Questions discussed in this category
Do anabolic agents have a role?
With the time intervals recommended after taking each medicine, I am wondering how patients should be counseled.
At what doses do you start? and how do you titrate therapy?
Is this seen more with high dose vitamin D supplementation?
Should uric acid levels be monitored regularly while on therapy?
If they are already on a preparation that contains animal products, would you change it?
Have you encountered changes in prolactin, testosterone, etc?
Would you consider testosterone therapy if he is otherwise asymptomatic?
How often do you recommend monitoring thyroid function tests in these situations?
Cholesterol Treatment Trialists' (CTT) Collaboration
Ahmad et al., PMID 36106278
Zha et al., PMID 35487459
What is your evaluation approach for RAI response? What cumulative dose do you use in practice for deciding a patient is RAI refractory?
Okubo et al., PMID 38442744
Yue et al., PMID 38554774
Normal Vitamin D, bone scan showed osteoarthritis
Herold et al., PMID 31180194
Dao et al., PMID 38663923
Trial has included diazoxide, decadron, verapamil and pasireotide with ongoing overnight lows.
Bergman et al., PMID 38458916
Liang et al., PMID 35900801
Chiung-Hui Peng et al., PMID 38436957
Do you base the decision off of the acuity and course of symptoms? The degree of estradiol elevation? Other factors?
Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?
Additional risk factors could be family history of VTE or thrombophilia, such as antithrombin deficiency.
Can 25 OH vitamin D be converted to activated vitamin D outside of PTH mediated mechanisms in some organs?
No evidence for acromegaly or Pagets.
Ferrell et al., PMID 38448791
Demay, et al., PMID 38828931
We know canagliflozin is not given to patients with amputations, what about other SGLT2 inhibitors
The patient is actively breastfeeding.
Butler et al., PMID 38587237
Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...
Bergman et al., PMID 38458916
The patient has very low urinary calcium despite calcium supplements, vitamin D used to be low now normal. Continues to have elevated PTH with normal ...
Viëtor et al., PMID 34503194
Asa et al., PMID 35291028
Would you recommend aiming for the postmenopausal range as per the lab reference range or do you have a specific goal?
Or other therapy - e.g., tolvaptan? Free water restriction may hinder QOL. Salt tablets may raise levels more quickly but have risks of edema and hype...
What techniques and doses would you prescribe to the primary and regional nodes?
Only the mCRPC population was included in the Fizazi et al. study, but the FDA approval is for prevention of skeletal related events from any solid tu...
After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...
Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?
There is literature showing small changes in both free T4 and TSH (despite steady state) in the first few hours after ingestion of L-T4. In occasional...
If so, what do you typically prescribe?
Patient is a 41F and overall good surgical risk candidate.
If so, when? Does surgery need to be timed with last dose of Prolia injection?
If not, what can be possible causes for a postmenopausal woman to have FSH, LH < 0.3 with low E2, and being asymptomatic and doing well otherwise? ...
A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...
Assuming follow-up IV bisphosphonate x2 infusions to prevent rebound fractures
Patient does not have hypercalcemia.
Can a diagnosis of acromegaly be made with just an elevated IGF-1 level in patients with features of acromegaly?
Are oral bisphosphonates contraindicated with all types of bariatric procedures?
Conflicting data exists on whether Graves' disease would increase the aggressiveness of the concomitant thyroid cancer vs having no effect/correlation...
Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient...
What level or additional signs/symptoms trigger a workup? What does your workup typically consist of?
What dose of RAI would you consider giving if recommended?
I have a longstanding patient with diabetes and a consistently significant difference between CGM average and that predicted by serum A1c. The CGM avg...
Does it depend on location of radiation, length of radiation, and time since radiation?
If so, how long should OCPs be held to reliably trust the dex suppression test results?
Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortiso...
And is there a preferred diagnostic test? Whenever cyclic hypercortisolemia is suspected, it is advised that evaluation should be repeated for months,...
I’ve seen several such patients who have no secondary causes for bone loss, on adequate calcium/vitamin D, and compliant with denosumab who do n...
Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigu...
For example, patients who have been maintained on 5mg of prednisone for years without previous tapering attempts and the rheumatic disease is not acti...
Should this patient population be treated differently?
At our institution, we have started using EPIC to screen many patients for osteoporosis and ou...
There is a current recommendation from the anesthesia society to hold one dose of GLP-RA prior to general anesthesia. Given the long half-life of the ...
The female patient is in her late 70s with cardiac disease (likely due to chronic hyperthyroidism that was missed due to non-suppressed TSH). I’...
NCCN cervical cancer guidelines added a new statement - Patients who have received prior pelvic radiation therapy and have osteoporosis may benef...
Elderly male with primary hypothyroidism, HTN, and progressive worsening cognition over several months. PCP has been increasing LT4 dose as outpatient...
Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC?
No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.
Do you attempt to taper fully or maintain at a low dose?
With studies showing non inferiority to zoledronic acid q 3 months in support of bone metastatic disease, would you consider extrapolating this data a...
If so, how often do you check these labs?
