Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?
Yes, in a patient who absolutely cannot take a statin or other common alternatives such as ezetimibe, PCSK9 inhibitors, or Bempedoic acid, Niacin for ASCVD risk reduction is still a reasonable choice. While the combination of statin and niacin has been shown to be unhelpful (and possibly of greater ...
Is it reasonable to tell patients that Evenity lowers fracture risk by about 70%, while Prolia reduces it by around 50%?
It depends on the skeletal site. A 3-year fracture relative risk reduction study of Prolia versus placebo revealed a 68% reduction in new vertebral fractures, a 40% reduction in hip fractures, and a 20% reduction in nonvertebral fractures. (Cummings et al., PMID 19671655) The relative risk of new ve...
Would you recommend the 1-hour OGTT over the 2-hour OGTT for postpartum glucose tolerance testing in women with previous gestational diabetes?
I would consider going straight to the 2 hour OGTT. I would screen in first and second trimester.
What is your approach to tapering chronic steroids in patients who are at high risk of HPA suppression?
There are rare cases when the adrenal function never seems to recover. The ACTH recovery happens before cortisol so that it can be monitored as a marker. When I get a consult about tapering GCs in a patient on long-term therapy, I usually let the primary team (e.g., rheumatologist) cut back on predn...
Is a history of provoked DVT a contraindication to starting testosterone replacement therapy in a middle aged man with symptomatic hypogonadism who is on anti-coagulation?
The data on testosterone replacement and thromboembolic disease is not so clear but there is likely a link and should be noted in patients at high risk (e.g smoking, prior event, erythrocytosis). It’s important to discuss the risk benefits with the patient but as long as they are on anticoagulation,...
Can anabolic agents be used in a patient with history of radioactive iodine treatment for hyperthyroidism?
This is an interesting question. When PTH was approved it had a black box warning for patients who had a history of radiation to the skeleton due to risk of potential osteosarcomas. The black box has been removed for the duration of use. Since we have another anabolic agent without that black box, I...
For patients on desiccated bovine thyroid hormone therapy, how do you approach transitioning to synthetic thyroid hormone derivatives?
The US Pharmacopoeia specifies that a1 grain (65 mg) dose of desiccated thyroid have approximately 38 mcg of T4 and 9 mcg of T3 (Blumberg et al., PMID 3598896). If T3 is approximately 3-4 times as metabolically potent as T4, then 65 mg of desiccated thyroid has about 38 + (4 x 9) = approximately 75 ...
Do you recommend switching from a GLP-1 agonist to insulin in female patients with type 2 diabetes who are planning to become pregnant?
Animal studies have indicated a potential for reproductive toxicity at maternally toxic doses of Semaglutide, Dulaglutide and Exenatide.Due to the paucity of data with Semaglutide and Human pregnancy, the manufacturer advises stopping the drug 2 months before conception.However, in a multicentric st...
Is Metformin contraindicated in patients using long term oxygen therapy at home?
If a patient is stable at home without hypoxia on oxygen and eGFR is over 30 cc/min, I would be comfortable with prescribing metformin at a dose appropriate to the eGFR. Metformin should be stopped for any pulmonary decompensation or hospital admission.
Would you start octreotide in a patient with suspected sulfonyurea overdose but without frank hypoglycemia?
The data in the literature supports treating with Octreotide once hypoglycemia is present. Otherwise, a watchful, waiting period would be employed. It is reasonable to have a low threshold for its use once indicated, given how prolonged and profound the hypoglycemia can be in this situation.