Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you transition to an anabolic agent in a patient who develops an atypical fracture while on denosumab?
It is not usual to suffer an atypical fracture of the femur from denosumab, however, they do occur. It is useful to start an anabolic agent, either abaloparatide or teriparatide for both augment fracture healing and to treat the osteoporosis. Both abaloparatide and teriparatide stimulate bone format...
How do you manage osteopenia, osteoporosis and calcium / Vit D supplementation in a patient with calcinosis?
Calcinosis is mineralization of the blood vessels. Currently, there is no evidence to support any association with circulating calcium levels and calcinosis. Therefore, calcium and vitamin D supplementation at recommended levels for age will not increase calcinosis. Also, remember that ASCVD, renal ...
How do you counsel patients about the risk of osteonecrosis of the jaw with anabolic agents such as teriparatide or romosozumab ?
Drug-induced osteonecrosis of the jaw (ONJ) has been reported to occur with all anti-resorptive osteoporosis medications. Romosozumab has a dual mechanism of actions with both anabolic (bone building) and anti-resorptive effects. In a double-blind, placebo-controlled study involving 3321 subjects wh...
What range of musculoskeletal complaints have you seen with romosozumab use?
The most common side effect with Romo is injection site reactions. Some patients may have musculoskeletal pain but so do many patients not on Romo. Overall, I found that it is very well tolerated, but if a patient believes that it is causing major undesirable effects, then it is probably best to sto...
Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?
Hyperparathyroidism does increase the risk of developing kidney stones. A study in New England Journal of Medicine, Broadus et al., PMID 7351950, reported that patients with elevated concentrations of 1,25-dihydroxyvitamin D are at increased risk for kidney stones. The reason is that 1,25-dihydroxyv...
Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?
Hypersensitivity with urticaria in someone on alendronate is quite rare. I am not aware of any publications showing another bisphosphonate safely used in this setting. Although there are significant chemical differences between the various oral and IV bisphosphonates, I personally would avoid the en...
How do you approach mild prolactin elevations (20-80) in women with galactorrhea on nipple stimulation but regular menses and no plans for pregnancy?
I get baseline MRI of the sella and then monitor prolactin every 6-12 months. I don't treat unless the patient develops symptoms.
Is there a role for using continuous glucose monitors for perioperative glucose monitoring in patients with diabetes?
Use of continuous glucose monitors is becoming more widely accepted for outpatients with diabetes to manage their glucose. Many hospitals now allow patients to continue to use their CGM when admitted, though most require some hospital monitoring as well. During the early phases of COVID, ICUs starti...
Should all kidney transplant patients be started on statin therapy post operatively given their increased risk of CVD?
A kidney transplant is not an indication for statin therapy per se. The 2018 cholesterol guidelines list CKD (but not ESRD or Transplant) as a risk-enhancing factor. I would guide the decision to use statin therapy based on the patient's risk as assessed for non-transplant patients. Having said that...
Is thyrotropin receptor antibody a good biomarker to predict development of thyroid eye disease?
Patients with thyroid eye disease usually have positive TRAb or TSI but in patients with Graves' hyperthyroidism it does not help predict the development of eye disease which is much less common than hyperthyroidism.