Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
For someone with asymmetric Graves ophthalmopathy, do you still treat both eyes, or target the single affected orbit?
Single site.
When tapering moderate to high doses of long term steroids do you routinely monitor for adrenal insufficiency?
This is always a good question on which to reflect. In general, moderate dosing of steroids (> or = 20 mg prednisone equivalents) for 5 days or less do not need a taper and pose low risk of adrenal suppression, and by extension chronic adrenal insufficiency. Up to date suggests that up to 3 weeks is...
What dose/fractionation would you use to treat a papillary thyroid cancer with bulky cervical adenopathy and laryngeal invasion with impending airway obstruction that is refusing laryngectomy and surgical management?
I have encountered this situation at times and assuming the patient has a tracheostomy and there is no way to convince them to undergo the recommended surgery, I have offered definitive radiation therapy. I have treated a number of patients with 70/63/56 Gy in 35 fractions ensuring coverage of level...
What strategy do you use to determine the appropriate timing to resume osteoporosis therapy after a drug holiday?
A drug holiday (drug sabbatical) is given to reduce the likelihood of an atypical femur fracture. Such fractures have characteristic x-ray appearances and are found from below the lesser trochanter to the supracondylar flare of the distal femur. While the overall incidence of these fractures is low,...
How do you approach a potential drug holiday in a patient with osteoporosis who has had improvement in BMD after several years of denosumab therapy?
If a patient on denosumab has achieved BMD of the spine and hip that are in the high osteopenia range or normal BMDs (T score above -1), and the patient has not fractured and is not on glucocorticoids or hormone depleting agents for breast or prostate cancer, can have denosumab stopped. However, at ...
For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?
In this scenario, I prefer zoledronic acid every 3 months with renally adjusted dose. In my experience, the risk of hypocalcemia seems higher with denosumab. Calcium/vitamin D supplementation would be important as well. The every 3 month dosing is an advantage over denosumab, which would have to be ...
How do you approach the use of bisphosphonates in reproductive-aged women?
This is an extremely difficult situation. I think it would be better to change this question to a discussion of a woman of childbearing potential since a woman of reproductive age with osteoporosis could have hormone failure and therefore is not of childbearing potential per se. A woman with celiac ...
Would you avoid the entire class of bisphosphonates if a patient develops an allergic reaction, or would you consider the use of an alternative bisphosphonate?
Interesting question and an important clinical issue. If the adverse event or side effect was not serious, I would try another bisphosphonate. If it occurred on alendronate, I would try a low dose or risedronate and monitor. If the side effect occurred from the IV infusion, I also would try a low do...
Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?
New onset hyperglycemia during ICPi therapy warrants careful review of potential risk factors for type 2 diabetes mellitus (T2DM) and close monitoring of symptoms and lab results to distinguish from the rare and typically more threatening checkpoint inhibitor-associated diabetes mellitus (CIADM). Ne...
Do you change management in patients that are taking bisphosphonates and develop atrial fibrillation?
I allow bisphosphonates in patients with afib. In both the alendronate and zolendronic acid trials subanalysis revealed a minimal increase of afib but FDA review suggested both conditions occur often in the elderly and there was no causality. Our group has given several thousand infusions with no af...