Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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.
Do you recommend osteoporosis medication in postmenopausal females on anastrozole with very low Vitamin D (4.5)?
A vitamin D level of 4 is very low and should be corrected before any osteoporosis therapy is considered. Severe low D is associated with decreased Ca absorption and sometimes low serum Ca. Giving an anti-resorptive could result in hypocalcemia. Sometimes D levels that low are associated with muscul...
Is there any difference in the cardiovascular risk reduction profile of brand name Vascepa versus generic icosapent ethyl for patients with hypertriglyceridemia?
The major clinical trial data (Bhatt et al., PMID 30415628) showing benefit for Icosapent Ethyl were with medication provided by the company that ultimately branded the medication. That is no different from the clinical trials showing the benefit of statins or anti-hyperglycemic medications. We do n...
How do you manage or monitor hypogonadal men on clomiphene citrate?
I typically monitor men being treated for hypogonadism on clomiphene citrate the same as other hypogonadal men. There is less concern for timing of ordering testosterone levels to assess response in regard to treatment administration. There is also theoretically less concern for abnormal hematocrit ...
How would you advise medical oncologists who recommend checkpoint inhibitors for a patient with baseline type 1 diabetes?
T1DM means near-complete beta-cell deficiency. These patients aren’t making enough insulin to impact blood glucose control. We always treat the cancer first, with the most appropriate medications, and worry about the diabetes later. We even advise oncologists to continue ICIs after a patient develop...
Is there a target alkaline phosphatase level for hypophosphatasia patients on asfotase alfa therapy?
The package insert states, “do not rely on serum alkaline phosphatase measurements for clinical decision making in patients treated with Strensiq”.
Does hyperprolactinemia always need to be treated if the patient has regular menses, no galactorrhea, no desire for fertility and MRI of the pituitary is normal?
No, it does not, although there is some soft data that hyperprolactinemia may be associated with metabolic dysfunction. However, a diagnosis is needed. Asymptomatic hyperprolactinemia may be due to macroprolactinemia. If monomeric prolactin is normal, you can reassure the patient that the only treat...
In a young male patient with hypogonadotropic hypogonadism and fertility goals, would starting testosterone replacement therapy affect fertility chances?
Men with hypogonadotropic hypogonadism due to congenital hypogonadotropic hypogonadism or acquired hypogonadotropic hypogonadism due to structural disease (e.g., a pituitary macroadenoma) typically require gonadotropin therapy to optimize spermatogenesis and fertility. For men who have hypogonadotro...
How do you counsel patients with non-statin associated inflammatory myopathies about statin use?
Patients with non-HMGCR-associated myositis could try statins, keeping in mind that they could develop statin-associated muscle symptoms (SAMS). Therefore, would start with fluvastatin/pravastatin/pitavastatin (that are less likely to cause SAMS) at a low dose and slowly escalate if there are no sid...
What is your approach to a patient with a low alkaline phosphatase?
This is a wonderful and increasingly relevant question as it is not uncommon for someone to have a low alkaline phosphatase and be told it is not important since alkaline phosphatase is only important if it is elevated. Causes for this abnormality include protein deficiency, Wilson’s disease, and hy...