It's always a pleasure to hear Dr. Biller speak about pituitary topics. Today is on GHD. Bottom line is that there are many barriers to dx & tx esp in those who had dx as kids and are now adults but treatment can come w/ a lot of benefit #AACE2021 #Endotwitter
Here are some considerations on who to test for GHD. Highest being those w/ prior pituitary/brain surgery -- if they have 3 or more pituitary deficits then it is more likely they have GHD than not. #AACE2021 #Endotwitter #ghd
Characteristics of GH stimulation tests. ITT still gold standard but not very tolerable/safe or speedy. Glucagon cheap, safe but remember the BMI cut off pts. Macimorelin very fast, easy to use and well tolerated but very expensive #AACE2021 #Endotwitter #ghd
Transitioning from peds to adult with GHD can be hard. Here are some of the barriers and tips on how to be effective in transition #aace2021 #Endotwitter #ghd
Algorithm for testing transition patients with clinical suspicion of GHD #Endotwitter #aace2021 #ghd
Now that GHD is confirmed here is how you start and monitor GHD treatment --higher doses in kids, lower doses as you age. Monitor clinical and biochemical parameters #Endotwitter #aace2021 #ghd

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More from @lissabauer

28 May
Yes looking forward to this lecture on intermittent fasting and does time of day matter. Here are types of intermittent east #AACE2021 #endotwitter ImageImage
Intermittent fasting definitely shows benefits in animals! #AACE2021 #endotwitter ImageImage
Here are the possible mechanisms of intermittent fasting #AACE2021 #endotwitter Image
Read 22 tweets
27 May
Yes please tell me what to do with the normocalcemic hyperpara's! #aace2021 #Endotwitter Image
In those with primary hyperparathyroidism the majority are asymptomatic. Next highest is kidney stones. It affects the radius more than fem neck more than lumbar spine #AACE2021 #Endotwitter #bone ImageImage
Differential for those with hypercalcemia with normal/high PTH #AACE2021 #Endotwitter #bone Image
Read 10 tweets
27 May
I'm always amazed at the complexity that is obesity and insulin resistance. 2 types: obesity with insulin resistance and obesity w/o insulin resistance both will have mechanical abcd complications but the second will have dysglycemia & the effects from that #aace2021 #endotwitter ImageImageImage
Obesity exerts multisystemic effects and there is more to it then just weight and BMI -->thus the creation of the ABCD classification using info from EOSS staging system and other data #obesity #aace2021 #endotwitter ImageImageImageImage
Higher morbidity in those with BMI >30 compared to lower #obesity #aace2021 #Endotwitter Image
Read 4 tweets
26 May
Excited to learn about bariatric and metabolic surgery and newer devices by Drs. Husain and Kothari and moderated by @DrKarlNadolsky #AACE2021
Each bariatric surgery has a different expected total body weight loss with duodenal switch being highest #obesity #AACE2021 #Endotwitter Image
Bariatric surgery can reduce long-term microvascular disease #obesity #AACE2021 #Endotwitter Image
Read 9 tweets
26 May
Intensive behavioral therapy by physicians can be effective helping lose >5% and even up to 10% weight loss #AACE2021 #obesity Image
Using the term "obesity" can have a negative impact on patient care. When speaking with patients, it is better to use the terms "weight" or "BMI" or even "excess weight" #AACE2021 #obesity Image
There is more eating disorders and disordered eating in PCOS #AACE2021 #obesity #Endotwitter Image
Read 7 tweets
23 Mar
When to reimage a nonfunctioning pituitary incidentaloma? Risk of growth depends on size. Dr. Molitch recommends <1cm repeat MRI 1, 2, 5yrs. >1cm 0.5, 1, 2, 5yrs #ENDO2021 #Endotwitter
What about symptomatic nonfunctioning pituitary adenomas? Depends on surgery outcome #ENDO2021 #Endotwitter
What about Acromegaly and Cushings? Depends on treatment and post-operative cure #ENDO2021 #Endotwitter
Read 5 tweets

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