Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is your approach to differentiating diabetes insipidus from primary polydipsia in the outpatient setting?
I usually do overnight dehydration tests for 12 hours and if fasting AM urine osmolality is >600 DI is less likely. If urine osmolality is low with high serum sodium it indicates DI, whereas with primary polydipsia the serum sodium is low with low urine osmolality.
Does papillary thyroid cancer with extensive squamous differentiation require specialized treatment beyond RAI and TSH suppression?
Squamous differentiation associated with PTC represents an aggressive pathologic feature with poor long-term outcomes. I would consider this as a step towards dedifferentiation. This disease is not chemo sensitive unfortunately. Chemo can be considered for advanced disease that requires rapid treatm...
Should we be aiming for normalization of both late-night salivary cortisol and 24hr urinary free cortisol levels when monitoring response to Cushing's disease treatment?
I usually follow UFC, but there is some data that in patients with Cushing disease treated with pasireotide there was a greater improvements in systolic/diastolic blood pressure and weight in patients with both normal late night salivary cortisol and UFC compared with only normal UFC (see: Newell-Pr...
What 24 hr urine calcium cut off value do you use for recommending parathyroidectomy in patients with asymptomatic hyperparathyroidism?
I use 5.0 mg/kg as a cut point.
Should we be considering transsphenoidal surgical resection as first-line therapy for prolactinomas?
A dopamine agonist is the first line of treatment for prolactinomas because most patients respond well to this treatment and tolerate it.
Despite low T scores (-2.5 or worse), what is the actual fracture risk in relatively younger patients (early 50s to mid 60s) with low BMD?
Good question. The first thing that I do is to accurately measure the height of my patient with a stadiometer. I then follow the height over time since it is the most sensitive indicator for silent spinal fractures occurring over time. I then evaluate them by measuring their vitamin D status, i.e., ...
How do you approach a patient with biochemical evidence of primary hyperparathyroidism, but normal parathyroid scan?
Negative sestamibi scans are not unusual in patients with primary hyperparathyroidism. Other imaging tests may be negative also. If the patient has biochemical evidence of the problem and has even mild complications referral to an experienced parathyroid surgeon would be warranted. Alternatively, ci...
After completing 12 months romosozumab, what is the next best treatment option for patients with severe osteoporosis, high risk for fracture, and normal kidney function?
Zoledronic acid is my clear-cut first choice in this setting.
What specific markers or symptoms guide your decision to adjust or stop prophylactic calcium supplementation and calcitriol in managing postoperative hypoparathyroidism following thyroidectomy?
I will taper off calcitriol first when the PTH is measurable >15 and the phos is normal. These are very good predictors of normal function.
When do you recommend plasmapheresis/plasma exchange for management of severe hypertriglyceridemia?
Generally, I recommend plasmapheresis for severe hypertriglyceridemia when patients are admitted with acute pancreatitis who either do not respond to NPO (and/or insulin if they have hyperglycemia) or if they are critically ill with for example necrotizing pancreatitis. Triglyceride concentrations d...