Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you consider the albuminuria reduction seen in FINE-ONE sufficient to start finerenone without hard kidney outcome data in a patient with CKD and type 1 diabetes?
I would prefer for all these agents to see significant reduction in proteinuria as well as eGFR stablization.
Do you start a GLP-1 receptor agonist to reduce decompensation risk in an older adult with MASLD and compensated cirrhosis?
If they have an approved indication and can get coverage, I would. Need to follow a bit more closely to ensure not rapid weight loss and protein focused with resistance exercise to avoid worse lean mass loss.
How do you prevent hyponatremia in a patient with arginine vasopressin deficiency on chronic desmopressin?
Adequate instruction is very important in order to minimize the risk of hyponatremia in patients with AVP-D (central DI). Patients need to understand that, rather than taking desmopressin on a fixed schedule, it is very important to allow the medication to wear off for at least 30 minutes once a day...
Do you recommend repeat TSH testing after a patient switches from brand-name to generic levothyroxine?
Yes. Because the FDA allows for variability in generics and the fact that some patients are very sensitive to small changes in their levothyroxine dose, I do repeat TSH after a patient switches levothyroxine formulations.
How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?
Phentermine has been available since 1959 and remains an affordable and effective medication option added to a full lifestyle-based weight management plan. In people who are generally healthy and without contraindications to the medication, I have had patients used in at least intermittently for sev...
Have any studies shown that testosterone replacement therapy lowers the incidence of prostate cancer in hypogonadal men, or is the evidence still largely neutral?
This is a broad question to which I will give a broad answer.For men with hypogonadism (symptoms and signs of androgen deficiency, reproducibly low serum testosterone with an accurate, reliable assay) and no reversible cause, the epidemiological data overall do not show evidence of increased risk of...
How do you proceed when the calcium-to-creatinine clearance ratio is between 0.01 and 0.02 in a patient with suspected primary hyperparathyroidism?
If has had normal calcium levels in the past, it is not FHH which is genetic, but likely to be due to negative calcium balance, either deficient intake or absorption.
Would you favor oral bisphosphonates over intravenous formulations for patients with hormone sensitive prostate cancer and androgen deprivation therapy (ADT) related osteopenia?
If kidney function is normal, either would do. Therapy depends on the risk level. (See Cosman et al., PMID 39073912.)
Do you forgo adrenal imaging in a patient with primary hyperaldosteronism who has decided against surgery?
Yes. It would be a waste of time and money. Can go straight to using spironolactone or other mineralocorticoid blocker.
What glucose lowering therapy do you recommend using when patients are discharged from hospital after being admitted with euglycemic DKA secondary to SGLT2i use?
Stop the SGLT-2. Continue other previous therapy and adjust dosage as needed.