Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you counsel patients on the risks and benefits of strontium supplements for osteoporosis management?
No experts whom I know prescribe Strontium for osteoporosis. It has not been shown to be efficacious to reduce fractures, although bone density will rise substantially. Also, bear in mind of very serious toxicities that have been associated with this drug. I would never use it in any of my patients....
How should diabetic retinopathy surveillance be adjusted for patients starting GLP-1 agonists?
As with traditional anti-hyperglycemic medications, GLP-1 agonists may cause transient worsening of diabetic retinopathy due to the initial rapid control of blood glucose. Therefore, if a patient has existing retinopathy and is about to start GLP-1 agonist therapy, I recommend closer monitoring. For...
Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?
The challenge with hypovolemic hyponatremia lies in the fact that, upon correcting volume depletion, the kidney's capacity to excrete dilute urine returns, potentially leading to a rapid excretion of large volumes of dilute urine. In the case of an asymptomatic patient with a sodium level of 120 mEq...
How frequently do you monitor for hypocalcemia in patients on romosozumab?
I do not know the clinical safety data well. In my own practice, I never saw anybody get hypocalcemia. I assume the potential cause of hypocalcemia is the anti-resorptive effect of the drug. Before any osteoporosis drug. I get a good chemistry panel, PTH level, vitamin D level, and when appropriate ...
What do you recommend to your patients to prevent muscle loss when prescribing a GLP-1 agonist for weight loss?
While there are no clear data supporting the best strategies to preventing muscle loss during weight loss in general or with GLP-1 based therapies, it is generally recommended that patients engage in an exercise program which emphasizes resistance-type exercise as well as ensuring adequate dietary p...
In asymptomatic patients with mild CKD, PTH independent hypercalcemia, and hypercalciuria—after excluding common causes such as hyperparathyroidism, vitamin D abnormalities, multiple myeloma, thyroid disease, vitamin A excess, and antacid use—what is the next best step in evaluation?
It would be helpful to have more information. What is the serum calcium, urinary calcium creatinine ratio, 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, urine NTX or serum CTX, phosphorus, P1NP or osteocalcin, creatinine clearance?
Which method provides a more accurate assessment of hypercalciuria: 24-hour urinary calcium excretion or the spot urine calcium-to-creatinine ratio?
24-hour urine should be more accurate. F. Singer
Is there any evidence regarding bone density gains/fracture reduction in the setting of treatment with romosozumab after a two year course of teriparatide?
There was a study by Ebina et al., PMID 34020048 titled "To investigate the effects of prior treatment and determine the predictors of a 12-month treatment response of romosozumab (ROMO) in 148 patients with postmenopausal osteoporosis".This study was a prospective, observational, and multicenter st...
What are the potential causes for significant discrepancies between predicted A1c by Dexcom CGM and standard serum A1c by lab draw?
When interpreting A1C and CGM results, it is important to remember that neither measure is perfect. As in all clinical conditions, it is important to evaluate A1C and CGM results in the context of the clinical situation. If there is a disparity between the two measures, one should review the limitat...
What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?
If patients truly have hypoparathyroidism, then the issue is to manage their hypocalemia, which usually requires large doses of oral calcium as well as treatment with VDRAs, which results in marked hypercalciuria, since they do not have PTH to help reabsorb calcium. This even occurs when they have C...