Do you look into their stage/risk to decide? Since patients can experience bone loss after stopping denosumab, how do you plan to discontinue?
The patient has no personal history of VTE, but has positive family history of VTE.
Any prophylactic anticoagulation options?
How would manage...
If a patient has been treated sucessfully for Graves but has persistent symptoms of diplopia, is radiation therapy helpful? Or is this just a dry and ...
Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?
Which agents would you select and for how long would you treat them?
For pts w/ eGFR between 30-60
Does the degree of resectability affect your management?
Would you hold these agents in the setting of invasive dental procedures?
Without a discrete mass to biopsy, is there any utility of any blind biopsies to rule out IgG4 related disease, infectious or neoplastic process?
Would you consider keeping the patient on denosumab or would switch to an anabolic agent?
Are there specific features that suggest drug-induced uveitis versus de novo uveitis?
Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).
Is there a role for earlier use of anabolic agents to promote bone healing in patients that develop AFFs?
Does denosumab effect knee replacement or hip replacement? Should replacement occur right before or after injection?
Is there concern for impaired healing? Do you pause therapy and for how long?
Do you encourage patients to take a break from/stop taking Fosamax or similar medications for their osteopenia or osteoporosis in order to prevent dev...
My understanding is that this risk is exceedingly rare even with treatment in and around the stalk and hypothalamus.
Should it be started at the initial diagnosis of bone mets?
What factors if any would influence your decision and what would your approach be?
Is there any evidence that this improves outcomes over a more simple and cost effective follow up of careful physical examination and checking a perio...
Does it matter whether the intracranial lesions have been treated with whole brain or SRS/SRT?
Do you extrapolate the results of OPTIMIZE-2 and CALGB 70604 showing that an every 12 week dosing of zolendronic acid is noninferior to ever...
Do you treat patients who are clinically hypothyroid but biochemically euthyroid?
If a patient had a recurrence that was pathologically proven despite negative idodine scans, what imaging scans would you follow up with for surveilla...
In the case of a partial resection with focal perineural invasion, but no lymphadenectomy due to severe fibrosis from prior radio-ablation for hyperth...
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Papers discussed in this category
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-04-10
Lancet, 2016 Mar 19
Eur. Urol.,
Cancer, 2001-12-01
Neuro-oncology, 2011 Jun 10
The Journal of clinical endocrinology and metabolism, 2001-12
J. Clin. Endocrinol. Metab.,
J. Clin. Endocrinol. Metab.,
Lancet,
Metab. Clin. Exp.,
J. Neurosurg., 2018 Nov 09
Clin Endocrinol (Oxf), 2009 Jul 24
Nat Clin Pract Endocrinol Metab,
Neurosurgery, 2008-01
Clinical neurology and neurosurgery, 2013-02
Ann. Endocrinol. (Paris),
Ann. Endocrinol. (Paris), 2013 Nov 25
JAMA oncology, 2018-02-01
Lancet,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-07-20
Curr Treat Options Oncol, 2019 Mar 14
Leuk. Lymphoma, 2011 Feb 08
Cancer,
Arthritis Rheumatol, 2017 Aug
Current opinion in rheumatology, 2015-05
Am J Med, 2012 Nov 20
Arthritis Care Res (Hoboken), 2017 Aug
JAMA, 2006-12-27
Annals of surgery, 2014-01
Perioper Med (Lond), 2018 Jun 08
BMJ, 2008 May 20
Circulation,
Cancer discovery, 2015-07
J Immunother Cancer,
J Clin Oncol, 2019 Sep 18
Blood, 2013-10-24
The Lancet. Oncology, 2011-08
The Lancet. Oncology, 2018-03
Lancet (London, England), 2015-09-19
Int J Part Ther, 2021 Summer
N Engl J Med,
J Clin Oncol, 2022 Jan 18
The Journal of clinical endocrinology and metabolism, 2022 Jun 16
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-12-10
Semin Dial, 2010 May 10
The Journal of clinical endocrinology and metabolism, 2016-05
Clinical journal of the American Society of Nephrology : CJASN, 2019-05-07
Curr Opin Cell Biol, 1995 Aug
The lancet. Diabetes & endocrinology, 2017-07
Post reproductive health, 2022 Dec 27
Cancer Chemother Pharmacol, 2021 Mar 31
J Bone Miner Metab, 2020 Jul 12
Endocrine reviews, 2019-02-01
Eur J Endocrinol, 2022 Apr 21
Pediatr Hematol Oncol, 2023 Mar 20
JAMA, 2021 Apr 13
Diabetes therapy : research, treatment and education of diabetes and related disorders, 2017 May 08
Journal of the American Heart Association, 2015 Jun 26
Mayo Clinic proceedings, 2023 Jun 29
The Journal of clinical endocrinology and metabolism, 2011 Dec 28
The New England journal of medicine, 2022 Apr 21
The lancet. Diabetes & endocrinology, 2019 Aug 22
The New England journal of medicine, 2019 Mar 23
BMC medicine, 2019-07-10
JAMA, 2017 Dec 12
The lancet. Diabetes & endocrinology, 2022 Mar 14
