Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you routinely recommend delaying dental extractions in patients who have recently received intravenous bisphosphonate therapy for osteoporosis treatment?
I don't because the risk of osteonecrosis of the jaw (ONJ) is very low.
When do you consider scheduled or more frequent POC blood glucose checks in hospitalized patients who are either not eating or otherwise at high risk for hypoglycemia?
Standard q6h (before meals + bedtime) monitoring is insufficient for patients who are NPO or at high risk for hypoglycemia. Evidence supports more frequent or scheduled monitoring in the following scenarios: 1. NPO/not eating Every 4–6 hours is recommended for NPO patients on basal insulin alone (E...
Would you start romosozumab in an active smoker?
This is not simple! But we are good at assessment of risk vs benefit (or benefit vs risk!)First I would reassess fracture risk, prior treatments, reason to consider romo. Then I would do a deep dive into risk assessment for cardiovascular disease: how much do they smoke, prior cardiovascular disease...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...
What patient factors are most important when considering who needs a broader workup for osteoporosis prior to starting therapy?
A workup to rule out secondary causes must be done prior to starting therapy for osteoporosis. A good history and exam are recommended to look for any clues for modifiable factors. At a minimum, one should do CMP, 25-OH vitamin D, TSH, and a 24-hour urinary calcium or calcium/creatinine ratio should...
Do you discontinue statin therapy when patients reach LDL levels way below their target goal with PCSK9 inhibitor therapy?
I will not routinely adjust statin dosing in patients on PCSK9 inhibitors unless their LDL levels fall below 15-25 mg/dl. In which case, I will reduce statin dosing to allow the LDL to rise above 15-25 mg/dl.
When can we consider deferring an insulin drip in patients with hypertriglyceridemia-induced pancreatitis?
Serum triglyceride levels >500 mg/dL (5.6 mmol/L) are required for hypertriglyceridemia to be considered the underlying etiology of acute pancreatitis (UpToDate).For patients with severe hypertriglyceridemic pancreatitis, such as those serum triglyceride levels >1000 mg/dL plus lipase >3 times the u...
Under what clinical circumstances, if any, would you prescribe fenofibrate along with statin therapy?
Yes, I do sometimes combine fibrates and statins. Usually, it’s in the setting of needing to treat severe hypertriglyceridemia with the fibrate in a patient who also has hypercholesterolemia and an indication for a statin. If a patient is on a statin and still has mild to moderate hypertriglyceridem...
Would you start a mineralocorticoid receptor antagonist in patients with unilateral primary aldosteronism while they are awaiting adrenalectomy?
It depends on their blood pressure and potassium levels. Some of our patients are already on MRA at the time of their diagnosis without a need to get off the medication. Others may be started or returned to MRA after completing their biochemical workup. We recommend stopping MRA on the day of surger...
In patients with MASLD/MASH, do you perform any cardiac testing to create a patient's risk profile, given that cardiac complications are the top cause of morbidity and mortality in this patient population (especially those with advanced fibrosis)?
Yes. I routinely perform cardiovascular risk assessment in patients with MASLD or MASH, but I recommend risk‑based cardiovascular evaluation rather than routine cardiac testing for all patients. Cardiovascular disease is the leading cause of morbidity and mortality in MASLD and MASH, particularly in...