Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
In patients using a tandem insulin pump on auto-mode/Control-IQ, would decreasing the basal settings on the profile actually reduce the delivered hourly insulin dose or is that only relevant if they switch to manual mode?
In the control IQ, the basal adjustment IS relevant in Auto-mode. The algorithm uses predicted CGM reading in 30 minutes (in the future) and responds to keep the glucose by CGM in the targeted range. See below: Above 160 mg/dL, basal insulin rate increases Above 180 mg/dL, a correction bolus is giv...
Can cinacalcet be used short-term to manage hypercalcemia from tertiary hyperparathyroidism in advanced CKD while awaiting parathyroidectomy?
Yes, cinacalcet can be effective to manage hypercalcemia in CKD-induced hyperparathyroidism.
How far in advance of a nuclear medicine thyroid update and scan should thionamides be discontinued and does this duration vary based on radio-isotope used (i.e. technetium versus RAI 123)?
The length of time I hold the thionamide depends on the nature of the underlying thyroid disease rather than the isotope used. If the patient is mildly hyperthyroid or well-controlled on low-dose thionamide (such as in a toxic nodule or toxic MNG), then I will hold the medication longer (1-2 weeks)....
How should PCOS be addressed after menopause?
I approach all patients with PCOs by assessing their risks and their main concerns. Premenopausal women are frequently concerned about irregular menses, infertility and hyperandrogen symptoms. For post menopausal women, the hyperandrogen symptoms continue and I will manage with spironolactone, consi...
Is there any evidence that spironolactone or finasteride therapy increase blood levels of testosterone?
Yes. It seems that both medications can do this at least in the short term. Spironolactone's effect may be more temporary.For spironolactone, an older article: Tidd et al., PMID 152681For finasteride: Stanczyk et al., PMID 23474436
Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?
When ZA is in its early days patients had to have a D level of 15ng/ml. To be on the safe side most of us want a 25 ng/ml level which is easy to obtain.
What is your experience with using anabolic therapy for treatment of osteoporosis in patients with EtOH cirrhosis and is one agent preferred over another (PTH analogue vs Evenity)?
The approach that has been recommended may be reasonable. It is important to recognize that a bone density score consistent with osteoporosis does not necessarily mean that the patient has osteoporosis i.e. loss of mineral and matrix. Osteomalacia, a mineralization defect of the collagen elastin mat...
Are SGLT2 inhibitors contraindicated in patients with osteoporosis and history of vertebral and hip fractures?
In ovariectomized mice, the GLP-1 agonists were found to improve bone density by reducing the inflammation in the bone marrow so there is no contra-indication for a patient with osteoporosis and vertebral fractures to take this class of medications. It is the first weight loss therapy that is not as...
Is the 6-month post-operative calcium level a good indicator of patients' risk of recurrence of primary hyperparathyroidism?
Probably, yes - see recent study: Hellums et al., PMID 40705364.
Would you recommend changing a patient from the pill form of levothyroxine to Tirosint-SOL if they are started on a proton pump inhibitor?
While it is true that PPI's may lead to a decrease in levothyroxine absorption due to decreased tablet dissolution in the stomach (Guzman-Prado et al., PMID 33469743), and that liquid formulations are not susceptible to this effect (Seng Yue et al., PMID 38554774), the decrease in levothyroxine abso...