screening patients with T2DM for heart failure?
Heart failure is increasingly being recognized as a complication of diabetes. Heart failure is classified in 4 stages. Stage A is “at risk” because of diabetes, stage B is asymptomatic for the patient but with detectable cardiac abnormalities and then stage C and D are symptomatic stages of heart fa...