Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should metformin be used in women with PCOS for weight loss?
I would not use metformin with the goal of weight loss in PCOS. Its effects on weight loss are modest (probably a few kg at most) and inconsistent. I agree with the Endocrine Society 2013 guidelines and that recommend metformin should not be used for the treatment of PCOS unless there is coexisting ...
Can FHH present with marked hypercalcemia (e.g., >12 mg/dL)?
Although unlikely, there have been several reports of FHH with parathyroid adenoma. FHH should have a setpoint. If you have previous blood calcium levels and the calcium has risen, I would search for a parathyroid adenoma.
Do you routinely use imaging (US, whole body iodine scans etc.) to follow papillary or follicular thyroid cancer after thyroidectomy and RAI therapy?
I am unaware of any prospective data suggesting a DFS or OS benefit to periodic imaging in patients with well differentiated thyroid cancer; that being said, beyond annual MMGs for our breast cancer patients, is there any benefit to any surveillance imaging in any malignancy? That has been recently ...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
In obese men presenting with gynecomastia, elevated estrogens, and hypogonadism, what clinical factors would push you to obtain testicular and/or adrenal imaging to rule out an estrogen-producing tumor?
It is not generally necessary or useful to measure serum estradiol in the evaluation of acute (tender and/or growing) gynecomastia. The widely available estradiol assays are generally immunoassays that are not accurate at the low estradiol concentrations in men. In addition, it is not uncommon to se...
How do you counsel patients on the use of berberine to prevent the progression of prediabetes to type 2 diabetes mellitus?
Berberine is a traditional Chinese medicine extracted from various plants. It has been reported to lower glucose, blood pressure, cholesterol, and weight, but the studies have varied greatly in quality. A recent meta-analysis (Liang et al., PMID 30393248) found a positive impact on glucose in patien...
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...