Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When cinacalcet is used to treat hypercalcemia in primary hyperparathyroidism, does it also normalize low serum phosphorus levels?
Cinacalcet can be used for treating primary hyperparathyroidism especially in patients who are unable to tolerate the surgery. Lowering the PTH cinacalcet will not only decrease serum calcium levels but will also increase serum phosphate levels. See Peacock et al., PMID 19837909.
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
Is there a role for levothyroxine in managing the symptoms of a patient with euthyroid Hashimoto’s thyroiditis?
No, there is no role for levothyroxine in the management of symptomatic, euthyroid patients with Hashimoto’s thyroiditis. However, in some guidelines, serum TSH levels are recommended to be less than 2.5 milliunits per liter in women with positive TPO antibodies, who are pregnant or planning pregnan...
Do you routinely use anti-resorptive medications in patients who have osteoporosis and longstanding hypoparathyroidism?
If a patient has hypoparathyroidism, I am unwilling to use bisphosphonates or denosumab because of fear of significant hypocalcemia. I will use other agents to treat their osteoporosis.
Do you recommend a particular antiresorptive/anabolic agent for patients who are at high risk for fractures but have high risk of osteonecrosis of the jaw?
Teriparatide has improved bone healing in patients with osteonecrosis of the jaw, so would be a good choice for patients at high risk of ONJ.
Is GLP-1 therapy a viable treatment option for a patient with Type 2 Diabetes complicated by atherosclerotic heart disease and cholelithiasis?
The absolute risk difference between GLP1RAs and placebo was not remarkable (5 -27/10,000 per year for different conditions such as biliary disease, cholelithiasis, cholecystitis, cholecystectomy and biliary cancer). In addition, the risk of pancreatitis was not higher (RR 1.46 [0.59 to 3.61], P val...
How do you approach management of osteoporosis in patients post lung transplant?
Osteoporosis in patients with lung transplants is essentially glucocorticoid-induced osteoporosis. Most patients with severe lung disease have a long history of glucocorticoid exposure. Post-transplant, these patients are often on long-term glucocorticoids. The primary pathophysiology of chronic glu...
What is the likelihood of recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients who develop immunotherapy induced adrenal insufficiency?
Essentially zero. ICI-induced central adrenal insufficiency is almost always permanent.
Do you recommend combined baseline cortisol and DHEA-S testing to improve the efficiency and accuracy of adrenal insufficiency diagnosis?
Yes, especially in the absence of recent glucocorticoid exposure, which can lower DHEAS levels and make it less helpful. Han et al., PMID 39657727 recently published a comprehensive manuscript on this topic.
Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?
This test indicates that this patient has fairly good urinary concentrating ability, but does not meet most criteria for "normal" since the osmoles did not go over 600. Since diabetes insipidus is a spectrum disorder, this result does not completely rule out the possibility of very mild diabetes ins...