Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What clinical sign or symptom do you consider to be the most specific for Cushing syndrome?
Cushing's syndrome is a rare disease. The following symptoms and signs are suggestive. Symptoms: weight gain, especially in the middle, muscle weakness, and easy bruising Signs: Moon facies Central obesity with relatively thin arms and legs Pad of fat behind the neck (Buffalo hump), thin skin, pur...
When do you consider using setmelanotide for treatment of hypothalamic obesity?
Setmelanotide is approved for people with rare monogenic forms of obesity (POMC, PCSK1 or LEPR deficiency) or Bardet Biedl Syndrome. I consider performing genetic testing in people with early onset of severe obesity and with uncontrollable hunger. I recommend sending these patients to an experienced...
Which patient population would most benefit from inhaled insulin (Afrezza)?
Afrezza has the fastest onset of action and peak and shortest duration of action of any of the “ultra-rapid” prandial insulins. Its peak effect is 45 minutes vs 2 hours for the fastest injected insulin. Its duration of action is 2-3 hours vs 5-8 hours for injected mealtime insulins. A recent study s...
Should serum calcitonin for surveillance of medullary thyroid cancer be done fasting ?
Food or proton pump inhibitor administration does not seem to affect calcitonin levels in MTC patients. If there is unexplained abrupt elevation or change in a previously stable subject, then repeat testing (on a fasted state) appears reasonable.
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...
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.