Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you start anabolic agents for osteoporotic hip fracture healing?
There are two relatively well-done trials for tptd for fracture healing of the proximal femur. There was a Phase 3 trial for femoral neck fractures. The FDA made it quite complicated and demanded 2 separate trials of 1,200 patients each. The trials were 3 years in duration with many difficult outcom...
How do you evaluate remission in acromegaly when postoperative IGF-1 and GH levels are discordant?
It depends how long after surgery. IGF-1 may take up to 3 months form curative surgery to normalize. If GH is low (<0.4 ng/mL) and IGF-1 is still abnormal and you are less than 3 months form surgery, I would just wait. If the opposite is true (Normal IGF-1 but elevated random GH), I would perform a ...
Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?
Any bone that sustains a fragility fracture can result from osteoporosis. The definition for fragility fracture is a broken bone that occurs after a low-energy trauma, such as a fall from standing height or less, or lifting something light. They are a type of pathologic fracture, which means they ha...
Would you refer a patient for parathyroidectomy if they have normal calcium levels, mild hyperparathyroidism, and evidence of osteopenia?
It is important to be certain the patient has primary hyperparathyroidism by demonstrating by ultrasound or sestamibi scan the presence of an adenoma. Often patients with an elevated PTH and a normal calcium are also vitamin D deficient and have parathyroid hyperplasia. It is also important to rule ...
How do you counsel breastfeeding women on their limitations post radioactive iodine ablation for thyroid cancer treatment?
I agree that stopping breastfeeding for 3 months before RAI RX is optimal, but nipple secretion may continue for > 6 months. I would consider: If the RAI therapy is adjvant (i.e., no current evidence of persistent disease), there is no rush for RAI, I would allow breastfeeding for about 6 months an...
Is abnormally elevated estradiol an expected finding in patients with PCOS?
High levels of estrogen can occur in PCOS, which can be prolonged due to lack of ovulation and insufficient amounts of progesterone. Particularly as these levels are expected to fluctuate throughout the cycle, I would not say there is a cut off necessarily for concern but would consider referring to...
How do you titrate the dose of an ACE inhibitor in a patient with type 1 diabetes mellitus who is normotensive but has moderately increased albuminuria?
I think the main goal would be to get some level of ACE inhibitor on board. The dose can be increased slowly as long as the patient is not having symptomatic orthostasis.
Do you prefer kidney ultrasound or a non-contrast CT scan to evaluate for nephrolithiasis in an asymptomatic patient with primary hyperparathyroidism?
I first order an ultrasound due to the lack of concern for radiation exposure and if it is equivocal then follow-up with a CT scan. Ultrasound is not as sensitive as a CT scan especially for very small stones.
What are the indications for use of inclisiran over anti-PCSK9 monoclonal antibody therapies?
Dr. @Dr. First Last has summarized the case for inclisiran in some patients very well. There is a growing sense that it's important to administer the injection as directed, that is, subcutaneously, not intramuscularly.
In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?
Normal saline, or a balanced fluid, e.g., Lactated Ringers or Plasmalye, if you are believers in balanced fluids. Shock trumps ANY concerns over rate of Na rise. Also if someone is in shock they are not going to have a water diuresis from volume.