Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
For patients with metabolic syndrome, is it reasonable to wait for the effect of tirzepatide therapy on their lipid profile prior to starting statin therapy?
While tirzepatide has shown significant improvements in lipid profiles, including reductions in total cholesterol, LDL cholesterol, and triglycerides, and increases in HDL cholesterol, these effects should be considered complementary to, rather than a replacement for, statin therapy.
What is your approach to management of hyperlipidemia in patients taking JAK inhibitors?
The ORAL Surveillance Study published in the NEJM in 2022 was a phase IIIb/IV open-label noninferiority study in RA patients over the age of 50 with at least one cardiovascular risk factor. The aim was to demonstrate that JAK inhibitors were non-inferior in terms of major adverse cardiovascular even...
Do you recommend the use of GLP1 R agonist therapy in patients with T1DM for weight loss?
GLP-1 agonists can be used as off-label in patients with Type 1 DM and obesity to help with weight loss; improve Hb A1c and decrease insulin requirements.A meta-analysis by Tan et al., PMID 38249345 of 11 RCT comprising 2,856 patients with Type 1 Diabetes and the use of GLP1 agonists as an adjunctiv...
Do you recommend parathyroid adenoma resection or ablation for patients with primary hyperparathyroidism and recurrent nephrolithiasis who are found to have a single gland adenoma on parathyroid ultrasound and nuclear medicine imaging?
Yes. My two indications for ablation/resection of a proven parathyroid adenoma are (1) metabolically active calcium-based kidney stone disease and/or (2) osteopenia/porosis as identified by bone scan. I think there is strong evidence that primary hyperparathyroidism can cause either or both. In the ...
Would you recommend cinacalcet for patients with recurrent nephrolithiasis who have hypercalciuria despite thiazide diuretic use and who also have an elevated PTH level without localizing parathyroid adenoma on imaging?
This is a tricky question with a nuanced answer. If the hyperparathyroidism is secondary, cinacalcet may have a role in treatment along with normalizing serum phosphorus and vitamin D. However, metabolically active kidney stones are unusual in advanced chronic kidney disease. If the hyperparathyroid...
In your practice, when do you opt to treat unilateral primary hyperaldosteronism medically rather than surgically?
There should be a good reason for not pursuing surgery in a patient with unilateral primary aldosteronism. The surgery is more cost-effective. Some but not all data suggest a faster decrease in cardiovascular morbidity, a lower risk of atrial fibrillation, arterial stiffness, left ventricular mass, ...
What is the optimal anti androgen dose of spironolactone when treating female hirsutism?
My experience with this issue has primarily been in treating women with PCOS who have hirsutism and so these comments are limited to that condition. First, it is important to establish normal renal function and electrolytes before starting. It is also important to know if the patient is on an ACE-I ...
Under what circumstances would you test for hypercortisolism in a patient with insulin resistance?
The American Diabetes Association meeting that just finished up featured the CATALYST study that found hypercortisolism by an abnormal dexamethasone suppression test was present in 24% of patients with difficult-to-control type 2 diabetes. For insulin resistance alone, I suspect the prevalence would...
How long does it take the hypothalamic-pituitary-gonadal axis to recover from secondary amenorrhea in the setting early onset and chronic use of oral combined contraceptive pills?
About 6 months after cessation of OCs.
Do you recommend the use of automated insulin delivery systems (such as Control IQ with Tandem insulin pumps) for managing gestational diabetes?
Currently, none of the current FDA-approved AID systems have algorithms set to achieve pregnancy-specific glucose goals. So using the manual mode with overnight target 90 along with appropriate bolus settings to keep PPG at goal is the most efficient.