Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What endocrine therapy would you recommend to a premenopausal female with early stage HR+ Breast cancer who is transitioning from female to male and currently on testosterone?
There is not a lot of data, and so shared decision-making is paramount, with the following considerations: Acknowledging the limited data in this setting, how would this patient feel about stopping testosterone? While many patients feel that T is critical for identity, others may not feel that way. ...
In what clinical scenarios should we use the 2-day 2mg DST instead of the 1mg overnight DST for screening of Cushing syndrome?
The 2-day low-dose DST may be of some value in patients suspected to have nonneoplastic hypercortisolism (normal cortisol <1.4-1.8 ug/dL). The Dex/CRH test performs better in such patients, but the CRH is not available.
What is your approach to determining recurrent versus RAI-refractory differentiated thyroid cancer in patients presenting with metastatic disease several years after surgery?
It sounds like you already know that there is a non-iodine avid distant disease. A brain MRI is recommended to exclude CNS disease. If insurance allows, go to a PET/CT with a diagnostic CT of the neck and chest. If insurance will not allow PET, then diagnostic CT of the neck, chest, and abdomen with...
Is there enough evidence now to use injectable semaglutide as a foundational therapy for symptomatic heart failure with preserved ejection fraction in the setting of overweight or obesity?
While the evidence for using injectable semaglutide in the setting of heart failure with preserved ejection fraction (HFpEF) and overweight/obesity is promising, it's still considered emerging! STEP-HFpEF trial: This large, well-designed study showed that semaglutide significantly improved symptoms,...
What is your protocol to starting/stopping glucocorticoid replacement in Cushing disease patients after their transsphenoidal resection surgery?
The initiation of glucocorticoid treatment post-transsphenoidal surgery in patients with Cushing's disease varies across different medical practices. Dr. Fleseriu's paper provides a comprehensive review of Cushing's disease management, offering valuable insights (Fleseriu et al., PMID 34687601). Typ...
Do you routinely check a TSH level in patients with recurrent kidney stones who have hypercalciuria of unknown cause?
No. Although hyperthyroidism is a reported cause of hypercalcemia and hypercalciuria, it must be very rare cause of nephrolithiasis. I suspect the patient would be obviously hyperthyroid on examination. Hyperparathyroidism is a much more common cause of kidney stones. In my practice, if the stone an...
Following abaloparatide use for osteoporosis treatment, how long do you consolidate with bisphosphonates before considering a drug holiday?
6 months
How do you time Evenity after completion of Forteo?
If a physician is considering transitioning an osteoporotic patient from a PTH treatment to romosozumab, there is no reason to delay. It should be fine to start romosozumab immediately upon discontinuing PTH if it is clinically indicated. However, it is important to remember that romosozumab has a b...
In SIADH due to malignancy, do you prefer to use free water restriction or salt tablets?
Fluid restriction is usually the first line measure in chronic SIADH. Salt tablets only work at high doses, as SIADH is a water, not a salt problem, and you improve sodium only minimally. Tolvaptan is a very powerful drug, but, as per the package insert, must be started in an inpatient setting. Addi...
When do you check macroprolactin in the evaluation of hyperprolactinemia?
I always check it for prolactin levels that are abnormal, but below 100 ng/mL. Macroprolactinemia is rather common in mild/moderate hyperprolactinemia, but it is very rare as sole cause of hyperprolactinemia when level is higher than 100 ng/mL. Importantly, even real hyperprolactinemia may appear mo...