Endocrine

Inpatient Diabetes Management: Case 4

October 11, 2007
Inpatient Diabetes Management: Case 4

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 4 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last several weeks, we have been presenting individual cases followed by some management questions and answers.

Case 4: The Case of Mr. Gary

Mr. Gary is a 54 year-old diabetic male admitted with acute renal failure who is being evaluated for…

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Why Does Hypertriglyceridemia Lead to Pancreatitis?

October 4, 2007
Why Does Hypertriglyceridemia Lead to Pancreatitis?

Commentary by Daniel Frenkel, PGY-2

Case: A 46 year old male with diabetes on oral hypoglycemic medications is admitted to the hospital with one day of constant epigastric pain, nausea, vomiting, and an inability to tolerate oral intake. You are concerned about pancreatitis but laboratory analysis reveals amylase levels that are within the normal reference range. You notice that his glucose level is 410mg/dL and that the specimen is described as lactescent. Should you still be concerned about acute pancreatitis?

Lactescent or lipemic blood samples…

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Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

October 3, 2007
Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

Diabetic neuropathy is one of the most commonly encountered complications of diabetes mellitus. It is seen in up to 20% of diabetics. Patients typically present with neuropathic pain in a “glove and stocking” distribution with the earliest signs in the feet. Night time complaints of “my feet are on fire” are common. Relying on a patient’s complaint of “pain” or “numbness” is inadequate in the diagnosis of peripheral neuropathy since…

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Inpatient Diabetes Management: Case 3

September 27, 2007
Inpatient Diabetes Management: Case 3

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 3 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 3: The case of Mr. Mejia

3A. Mr. Mejia is a 30 year old man with Type 1 diabetes who is admitted for…

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Inpatient Diabetes Management: Case 2

September 14, 2007
Inpatient Diabetes Management: Case 2

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 2 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 2: The case of Mr. Jones
Mr. Jones is a man with (insulin requiring) type 2 diabetes who is admitted…

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Inpatient Diabetes Management: Case 1

August 28, 2007
Inpatient Diabetes Management: Case 1

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 1: The case of Mr. Smith
Mr. Smith is a 65 year old obese male admitted to the hospital with acute renal…

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Part II- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

August 8, 2007
Part II- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

Commentary by Melissa Freeman MD, PGY2

Please also see Part I of this series

In 2002, the American Association of Clinical Endocrinologists (AACE), the American Thyroid Association (ATA), and The Endocrine Society (TES) sponsored an evidence- based Consensus Development Conference with a panel of thirteen experts to address unresolved issues about subclinical thyroid dysfunction. Though these sponsors agreed with many of the recommendations made by the consensus, they felt that they relied too heavily on evidence-based medicine that did not yet exist. Two years later,…

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Part I- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

July 31, 2007
Part I- Subclinical Thyroid Dysfunction: To Treat or Not to Treat?

Commentary by Melissa Freeman MD, PGY2

Modern day science has revealed to us the intricate relationships that thyroid hormones have with multiple systems of the human body.  Many of today’s physicians find themselves checking patients’ thyroid function tests (TFTs) almost as reflexively as a baseline basic metabolic panel. Yet, what seems to the physician to be a harmless bit of thoroughness can often turn into hours of inquisitive head scratching if the TFTs reveal subclinical thyroid dysfunction, especially since automated assays for TFTs are more…

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Meeting Perspectives: The ADA Scientific Sessions: Advances in the Pharmacologic Management of Type 2 Diabetes Mellitus

July 5, 2007
Meeting Perspectives: The ADA Scientific Sessions:  Advances in the Pharmacologic Management of Type 2 Diabetes Mellitus


Commentary by Mitchell Charap MD, Senior Associate Program Director, NYU Internal Medicine Residency Program

Caveat: What follows below reflects my perspective on new and old pharmacologic approaches to Type 2 Diabetes. It is not intended to be a comprehensive review of this topic.

TZDs

The ADA did not mount a serious attack on the Nissen NEJM metanalysis of Rosiglitazone. They suggested that patients speak to their physicians regarding the drug. I missed the Nissen/ADA debate that occurred, but gather…

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How Do you Approach a Patient with Primary Hyperaldosteronism?

June 28, 2007
How Do you Approach a Patient with Primary Hyperaldosteronism?

An 80 year old male with atrial fibrillation, hypertension, hypokalemia is diagnosed with hyperaldosteronism with an aldosterone to renin ratio of 34.5/0.15=230 . CT scan reveals a right adrenal 1 cm presumed adenoma

Questions:
1. How do you accurately diagnose primary hyperaldosteronism?
2. Do medications which the patient is taking influence the work-up?
3. Can you have primary hyperaldosteronism in the absence of hypokalemia?
4. Can the adrenal mass be incidental? Should the patient have additional testing?

-Anna Dvorak PGY-3

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Hyperparathyroidism in Chronic Kidney Disease

June 13, 2007
Hyperparathyroidism in Chronic Kidney Disease

Commentary by Sarah Berry MD, PGY-3 and Joseph Weisstuch, MD Clinical Assistant Professor of Medicine, Divsion of Nephrology

Case: Mr. K is a 59 year old gentleman with a past medical history of hypertension, non-insulin dependent diabetes mellitus, dyslipidemia and worsening chronic kidney disease (CKD) over the last six years, despite compliance with his medications and optimized glucose and blood pressure control. His current medication regimen includes metoprolol, hydrochlorothiazide, aspirin, simvastatin, glyburide, and monopril. Mr. K’s most recent lab work indicates that his…

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Clinical Commentary: The Travesty of Grinding Axes with Science: Rosiglitazone and Cardiac Risk

June 12, 2007
Clinical Commentary: The Travesty of Grinding Axes with Science: Rosiglitazone and Cardiac Risk

Welcome to our first blog commentary. One of the purposes of the blog is to generate discussion about issues in health care. This “Clinical Commentary” section is an invitation to our housestaff and faculty to submit their own thoughts and viewpoints on current issues. The views expressed in this section are soley those of the authors and do not necessarily represent the views of Clinical Correlations.

Commentary by Gregory Mints MD and Nirav Shah MD, MPH

The meta-analysis of Rosiglitazone’s effect on cardiovascular events…

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