Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you approach checking an aldosterone to renin ratio in an outpatient with hypertension and hypokalemia that is difficult to correct with oral potassium replacement?
It is well known that hypokalemia can affect the aldosterone-renin ratio (ARR). Since hypokalemia directly inhibits aldosterone production, this can lead to false negative results when using ARR to screen for primary aldosteronism. If it is difficult to correct hypokalemia with oral potassium repla...
In adults ≥80 years with TSH 6–10 mIU/L and minimal symptoms, do you initiate levothyroxine, monitor, or avoid treatment entirely?
I tend to check free T4 in this situation. Aging is associated with some elevation in TSH value up to 10 mIU/L with normal free T4, and in those patients, levothyroxine is not needed. In some patients, I have seen it rise above 10 with normal free T4. Supplementing levothyroxine to lower serum TSH w...
Would you consider a history of pancreatitis an indication for parathyroidectomy in patients with mild hypercalcemia secondary to primary hyperparathyroidism?
The association of pancreatitis with primary hyperparathyroidism (PHPT) has been a classic one, although an uncommon complication of PHPT. Studies vary in reporting an incidence of pancreatitis between 4-16% in patients with PHPT (usually single institution consecutive series). I think most people f...
When treating osteoporosis, does your duration of maintenance bisphosphonate therapy post anabolic therapy with PTH analogue change based on C-telopeptide levels?
I have treated many patients with teriparatide and conducted non-clinical studies on PTH/PTHrP receptors. Despite the fact that there are no PTH/PTHrP receptors on osteoclasts, when PTH stimulates osteoblast activity, the normal coupling via osteoprotegerin is intact, and about 4 weeks after one det...
How do we decide between Gallium-DOTATATE PET/CT and MIBG scans when evaluating a patient for suspected pheochromocytoma?
Mostly availability and feasibility. Gallium-DOTATATE is very sensitive.
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...
How do you counsel patients with diabetes regarding the risks of cannabis use?
Cannabis use is becoming increasingly more common among patients with diabetes, with 10% recording use in the past month in a survey from 2022 (Han et al., PMID 39037352). Severe medical problems have been associated with cannabis use, including addiction(CUD), increased cardiovascular events, and a...
Do you initiate a GLP-1 receptor agonist as first-line pharmacotherapy ahead of metformin in a patient with newly diagnosed type 2 diabetes and a BMI above 35?
Yes
Would the diagnostic yield for ABIs or peripheral arterial duplex doppler in a patient with metal rods in both legs be similar or acceptable in comparison to those tests in a patient without metal rods?
Ankle-brachial index(ABI) relies on the compression of upper and lower extremity arteries with blood pressure cuffs and measuring the ratio of blood pressure between them. While I am not aware of specific studies in those with metallic rod fixation, ABI measurements should have similar utility as lo...
How do you manage patients with mildly elevated free T4 levels but normal TSH and Total T3 levels who have symptoms of hyperthyroidism but negative Graves' antibodies and normal pituitary imaging?
I would make sure to double check the accuracy of the free T4 assay/measurement. If it is very mildly high (0.1 ng/dl higher than ULN) might be an assay issue, but if it is 1.5-2x ULN, then maybe a real elevation. I would make sure the patient is not on high-dose biotin or any other interfering medi...