Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you plan to use adjuvant denosumab in patients with hormone positive breast cancer given the survival advantage seen in the ABCSG-18 trial?
Both adjuvant denosumab at 60 mg SQ every 6 months and adjuvant zoledronic acid at 4 mg IV every 6 months are reasonable options to consider as part of adjuvant treatment in post-menopausal women and both have prospective data to show statistically significant but very small improvements in disease ...
What is your approach to adjuvant hormone therapy for HR+ breast cancer in post-menopausal women with pre-existing osteoporosis?
Pre-existing osteoporosis, I assume secondary causes of osteoporosis and vitamin D3 deficiency have been ruled out, and she is on antiresorptive medications. In this case, I would use tamoxifen. In postmenopausal osteoporosis, tamoxifen mitigates bone loss but does prevent fractures. Suppose there a...
Are there contraindications to growth hormone therapy in patients who have completed treatment for pediatric cancer?
While there are theoretical and anecdotal concerns about recombinant growth hormone stimulating tumors, multiple reviews have concluded that there is no increase in tumor recurrence or second malignancy in patients treated with GH therapy for GH Deficiency after pediatric cancer treatment. In 2022, ...
Does cinacalcet reduce hypercalciuria in primary hyperparathyroidism?
Thank you for asking, and please remember that cinacalcet is an excellent temporary treatment option because it does not protect bone. Cinacalcet is usually prescribed when parathyroidectomy is absolutely not an option (rare, given the surgical talent) or must be delayed. There are patients with rec...
How do you manage osteoporosis in patients with anorexia nervosa (who often are young women < 40)?
There are several considerations when a diagnosis of osteoporosis is made in an anorexic female. 1. The bone mineral density study simply provides you with information for how much calcium per unit area is present in the bone. Based on this information a T score is provided. However, a T score of -2...
Is the combination of SGLT2i and GLP 1 R agonist therapy contraindicated in patients who develop an episode of euglycemic DKA?
Therapy always needs to be individualized, but in most cases, SGLT2 inhibitors should be stopped in patients who have had euglycemic DKA. Such individuals likely have low endogenous insulin production. GLP1R agonists could further increase the risk of recurrent euglycemic DKA, and I agree with Mehta...
For a patient with idiopathic hypercalciuria and a history of calcium kidney stones who has not normalized 24-hr urine calcium level on thiazide diuretic, is there evidence for targeting a certain urine calcium level for decreased future risk of nephrolithiasis and osteoporosis?
A good question, and the answer depends on your definition of a "normal" urine calcium level. If you use the standard definition of abnormal, the upper 5 percentile, depending on your laboratory, you will get values for upper normal calciuria in the 250-300 mg per day. However, approximately 10% of ...
Under what circumstances would you prioritize injectable semaglutide over oral semaglutide in patients with type 2 diabetes with atherosclerotic cardiovascular disease or chronic kidney disease?
The use of oral semaglutide may be preferable for many patients in this category, based on the results of the SOUL study. Injectable semaglutide may be preferred in patients who have a history of surgical procedures that might affect absorption of the drug or in individuals in whom higher doses are ...
How do you adjust levothyroxine dose for elderly individuals with decompensated heart failure on low dose levothyroxine therapy presenting with TSH >10?
I think this depends on what the FT4 is. If subclinical hypothyroidism vs overt hypothyroidism. With elderly who have decompensated heart disease, etc, it may be best to start low (12.5 - 25 mcg of levothyroxine daily) and titrate up by 12.5 - 25 mcg every 2 weeks or so. If >80 years of age, don't f...
What is your experience with metformin for improving cognitive impairment in schizophrenia?
I have not found that it does much. But there was a recent promising study for using TMS on a particular brain region that is hopeful.