Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you add cholecalciferol or ergocalciferol to calcitriol therapy in patients with post operative hypoparathyroidism who have low 25 OH vitamin D levels?
Yes, if a person with hypoparathyroidism has a low 25(OH) D level, on calcitriol, I would do several things; first, figure out why it is low; and second, check a serum calcium and phosphorus level. If the calcium is low and the phosphorus is elevated, I would try using cholecalciferol 1000 IU daily ...
Is active smoking a contraindication to starting menopausal hormone therapy (HRT) in a post-menopausal woman with severe vasomotor symptoms and no other cardiovascular risk factors?
Not much prescription or guidance during fellowship and now learning.
Should fasting C-peptide levels be used to guide T2DM management?
For most patients, it is not necessary to measure C-peptide to make treatment decisions. However, it is important to remember that ~5% of adults with new-onset diabetes actually have type 1 diabetes (sometimes called LADA in adults) and not type 2 diabetes. If there are concerns that type 1 diabetes...
What is your approach to a patient on long-term denosumab who now requires multiple invasive dental procedures?
This is an important issue and one our practice faces routinely. We have close to 2,000 patients on Prolia. When we initiate Prolia we discuss the concern about rapid bone loss associated with discontinuation. We advise that if they need a dental extraction we hope they can get it done before initia...
Do you delay spinal surgery (e.g. lumbar decompression for stenosis) in men or women with newly diagnosed osteoporosis and multiple thoracic compression fractures (not involving site of potential surgery) in order to initiate anabolic or anti-resorptive therapy to potentially improve surgical healing outcomes?
This is a fairly common clinical issue. Increasingly, spine surgeons are requesting anabolic bone medications prior to the type of surgery outlined in the question. Our approach has been to use three months of such treatment prior to the surgical procedure and then to continue that treatment after t...
Do you recommend stopping a SGLT2i indefinitely if a patient with chronic kidney disease and diabetes develops euglycemic diabetic ketoacidosis?
I would. In my opinion, the risk of ketoacidosis will outweigh the possible benefit from SGLTs.
Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?
Joint replacement surgery can be done in patients with Paget's disease. There should be no problem particularly if the patient has been treated to suppress disease activity. The best treatment is a 5 mg intravenous infusion of Recast which can suppress disease activity for 5 years or more.
How reliable is the FRAX score for assessing risk of osteoporotic fractures?
FRAX model predictions are moderately good. One commonly used measure of a prediction tool's robustness is the C-statistic, which is a generalized analogue of the area under the curve. No predictive value yields C = 0.5, while perfect prediction yields c = 1.0. There are different FRAX models for di...
Should dopamine agonist treatment stop in pregnant patients with recurrent prolactinoma despite prior surgery?
That depends on the size of the residual adenoma, the distance from the optic chiasm, and on the responsiveness of the adenoma to cabergoline. If patient had surgery, I am assuming that was poorly responsive to DA. Sometimes it is prudent to stop during the first trimester, and re-start after organo...
Should oral combined contraceptives be held prior to overnight dexamethasone suppression test to rule out Cushings?
Yes, they should be stopped for one month due to an increase in cortisol levels secondary to oral estrogen-increasing CBG. However, many women will still suppress while on OCP. Therefore, an alternative approach is to do the test while on OCP and to repeat it off OCP if the test is abnormal.