Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you use FRAX score or BMD scores to determine whether patients with primary hyperparathyroidism would benefit from parathyroidectomy to reduce fracture risk?
I use FRAX for all patients. Basing a diagnosis of osteoporosis simply by a patient having one T-score >2.5 SD below the mean of young normal persons diagnoses only 1/3 of women older than 50 who experience a fracture of the spine, hip or wrist. FRAX uses femoral neck BMD values, as well as other re...
How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?
Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...
Would you recommend getting a PET scan or an iodine whole body scan in a patient with recurrence of thyroid cancer in the neck previously treated with total thyroidectomy and 2 radioactive iodine ablations in the past?
The usual patient who has had 2 doses of I131 is not usually iodine-avid or iodine-sensitive. You will be able to determine with this information: When were the 2 doses of I-131? What did the post-therapy scan show after the last dose of I-131 and Was the tumor responsive either by Tg or tumor size...
Do patients with hypogonadism commonly present with dizziness?
Dizziness is not a symptom associated with hypogonadism. It is possible that a cause of hypogonadism, such as a large sellar tumor that is extending into the cerebral cortex, might cause dizziness, but it would not be due to hypogonadism per se.
Does solid/trabecular type papillary thyroid carcinoma pathology confer a higher risk of recurrence and warrant radioactive iodine ablation therapy?
Solid variant papillary thyroid carcinoma (SVPTC) is a rare subtype of PTC and has been noted particularly in pediatric thyroid cancers resulting from exposure to radiation (e.g., Chernobyl). In adults, it tends to occur in somewhat older patients, which may be attributed to some reports of more agg...
For which patients with type 2 diabetes mellitus would you consider switching to once-weekly basal insulin (Awiqli)?
Once weekly basal insulin is an advance in diabetes pharmacology, but it will not be optimal for everyone. I would suggest it for people with a very stable eating and activity schedule week to week, and may have problems with adherence to or reluctance to daily basal insulin. This may work well for ...
Is it a good practice to prescribe clonidine to take as needed for occasional severe blood pressure elevations?
Prescribing as needed clonidine is not part of my routine BP management. If the BP is uncontrolled consistently then long-acting medications can be uptitrated or dose adjusted. As needed clonidine may be helpful in the initial evaluation period or when making medications changes. It is important for...
What is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?
I have successfully treated several patients with bisphosphonate-induced subtrochanteric femoral fractures with Forteo. However, before initiating another antiresorptive therapy, I first want to be sure that the Forteo at the desired effect on bone remodeling by increasing both bone formation and bo...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
Do you recommend the use of crinecerfont in patients with congenital adrenal hyperplasia to reduce corticosteroid requirements?
Data looks good but I have not treated any patients with it.