Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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.)
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...