Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do 24-hour urine creatinine levels affect your interpretation of 24-hour urinary calcium or cortisol studies?
24-hour urine is not so easy for patients to collect. They may end up collecting urine for less than 24 hours or may include the specimen obtained after the 24 hours are up, thus collecting an inadequate specimen or collecting too much urine. Creatinine is tested to determine the adequacy of the sam...
How do you approach diagnosis and management in patients with persistent hypercalcemia and elevated (but improved) PTH six months after parathyroidectomy for primary hyperparathyroidism?
I believe that what is most important is to rule out familial hypocalciuric hypercalcemia as the likely cause for the persistence of an elevated PTH and persistent hypercalcemia. It is also possible that there is an extraneous parathyroid gland located either near the thymus or in the upper thorax o...
Is history of radiation an absolute contraindication to using parathyroid hormone (PTH) analogues?
Hx of prior radiation was never a contraindication, it was a warning due to the known increase in osteosarcoma in patients who had prior radiation. A contraindication requires proof of harm. There was no data that radiation plus a PTH anabolic increased the risk of osteosarcoma. With the review of 1...
How do you approach peri-operative management of anti-resorptive therapies such as denosumab in patients undergoing joint replacement?
This is a very practical question. I think it is fine to continue the denosumab on a regular 6-month schedule for patients undergoing joint replacement. The reduction in bone turnover should not affect the implant. In fact, with denosumab, there is a small anabolic effect with each treatment that mi...
Does your decision to start or continue Ozempic therapy in patients with diabetic retinopathy depend on the severity of the retinopathy?
Yes. The concern for use of semaglutide in patients with DR is based on results of the SUSTAIN-6 trial where patients at risk for cardiovascular disease were given 1 mg of semaglutide or placebo. While semaglutide decreased the progression of renal disease in this cohort, retinal complications were ...
How do you approach a patient with Paget’s disease of bone with elevated alkaline phosphatase and history of chronic kidney disease?
You can give Zol IV, which is clearly the optimal treatment for active Paget's. Those in the field that treat many such patients just administer this very slowly over 1-2 hours and assure good hydration concomitantly. I have treated a number of patients like this, with this scenario, without any pro...
How do you approach treatment of a patient with bilateral adrenal gland thickening & biochemical evidence of ACTH-independent hypercortisolism?
Treatment options may include removing the larger adrenal mass/hyperplasia and then assessing the HPA axis after surgery or considering medical therapy. The AVS does not have a well-established role in such patients. A nice review on this topic was recently published in Endocrine Practice (Sweeney e...
Would you recommend pharmacologic treatment with levothyroxine for a patient with subclinical hypothyroidism and CAD s/p stent placement even if the TSH is less than 10mIU/L, given a described association with reduced risk for major adverse cardiovascular events with treatment?
As always, the treatment should be individualized. The treatment of subclinical hypothyroidism can be very different in younger patients compared to the elderly. According to the European Thyroid Association, initially, if the serum TSH is elevated in the range of 4 to 10 but with a normal Free T4, ...
Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?
The secondary stroke prevention trial showed that high/moderate-intensity statin therapy combined with ezetimibe and titrated to achieve LDLc <70 were equally effective (compared to goal LDLc <100). Overall, the most important determinant of risk reduction is the achieved LDLc, and so moderate inten...
Would you switch a patient with glucocorticoid induced osteoporosis to romosozumab if a patient sustained a fragility fracture 1 year into treatment with teriparatide?
This is an interesting question for which there is no evidence-based medicine. It would be important to know what bone was broken. If it was a vertebral fracture I would likely suggest a change to romosozumab because vertebral fractures are usually not traumatic and are the purest osteoporotic fract...