The New England journal of medicine, 2020 Sep 24
The Journal of clinical endocrinology and metabolism, 2010 Jan 15
The New England journal of medicine, 2023 Jun 16
Clinics (Sao Paulo, Brazil), 2018 Dec 10
Metabolites, 2020 Jul 11
Protein & cell, 2014 Jul 12
Trends in biochemical sciences, 2016 Jan 05
The Journal of clinical endocrinology and metabolism, 2005-04
European journal of cancer (Oxford, England : 1990), 2012-07
The New England journal of medicine, 2018 Oct 01
The New England journal of medicine, 2015 Sep 17
The New England journal of medicine, 2020 Sep 24
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2018-05
The American journal of medicine, 2016-05
Clinical journal of the American Society of Nephrology : CJASN, 2018-07-06
Journal of critical care, 2023 May 13
The Journal of urology, 1992-06
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2019-02
European journal of endocrinology, 2023 Jul 20
JBMR plus, 2021 Aug 30
World journal of surgery, 2004 Apr 19
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-05-10
The New England journal of medicine, 2018-07-12
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-05-10
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-04-10
Clinical breast cancer, 2023 Mar 28
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010 Jun 14
The New England journal of medicine, 2023 Aug 25
Kidney international, 2022 Nov
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2023 Jan 18
Cardiovascular diabetology, 2024 Feb 08
The New England journal of medicine, 2024 May 24
Diabetes care, 2011-09
Nutrients, 2023 Aug 18
Endocrine reviews, 2019 Feb 01
The lancet. Diabetes & endocrinology, 2021 Oct 20
Arteriosclerosis, thrombosis, and vascular biology, 2019-07
The New England journal of medicine, 1980-04-17
International journal of endocrinology, 2015 Oct 20
Clinical journal of the American Society of Nephrology : CJASN, 2017-08-07
Endocrine, 2019 Nov 21
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013-04
Calcified tissue international, 2022 Oct 26
Thyroid : official journal of the American Thyroid Association, 2018 Apr 05
Nature reviews. Endocrinology, 2022 Jan 18
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2020 Sep
European journal of endocrinology, 2022 Nov 22
Journal of cardiovascular development and disease, 2022 Sep 08
Curr Rheumatol Rep, 2020 Aug 26
JMIR diabetes, 2023 Sep 11
JAMA network open, 2024 Mar 04
The lancet. Diabetes & endocrinology, 2019 Feb 28
BJS open, 2022 Jul 07
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2018-10-05
Pituitary, 2022 May 26
Annals of oncology : official journal of the European Society for Medical Oncology, 2022 Mar 14
N Engl J Med, 2023 Mar 02
The New England journal of medicine, 2024 Apr 06
Joint bone spine, 2021 May 19
Genes, 2022 Oct 17
JAMA, 2007-01-24
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2017-07
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2019 Dec 01
JAMA network open, 2022 Oct 03
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2022 Oct 17
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2020 Mar 16
The New England journal of medicine, 2016 Sep 15
The American journal of cardiology, 2004-02-01
Nature medicine, 2024 Feb 19
Journal of clinical lipidology, 2024 Mar 29
BMJ (Clinical research ed.), 2007 Feb 19
European journal of endocrinology, 2003 Dec
Current osteoporosis reports, 2021 Feb 01
The Journal of clinical endocrinology and metabolism, 1974 Nov
Diabetes Care, 2024 Jan 1
The New England journal of medicine, 2013 Sep 12
Journal of thrombosis and haemostasis : JTH, 2019 Sep 13
The Journal of clinical endocrinology and metabolism, 2024 Jan 18
Diabetes care, 1999-08
Diabetes research and clinical practice, 1994 Jan
Clinical endocrinology, 2020 Feb 26
Journal of the Endocrine Society, 2022 Dec 02
Diagnostics (Basel, Switzerland), 2021 Apr 20
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2024 Mar 28
Journal of general internal medicine, 2021 Jan 19
Frontiers in pharmacology, 2023 Mar 16
Nutrition & diabetes, 2019 Nov 04
Diabetes, obesity & metabolism, 2019 Aug 19
BMC endocrine disorders, 2021 Sep 16
Frontiers in endocrinology, 2022 Aug 18
The Journal of clinical endocrinology and metabolism, 2023 Sep 18
European journal of endocrinology, 2018 Apr 27
BMJ open, 2024 Apr 24
The New England journal of medicine, 2023 Oct 18
N Engl J Med,
Autoimmunity reviews, 2023 Dec 20
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2023 Jul 01
Diabetes care, 2021 May 05
Hospital & community psychiatry, 1983 Dec
Clinical endocrinology, 1978 Nov
The Journal of steroid biochemistry and molecular biology, 2013 Mar 06
The Journal of clinical endocrinology and metabolism, 2007-05
The Journal of clinical endocrinology and metabolism, 1975 Oct
Clinical endocrinology, 1978 Dec
The New England journal of medicine, 1980-02-21
The New England journal of medicine, 2018 Sep 13
Annals of surgery, 2008-10
Kidney360, 2022 Aug 25
Circulation, 2019-06-18