Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is the recommended workup for PTH-independent hypercalcemia secondary to an elevated 1,25-dihydroxyvitamin D level?
I presume what is meant is that the PTH is suppressed, and therefore, with an elevated 1,25-dihydroxyvitamin D concentration, it is likely the primary cause? The 2 major causes for elevated 1,25-dihydroxyvitamin D when serum 25-hydroxyvitamin D is normal or sometimes low are due to either a granulom...
Do you recommend prescribing methimazole to prevent iodinated contrast media-induced exacerbation of thyrotoxicosis in patients with pre-existing hyperthyroidism?
Yes. If someone has pre-existing UNTREATED hyperthyroidism and elderly, Methimazole should be started. The exact dose has not been proven but I use 5 mg daily for 2 months. Urinary iodine after a CT scan with contrast has been documented to be high at 2 weeks and 1 month but not 2 months post infusi...
Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?
The key word in this question is "consider". GIven the lack of published clinical trials to assess efficacy (CV and CKD hard outcomes) versus safety (DKA) in this population, an answer at this time would be a qualified yes, with the qualifications being a well-motivated patient who adheres to self-g...
Can the desmopressin stimulation test be used to assess for central adrenal insufficiency?
No. Normal corticotroph cells do not respond to desmopressin. This is the point of using the test to differentiate between Cushing's disease and pseudo-Cushing.
In patients with secondary adrenal insufficiency, when would you consider adding fludrocortisone to their steroid regimen?
Since the pituitary gland plays a small role in regulating aldosterone secretion, patients with secondary adrenal insufficiency should not need fludrocortisone therapy. In patients with adequate glucocorticoid replacement, other causes of low BP or elevated K should be searched for.
Would you consider hormone replacement therapy in young women with germline BRCA1 mutation and history of triple negative breast cancer who underwent bilateral mastectomy and prophylactic bilateral salpingo-oophorectomy?
There is inadequate data to clearly answer the question of safety of HRT after a diagnosis of breast cancer. A recent review by Ugras and Rahman summarized the published literature and concluded that the evidence does not suggest an increase in recurrence or death with the use of HRT in this setting...
In patients using NuvaRing for contraception, is the 1mg dexamethasone suppression test reliable to screen for cortisol excess?
NuvaRing should have minimal effect on cortisol-binding globulin (see Duijkers et al., PMID 15697102). Therefore, I think you can perform the DST. However, should it be abnormal, I would repeat it after 1 month off NuvaRing, and if it returned significantly different, you should post the info here.
How do you approach treatment of depression in Graves' Disease?
Though depression is often associated with hypothyroidism, it has also been found to be associated with hyperthyroid states and depression itself can impact thyroid function levels (1, 2). It is important to normalize thyroid function as psychiatric symptoms physiologically stemming from hyperthyro...
Do you recommend up-titrating the Metformin dose of patients with T2DM who are at goal A1c in order to decrease their risk of diabetes-related delirium?
I have not been adjusting metformin based on delirium.
Would you favor oral bisphosphonates over intravenous formulations for patients with hormone sensitive prostate cancer and androgen deprivation therapy (ADT) related osteopenia?
If kidney function is normal, either would do. Therapy depends on the risk level. (See Cosman et al., PMID 39073912.)