Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you assess and adjust treatment in patients who develops hypothyroidism after being on lithium for several years?
It depends on whether the patient is symptomatic. If not, careful monitoring is all that is needed. If there are significant symptoms, treatment with levothyroxine would be needed. Continued use of lithium is appropriate if it has been effective over time.
When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?
My practice has been that after 2-3 years of denosumab, I wait 6 months and then start zoledronic acid.
How often do you monitor pituitary adenomas once established as non-functioning?
That depends on the size and location (close to the chiasma?). Without pathology, which may help determine aggressiveness (mitotic rate, Ki67), it is impossible to predict the growth rate. For macros, I repeat an MRI in 6 months, and, if no change, I double the interval. For micros, there is recent ...
Do you recommend using anastrazole in men developing gynecomastia while on testosterone replacement treatment for hypogonadism depending on pre-treatment estradiol level?
There is no role for aromatase inhibitors (e.g., anastrozole) for the prevention of gynecomastia. A randomized trial of anastrozole for the treatment of gynecomastia demonstrated no benefit compared to placebo.There is no reason to administer prophylactic therapy prior to the initiation of testoster...
What factors would lead you to extend the duration of antithyroid drug therapy in a patient with Graves' disease who is clinically euthyroid at 12 months but has risk factors for recurrence?
One should never discontinue methimazole after an arbitrary period of time without checking anti-TSH receptor antibody levels. If they are positive or even “normal” but not undetectable, the patient will inevitably have a recurrence of their hyperthyroidism relatively quickly (Laurberg et al., PMID ...
For hypothyroid patients on dual replacement therapy (levothyroxine & liothyronine), do you recommend monitoring TSH while holding off on the morning T3 dose?
No, I do not withhold the morning dose of T3. Older studies have shown no effect of an oral dose of T3 on serum TSH levels (Saberi & Utiger, PMID 4422006).
Do you recommend initiating zoledronic acid for osteoporosis at the time of hospitalization for a fracture?
I did not institute bisphosphonate therapy during hospitalization for a fracture. It would have been helpful to have known bone remodeling markers if the patient had been followed for osteoporosis. It is reasonable to institute antiresorptive therapy in patients with high bone turnover. However, I d...
What other considerations for hyperlipidemia management would you have for a patient with multiple prior PCIs whose LDL remains above goal on high intensity statin, ezetimibe, and evolocumab, assuming the patient is compliant with medications?
There are a few options, most of which depend on insurance coverage and patient preferences. But first, would do a chart biopsy to assess the efficacy of each of the therapies to better understand the reason for persistent LDL elevation. Perhaps they have a dysfunctional LDL receptor, so upregulatio...
Do you recommend the use of albumin-adjusted calcium measurement formulas to accurately assess calcium levels?
It is a reasonable approach to correct serum calcium using albumin when hypocalcemia is present, especially in a hospital setting. I believe it is less useful for evaluating hypercalcemia.Although it is reasonable to use albumin to correct serum calcium in patients with hypocalcemia it may be worthw...
During treatment of severe osteoporosis with PTH analogs (abaloparatide), would a rise in alkaline phosphatase level >200 (in the setting of normal GGT) warrant discontinuation of medication?
During treatment with PTH analogs, it is not recommended to monitor the alkaline phosphatase but only Vitamin D and calcium every three months. The alkaline phosphatase, of course, increases with PTH analog therapy, but there is no upper limit, and the concerns about osteosarcoma have been removed f...