Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would elevated bone mineral density/T-score be enough to make a diagnosis of osteopetrosis?
You should not make the diagnosis of osteopetrosis based on a high bone density. There are several causes for high bone density including the autosomal recessive genetic disorder sclerostosis which is caused by mutations in the STOST gene which prevents the production of functional sclerostin.
What is the therapeutic role and blood glucose lowering capability of bromocriptine and cholestyramine for the treatment of Type 2 diabetes?
In the 15 or so years since bromocriptine and cholestyramine were approved for the treatment of hyperglycemia in T2DM, I have never prescribed them for this indication. I also have very rarely used other FDA-approved glucose-lowering agents including meglitinides, alpha-glucosidase inhibitors and am...
Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?
While long-term GH replacement in GHD individuals increased BMD (after an initial decline at 6 months point), I am not aware of any placebo-controlled study that convincingly showed an effect on fractures.
Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?
I am not aware of a well done study in this regard, but oral contraceptives containing estrogen induce growth hormone resistance and may lower IGF-1, but the beneficial effect of estrogen on bone density would almost certainly outweigh any negative effects caused by lowering the IGF-1.
Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?
The strict answer to this question, including "all patients hospitalized with acute MI" is no based on the results of the recently reported EMPACT-MI trial. In this study of more than 6000 patients empagliflozin did not significantly improve a composite endpoint of hospitalization for heart failure ...
Would you recommend RAI ablation therapy to patients with PTC who are s/p hemi-thyroidectomy and decline completion thyroidectomy despite meeting criteria based on pathology results?
RAI therapy will work to ablate the remaining thyroid lobe with about a 69% success rate using high dose of I 131. However, extra-thyroidal tumor cells will likely not pick up I 131 with this treatment. A good reference is the 2020 meta-analysis in the journal of nuclear medicine: Piccardo et al., P...
How do you determine osteoporosis treatment response when patients have discrepant DEXA scan results during monitoring (eg improved BMD of the hip and spine but worsening BMD of the femoral neck)?
This is not all that uncommon. The first thing I do is ask if they have fractured since we started the therapy. If not, I relax a little. This is a nice scenario for using bone turnover markers as part of initial work up. If PINP goes up by >10 I am happy that an anabolic drug is working... more you...
How do you choose between antithyroid drugs, RAI, and surgery for hyperthyroidism patients with existing cardiovascular disease, given their varying effects on cardiovascular outcomes?
This recent JAMA study (Chiung-Hui Peng et al., PMID 38436957), and others like it (e.g., Okosieme et al., PMID 30827829) show higher mortality rates and CV disease in patients receiving ATDs vs RAI, or better outcomes with surgery vs both RAI and ATDs (Liu et al., PMID 35822337). The main reason ap...
Would you start osteoporosis treatment in patients with low FRAX scores but have T scores lower than -2.5?
It is a good question and it does depend on what is contributing to the FRAX score. If it is due to being on medications like prednisone or having a strong family history for early-onset fractures, it is reasonable to consider osteoporosis therapy. Age is also a significant factor. For the same bone...
How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?
While there are no published clinical trials treating AFF with anabolics, we have considerable experience taking care of AFF's. Between myself and two ANP's doing strictly bone health with a large group of orthos who manage a large percentage of fractures in the Phoenix valley, we unfortunately stil...