Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When do you recommend plasmapheresis/plasma exchange for management of severe hypertriglyceridemia?
Generally, I recommend plasmapheresis for severe hypertriglyceridemia when patients are admitted with acute pancreatitis who either do not respond to NPO (and/or insulin if they have hyperglycemia) or if they are critically ill with for example necrotizing pancreatitis. Triglyceride concentrations d...
How do you manage antipsychotic-induced prolactinemia?
Most patients treated with standard doses of risperidone and paliperidone will develop hyperprolactinemia, typically below 100 ng/ml. However, not all individuals with elevated prolactin levels will exhibit clinical symptoms such as erectile dysfunction, galactorrhea, or irregular/absent menstrual c...
Is it safe to continue administering Prolia per schedule for osteoporosis treatment shortly after a patient has undergone extensive spinal surgery?
There is no evidence that spine surgery is a contraindication to receiving Prolia. If the bone was incised, Prolia could help healing.
What patient-specific factors would influence your decision to initiate semaglutide therapy in patients with HIV-associated lipohypertrophy?
I would consider it if the patient had diabetes. But there is not much data on this question.
Is it possible for certain individuals with osteoporosis to be a denosumab "non-responder"?
As far as I know, there are non-responders to every drug. There are 2 considerations that you should particularly consider, and which you could address. First, does the patient have an unrecognized secondary cause for low bone mass or fracture? It is really important to reevaluate a patient who is n...
Would you order a fibroscan to screen for MASLD in patients with insulin resistance but normal LFTs?
Suggest that you check the FIB-4 score first.
Can combined oral contraceptive use cause falsely elevated 24-hour urine-free cortisol?
UFC is an expression of free cortisol. It should not be affected by oral estrogen.
How long should T3 be continued in hypothyroid patients who received no symptomatic benefit after starting T3/T4 combination therapy?
I stop at next visit and increase T4 replacement accordingly.
Does the presence of osteoporosis change the extent of workup that should be performed for an older patient with otherwise serologically low-risk MGUS?
In brief - no, it shouldn't. While some previous studies have suggested that patients with MGUS are more likely to develop osteoporosis than those who don't, this is often related to confounders when MGUS is picked up clinically - in other words, patients with comorbidities that prompt a doctor to l...
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.