Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?
When ZA is in its early days patients had to have a D level of 15ng/ml. To be on the safe side most of us want a 25 ng/ml level which is easy to obtain.
What is your experience with using anabolic therapy for treatment of osteoporosis in patients with EtOH cirrhosis and is one agent preferred over another (PTH analogue vs Evenity)?
The approach that has been recommended may be reasonable. It is important to recognize that a bone density score consistent with osteoporosis does not necessarily mean that the patient has osteoporosis i.e. loss of mineral and matrix. Osteomalacia, a mineralization defect of the collagen elastin mat...
Are SGLT2 inhibitors contraindicated in patients with osteoporosis and history of vertebral and hip fractures?
In ovariectomized mice, the GLP-1 agonists were found to improve bone density by reducing the inflammation in the bone marrow so there is no contra-indication for a patient with osteoporosis and vertebral fractures to take this class of medications. It is the first weight loss therapy that is not as...
Is the 6-month post-operative calcium level a good indicator of patients' risk of recurrence of primary hyperparathyroidism?
Probably, yes - see recent study: Hellums et al., PMID 40705364.
Would you recommend changing a patient from the pill form of levothyroxine to Tirosint-SOL if they are started on a proton pump inhibitor?
While it is true that PPI's may lead to a decrease in levothyroxine absorption due to decreased tablet dissolution in the stomach (Guzman-Prado et al., PMID 33469743), and that liquid formulations are not susceptible to this effect (Seng Yue et al., PMID 38554774), the decrease in levothyroxine abso...
Would you start anabolic agents for osteoporotic hip fracture healing?
There are two relatively well-done trials for tptd for fracture healing of the proximal femur. There was a Phase 3 trial for femoral neck fractures. The FDA made it quite complicated and demanded 2 separate trials of 1,200 patients each. The trials were 3 years in duration with many difficult outcom...
How do you evaluate remission in acromegaly when postoperative IGF-1 and GH levels are discordant?
It depends how long after surgery. IGF-1 may take up to 3 months form curative surgery to normalize. If GH is low (<0.4 ng/mL) and IGF-1 is still abnormal and you are less than 3 months form surgery, I would just wait. If the opposite is true (Normal IGF-1 but elevated random GH), I would perform a ...
Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?
Any bone that sustains a fragility fracture can result from osteoporosis. The definition for fragility fracture is a broken bone that occurs after a low-energy trauma, such as a fall from standing height or less, or lifting something light. They are a type of pathologic fracture, which means they ha...
Would you refer a patient for parathyroidectomy if they have normal calcium levels, mild hyperparathyroidism, and evidence of osteopenia?
It is important to be certain the patient has primary hyperparathyroidism by demonstrating by ultrasound or sestamibi scan the presence of an adenoma. Often patients with an elevated PTH and a normal calcium are also vitamin D deficient and have parathyroid hyperplasia. It is also important to rule ...
How do you counsel breastfeeding women on their limitations post radioactive iodine ablation for thyroid cancer treatment?
I agree that stopping breastfeeding for 3 months before RAI RX is optimal, but nipple secretion may continue for > 6 months. I would consider: If the RAI therapy is adjvant (i.e., no current evidence of persistent disease), there is no rush for RAI, I would allow breastfeeding for about 6 months an...