Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Which other GLP 1-R agonist, if any, would you consider re-trialing in patients who had severe gastrointestinal side effects with Ozempic?
I am curious if you mean someone who has not tolerated the lowest dose of Ozempic, or higher doses. I have had patients who have not tolerated semaglutide but who can tolerate tirzepatide (or dulaglutide or even liraglutide if a daily injection is OK). I have also used "click counting," which is uni...
What therapies do you offer to young patients with secondary hypogonadism due to obesity who have lost weight but have ongoing hypogonad symptoms and lower end of normal testosterone levels?
First of all, the symptoms may not be due to low testosterone. Keep in mind that obesity can be associated with low SHBG. Total testosterone may thus be low but free testosterone may be normal. Free testosterone assays are not the most reliable. Therefore, clinical judgment is often needed in border...
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
Would you use a parathyroid hormone analog for treatment of osteoporosis in a patient with mildly elevated AlkPhos of unclear etiology?
I would be hesitant to administer an anabolic in this setting without first delineating the reason for an elevated AlkPase. I would suggest starting with sorting out the source of the AlkPase (i.e., bone, liver, or gut with measuring bone-specific AlkPase, G-GGT levels, and possibly a liver ultrasou...
Do you recommend starting a statin in youth (greater than 10 years old) with Type 1 diabetes mellitus and LDL cholesterol levels greater than 130?
In general, I probably would not consider starting a statin in a youth with T1D unless they had T1D AND Familial Hypercholesterolemia and/or an LDL >190 mg/dL or significant microvascular complications already. Recommendations are to consider statin therapy in individuals with diabetes of long durat...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
In patients with osteoporosis at high fracture risk, what factors most influence your decision to prescribe teriparatide versus abaloparatide?
Both abaloparatide and teriparatide are very effective anabolic agents to reduce vertebral and nonvertebral fracture risk in patients with osteoporosis (although clinical trials did not demonstrate reduction of hip fracture risk). The two agents are more similar than different and both induce an an...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What workup do you recommend for patients requiring higher-than-expected levothyroxine doses for their weight?
If someone is on a significantly greater than expected dose of levothyroxine for their weight, I take a careful history to confirm they are taking the medication appropriately. Usually, the issue is mistiming of medication with regards to proximity to food or supplements - or even simple nonadherenc...