Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How does your hospital approach the use of insulin pumps for admitted patients?
Patients using insulin pumps are only on rapid-acting insulin, so that any interruption in the use of the pump requires them to switch to a combination of basal insulin and rapid-acting insulin. This is hard to do in a controlled outpatient setting (for example, technical failure of the pump), but v...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...
Should all thyroid cancer patients have thyroglobulin levels measured pre-operatively?
Should all patients be tested? No A] Situations where TG might play a supportive role: In a rare patient with pathological bone fracture due to bone metastasis as a presenting manifestation of thyroid cancer. This is an uncommon presentation, where in TG estimation may assist in the diagnosis. Sim...
What is the recommended workup for PTH-independent hypercalcemia secondary to an elevated 1,25-dihydroxyvitamin D level?
I presume what is meant is that the PTH is suppressed, and therefore, with an elevated 1,25-dihydroxyvitamin D concentration, it is likely the primary cause? The 2 major causes for elevated 1,25-dihydroxyvitamin D when serum 25-hydroxyvitamin D is normal or sometimes low are due to either a granulom...
Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?
The key word in this question is "consider". GIven the lack of published clinical trials to assess efficacy (CV and CKD hard outcomes) versus safety (DKA) in this population, an answer at this time would be a qualified yes, with the qualifications being a well-motivated patient who adheres to self-g...
Can the desmopressin stimulation test be used to assess for central adrenal insufficiency?
No. Normal corticotroph cells do not respond to desmopressin. This is the point of using the test to differentiate between Cushing's disease and pseudo-Cushing.
In patients with secondary adrenal insufficiency, when would you consider adding fludrocortisone to their steroid regimen?
Since the pituitary gland plays a small role in regulating aldosterone secretion, patients with secondary adrenal insufficiency should not need fludrocortisone therapy. In patients with adequate glucocorticoid replacement, other causes of low BP or elevated K should be searched for.
Would you consider hormone replacement therapy in young women with germline BRCA1 mutation and history of triple negative breast cancer who underwent bilateral mastectomy and prophylactic bilateral salpingo-oophorectomy?
There is inadequate data to clearly answer the question of safety of HRT after a diagnosis of breast cancer. A recent review by Ugras and Rahman summarized the published literature and concluded that the evidence does not suggest an increase in recurrence or death with the use of HRT in this setting...
In patients using NuvaRing for contraception, is the 1mg dexamethasone suppression test reliable to screen for cortisol excess?
NuvaRing should have minimal effect on cortisol-binding globulin (see Duijkers et al., PMID 15697102). Therefore, I think you can perform the DST. However, should it be abnormal, I would repeat it after 1 month off NuvaRing, and if it returned significantly different, you should post the info here.
How do you approach treatment of depression in Graves' Disease?
Though depression is often associated with hypothyroidism, it has also been found to be associated with hyperthyroid states and depression itself can impact thyroid function levels (1, 2). It is important to normalize thyroid function as psychiatric symptoms physiologically stemming from hyperthyro...