Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you recommend early oral nutrition when managing diabetic ketoacidosis?
There are many benefits to starting enteral feedings in patients undergoing treatment for DKA. Once insulin is being infused, the use of enteral nutrition will help suppress ongoing ketosis. Also, restarting nutrition will help prevent weight loss during recovery. Of course, some patients have condi...
When do you recommend the use of oral testosterone replacement over injectable testosterone?
Oral testosterone was approved by the FDA for men who have low testosterone levels due to specific medical conditions, such as genetic disorders like Klinefelter syndrome or pituitary conditions causing damage to the pituitary gland.
How should we approach the management of PCOS in transgender men seeking virilization?
Manage metabolic aspects only by controlling risk factors for CVD, OSA, fatty liver disease.
How would you approach a finding of osteoporosis (Z score -4.5) in a recently postpartum patient who had DEXA sent for long-term low-dose glucocorticoid use?
Ensure adequate calcium, vitamin D, and magnesium. I would check the PTH level and a 24-hour urine for calcium and creatinine.
What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?
There are a lot of variables to this question. I would worry that the person may have a variant of OI (osteogenesis imperfecta) or some other collage problem and then add renal failure to the mix. I would try to establish the causes of each problem first such as steroid induced bone disease or a bon...
How do you approach long term management of glucocorticoid-induced osteoporosis in patients who develop osteonecrosis of the jaw on antiresorptive agent?
Osteonecrosis of the jaw is a rare complication of anti-resorptives with the exception of high doses used for cancer patients. Teriparatide (TPTD) has been anecdotally reported to assist in healing of ONJ. The patient described remains on glucocorticoids and is at very high risk for fracture, especi...
When cinacalcet is used to treat hypercalcemia in primary hyperparathyroidism, does it also normalize low serum phosphorus levels?
Cinacalcet can be used for treating primary hyperparathyroidism especially in patients who are unable to tolerate the surgery. Lowering the PTH cinacalcet will not only decrease serum calcium levels but will also increase serum phosphate levels. See Peacock et al., PMID 19837909.
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
Is there a role for levothyroxine in managing the symptoms of a patient with euthyroid Hashimoto’s thyroiditis?
No, there is no role for levothyroxine in the management of symptomatic, euthyroid patients with Hashimoto’s thyroiditis. However, in some guidelines, serum TSH levels are recommended to be less than 2.5 milliunits per liter in women with positive TPO antibodies, who are pregnant or planning pregnan...
Do you routinely use anti-resorptive medications in patients who have osteoporosis and longstanding hypoparathyroidism?
If a patient has hypoparathyroidism, I am unwilling to use bisphosphonates or denosumab because of fear of significant hypocalcemia. I will use other agents to treat their osteoporosis.