Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should GLP-1 agonists be weaned in patients who have achieved goal weight loss and glycemic control?
This is a good question that comes up often. The short answer is no -- GLP-1 receptor agonists should not be weaned after achieving goals. There are several trials where GLP-1RA has been discontinued after 6 or more months of therapy and weight regain is substantial on average and the loss of glycem...
What is the goal of estradiol levels on ovarian suppression and AI for breast cancer?
This is a sneaky difficult question. We've known since George Beatson that estrogen was important for breast cancer, and the Early Breast Cancer Trialists Collaborative Group helped get Tamoxifen approved in 1978. I've heard it said that we've had more trials looking at estrogen therapy for breast c...
Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?
As reviewed recently by Dr. Teblick et al., PMID 35358303, this is still a controversial and complex issue. Based on many studies, it would be preferable to avoid ACTH stimulation unless there is rapid availability of free cortisol. Random total cortisol is probably the better alternative.
Which patients would benefit most from teplizumab therapy to delay the onset of T1DM?
First, for full disclosure, I am an adult endocrinologist and I have not prescribed teplizumab so what I will say is what I have distilled from reading the literature and discussing this topic with colleagues.Teplizumab was approved for use in a very narrow category of patients with a relatively sma...
Do you recommend the use of GLP 1 R agonist therapy for obese women with PCOS who are actively trying to conceive?
This is a very relevant question. GLP 1 RA therapy is recommended by the recently published International Consensus Guideline in Management of PCOS for assistance with weight loss in combination with lifestyle modification (Teede et al., PMID 37580314). The guideline states that this should be done ...
What are the treatment options for severe recurrent hypoglycemia in a patient with malignant insulinoma?
Can try increasing dose of diazoxide or adding sandostatin or octreotide. Not sure what the patient profile looks like, but would any resection be amenable. Can also consider adding corn starch a few times a day.
When do you start bisphosphonates empirically, irrespective of DEXA results, in patients going on chronic glucocorticoids?
I think this is an important question. I personally got really interested in bone in large part because of all the glucocorticoids that I was using to treat serious inflammatory diseases. I was fortunate to spend time with Dr. Howard Polley from Mayo when I was a fellow. He was on the team that gave...
Can romosozumab be used in patients on dialysis?
This is an interesting question given the common finding of osteoporosis among patients undergoing hemodialysis. There have been several individual case reports suggesting that treatment with romosozumab in this patient population can be safe and effective. The largest study (no control group) of wh...
How do you adjust your HbA1c goal for managing diabetes in elderly patients with multiple chronic illnesses but no limitations in performing self-care tasks?
There is guidance from ADA, AACE and other organizations. Most agree that an A1c target of 8% is perfectly acceptable in advanced elders and/or people with multiple comorbidities and limited life expectancies. The critical issue is to understand what a reasonable timeline for the patient is. The nat...
What is the role of radiation therapy for an elderly patient with medullary thyroid cancer who is not a surgical candidate?
We have offered definitive RT for MTC patients who are medically or surgically unresectable. Dosing is variable based on involved structures, performance status, staging, etc. We have used 5400 cGy in 18 fractions, particularly for the more elderly, poor performance status patients. Coverage of elec...