Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you consider use of an oral bisphosphonate (such as alendronate liquid) in a patient with eosinophilic esophagitis?
My general approach to patients with any form of esophagitis for whom bisphosphonate therapy is indicated is to treat with zoledronate. I am not aware of any data that has reviewed the use of a liquid form of a bisphosphonate for patients with esophageal disorders including eosinophilic esophagitis,...
When do you include the neck in the RT field for resected thyroid cancer?
I will use external beam RT to the neck for medullary thyroid cancer, anaplastic thyroid cancer, or local-regional recurrence of papillary or follicular that is no longer iodine-avid, and thus cannot be treated by I-131.
In a patient with inflammatory orbital disease without a discrete mass to biopsy and recent bisphosphonate use, how much additional workup would you do if basic labs, urine studies, ANCA serologies, thyroid studies, chest imaging (to r/out sarcoid) are normal, before concluding that the process is likely secondary to bisphosphonate use?
Bisphosphonates are a known but rare cause of orbital inflammation. An intravenously administered bisphosphonate is far more likely to cause this compared to an oral drug. There is usually a close temporal association between taking the medication and developing the inflammation. The diagnosis is on...
For someone with asymmetric Graves ophthalmopathy, do you still treat both eyes, or target the single affected orbit?
Single site.
When tapering moderate to high doses of long term steroids do you routinely monitor for adrenal insufficiency?
This is always a good question on which to reflect. In general, moderate dosing of steroids (> or = 20 mg prednisone equivalents) for 5 days or less do not need a taper and pose low risk of adrenal suppression, and by extension chronic adrenal insufficiency. Up to date suggests that up to 3 weeks is...
What dose/fractionation would you use to treat a papillary thyroid cancer with bulky cervical adenopathy and laryngeal invasion with impending airway obstruction that is refusing laryngectomy and surgical management?
I have encountered this situation at times and assuming the patient has a tracheostomy and there is no way to convince them to undergo the recommended surgery, I have offered definitive radiation therapy. I have treated a number of patients with 70/63/56 Gy in 35 fractions ensuring coverage of level...
What strategy do you use to determine the appropriate timing to resume osteoporosis therapy after a drug holiday?
A drug holiday (drug sabbatical) is given to reduce the likelihood of an atypical femur fracture. Such fractures have characteristic x-ray appearances and are found from below the lesser trochanter to the supracondylar flare of the distal femur. While the overall incidence of these fractures is low,...
How do you approach a potential drug holiday in a patient with osteoporosis who has had improvement in BMD after several years of denosumab therapy?
If a patient on denosumab has achieved BMD of the spine and hip that are in the high osteopenia range or normal BMDs (T score above -1), and the patient has not fractured and is not on glucocorticoids or hormone depleting agents for breast or prostate cancer, can have denosumab stopped. However, at ...
For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?
In this scenario, I prefer zoledronic acid every 3 months with renally adjusted dose. In my experience, the risk of hypocalcemia seems higher with denosumab. Calcium/vitamin D supplementation would be important as well. The every 3 month dosing is an advantage over denosumab, which would have to be ...
How do you approach the use of bisphosphonates in reproductive-aged women?
This is an extremely difficult situation. I think it would be better to change this question to a discussion of a woman of childbearing potential since a woman of reproductive age with osteoporosis could have hormone failure and therefore is not of childbearing potential per se. A woman with celiac ...