Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is there a role for using continuous glucose monitors for perioperative glucose monitoring in patients with diabetes?
Use of continuous glucose monitors is becoming more widely accepted for outpatients with diabetes to manage their glucose. Many hospitals now allow patients to continue to use their CGM when admitted, though most require some hospital monitoring as well. During the early phases of COVID, ICUs starti...
Should all kidney transplant patients be started on statin therapy post operatively given their increased risk of CVD?
A kidney transplant is not an indication for statin therapy per se. The 2018 cholesterol guidelines list CKD (but not ESRD or Transplant) as a risk-enhancing factor. I would guide the decision to use statin therapy based on the patient's risk as assessed for non-transplant patients. Having said that...
Is thyrotropin receptor antibody a good biomarker to predict development of thyroid eye disease?
Patients with thyroid eye disease usually have positive TRAb or TSI but in patients with Graves' hyperthyroidism it does not help predict the development of eye disease which is much less common than hyperthyroidism.
Do you recommend non-bypass bariatric surgeries over intestinal bypass procedures for kidney transplant-eligible candidates to prevent oxalate nephropathy, given the higher risk of kidney oxalate deposition with intestinal bypass?
Yes, my preference is for non-bypass bariatric surgery in my patients with severe obesity and sleeve gastrectomy is preferred. However, the GLP-1 agonists have really had an impact on weight loss in transplant patients and transplant candidates alike. There was a nice editorial by Lorden and Parajul...
Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?
Considering the boxed warning to stop Evenity in a patient who has a stroke or MI while receiving it, yes, I would stop it. It is the prudent thing to do. However, I know of no evidence of harm with continuing it, and I might consider continuing it if the balance of benefits and risks were overwhelm...
How do you manage osteoporosis treatment following parathyroidectomy for primary hyperparathyroidism?
Good question and I usually do this with input from an endocrinologist. I monitor serum and urine calcium and provide supplements and if the bone mass declines, I consult an endocrinologist on the next steps. As a rheumatologist, I am not an expert on this issue.
How should patients time the ingestion of their alendronate and levothyroxine given issues with food/drug interactions?
Since the half-life of levothyroxine is 7-10 days, you can double the dose of Levothyroxine on 1 day and then the next day take only the alendronate. There will not be a significant change in T4 levels.
What factors guide you in adjusting the dose of fludrocortisone in a patient with primary adrenal insufficiency?
Adjustment of the dose is generally based on clinical factors. Orthostatic blood pressure should be measured on each visit with normalization of blood pressure as a goal. Also electrolytes should be measured each visit to make sure potassium levels are normal and a supplement added if need it. Lower...
What is the typical timeline for remission of autoimmune hypoglycemia?
Insulin autoimmune syndrome (IAS) or Hirata disease is a rare disorder characterized by hypoglycemic episodes due to the presence of high titers of insulin autoantibodies (IAA). The disease was first described in 1970. Because of its rarity, large clinical experiences with this disorder are limited....
What work up do you recommend in post bariatric surgery patients who are slowly gaining back the weight despite no changes in diet?
Depending on which surgical procedure they had and how long ago they had it, patients may need evaluation by their surgeon. Meanwhile, I approach these patients similarly to patients who have not had surgery. I look for reasons for their weight gain such as change in diet (even if patient denies it ...