Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?
I have successfully treated several patients with bisphosphonate-induced subtrochanteric femoral fractures with Forteo. However, before initiating another antiresorptive therapy, I first want to be sure that the Forteo at the desired effect on bone remodeling by increasing both bone formation and bo...
How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?
I would first determine if there are other medications the patient is on that reduce the blood glucose. Hypoglycemia with SGLT-2 inhibitors is usually due to something else. Another medication is most likely. Could be very poor dietary intake. Could lower the dose if not on the lowest available dose...
When do you recommend screening patients with T2DM for heart failure?
Heart failure is increasingly being recognized as a complication of diabetes. Heart failure is classified in 4 stages. Stage A is “at risk” because of diabetes, stage B is asymptomatic for the patient but with detectable cardiac abnormalities and then stage C and D are symptomatic stages of heart fa...
Does solid/trabecular type papillary thyroid carcinoma pathology confer a higher risk of recurrence and warrant radioactive iodine ablation therapy?
Solid variant papillary thyroid carcinoma (SVPTC) is a rare subtype of PTC and has been noted particularly in pediatric thyroid cancers resulting from exposure to radiation (e.g., Chernobyl). In adults, it tends to occur in somewhat older patients, which may be attributed to some reports of more agg...
Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?
Interesting, I have just received a message from a patient in this very same situation. I am not aware of any specific literature on this. In absence of such data, I usually recommend remaining on the same desmopressin dose and obeying to thirst, as I worry about hyponatremia that may be caused by a...
In postmenopausal osteoporosis, would you switch to romosozumab (rather than a PTH/PTHrP analog) if a patient fractures while on denosumab?
This is an interesting question because it raises the subject of how one defines "treatment failure" among patients who are using bone-strengthening medications. I remind patients that our drugs are most effective at preventing spinal fractures with efficacy that can exceed 70% relative risk reducti...
Do patients with hypogonadism commonly present with dizziness?
"Brain fog" and/or fatigue, but none have complained of dizziness.
Is azilsartan superior to other angiotension receptor blockers in regard to cardiorenal outcome data?
In short, there are no data. There are very few head-to-head comparisons of ARBs on hard outcomes. Azilsartan was used in SPRINT (alongside losartan and valsartan), though the secondary analyses focused on class effect as opposed to specific med-to-med comparisons within a class (DeCarolis et al., P...
Is it safe to discontinue prenatal vitamins that contain biotin for a few days during pregnancy when labs in particular thyroid tests are planned for treating hypo or hyperthyroidism in pregnancy?
Biotin doses of 5-10 mg can impact TFTs. Most prenatal vitamins contain 30-35 mcg of biotin (although there are some that contain up to 500 mcg of biotin). This is usually too low to cause assay interference, so I do not recommend cessation of prenatal vitamins prior to TFTs (although I will ask tha...
Is the accuracy of continuous glucose monitors (DEXCOM or Libre) lower in patients undergoing dialysis?
The question of the accuracy of CGM in dialysis patients is an important one and has been debated for some time. CGM is a superior method for glucose management over fingersticks in most clinical settings. Patients with ESRD on dialysis in particular, can have very difficult-to-control diabetes. A r...