Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you manage or monitor hypogonadal men on clomiphene citrate?
I typically monitor men being treated for hypogonadism on clomiphene citrate the same as other hypogonadal men. There is less concern for timing of ordering testosterone levels to assess response in regard to treatment administration. There is also theoretically less concern for abnormal hematocrit ...
How would you advise medical oncologists who recommend checkpoint inhibitors for a patient with baseline type 1 diabetes?
T1DM means near-complete beta-cell deficiency. These patients aren’t making enough insulin to impact blood glucose control. We always treat the cancer first, with the most appropriate medications, and worry about the diabetes later. We even advise oncologists to continue ICIs after a patient develop...
Is there a target alkaline phosphatase level for hypophosphatasia patients on asfotase alfa therapy?
The package insert states, “do not rely on serum alkaline phosphatase measurements for clinical decision making in patients treated with Strensiq”.
Does hyperprolactinemia always need to be treated if the patient has regular menses, no galactorrhea, no desire for fertility and MRI of the pituitary is normal?
No, it does not, although there is some soft data that hyperprolactinemia may be associated with metabolic dysfunction. However, a diagnosis is needed. Asymptomatic hyperprolactinemia may be due to macroprolactinemia. If monomeric prolactin is normal, you can reassure the patient that the only treat...
In a young male patient with hypogonadotropic hypogonadism and fertility goals, would starting testosterone replacement therapy affect fertility chances?
Men with hypogonadotropic hypogonadism due to congenital hypogonadotropic hypogonadism or acquired hypogonadotropic hypogonadism due to structural disease (e.g., a pituitary macroadenoma) typically require gonadotropin therapy to optimize spermatogenesis and fertility. For men who have hypogonadotro...
How do you counsel patients with non-statin associated inflammatory myopathies about statin use?
Patients with non-HMGCR-associated myositis could try statins, keeping in mind that they could develop statin-associated muscle symptoms (SAMS). Therefore, would start with fluvastatin/pravastatin/pitavastatin (that are less likely to cause SAMS) at a low dose and slowly escalate if there are no sid...
What is your approach to a patient with a low alkaline phosphatase?
This is a wonderful and increasingly relevant question as it is not uncommon for someone to have a low alkaline phosphatase and be told it is not important since alkaline phosphatase is only important if it is elevated. Causes for this abnormality include protein deficiency, Wilson’s disease, and hy...
When should you consider adding clonidine to an antihypertensive regimen for patients with advanced CKD?
Clonidine patch is useful in severely uncontrolled hypertension. In patients with CKD, not responding to conventional medications - like calcium blockers. Though the side effect profile is not great, it is less expensive and practical.
Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?
Yes, in a patient who absolutely cannot take a statin or other common alternatives such as ezetimibe, PCSK9 inhibitors, or Bempedoic acid, Niacin for ASCVD risk reduction is still a reasonable choice. While the combination of statin and niacin has been shown to be unhelpful (and possibly of greater ...
Is it reasonable to tell patients that Evenity lowers fracture risk by about 70%, while Prolia reduces it by around 50%?
It depends on the skeletal site. A 3-year fracture relative risk reduction study of Prolia versus placebo revealed a 68% reduction in new vertebral fractures, a 40% reduction in hip fractures, and a 20% reduction in nonvertebral fractures. (Cummings et al., PMID 19671655) The relative risk of new ve...