Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you time Evenity after completion of Forteo?
If a physician is considering transitioning an osteoporotic patient from a PTH treatment to romosozumab, there is no reason to delay. It should be fine to start romosozumab immediately upon discontinuing PTH if it is clinically indicated. However, it is important to remember that romosozumab has a b...
In SIADH due to malignancy, do you prefer to use free water restriction or salt tablets?
Fluid restriction is usually the first line measure in chronic SIADH. Salt tablets only work at high doses, as SIADH is a water, not a salt problem, and you improve sodium only minimally. Tolvaptan is a very powerful drug, but, as per the package insert, must be started in an inpatient setting. Addi...
When do you check macroprolactin in the evaluation of hyperprolactinemia?
I always check it for prolactin levels that are abnormal, but below 100 ng/mL. Macroprolactinemia is rather common in mild/moderate hyperprolactinemia, but it is very rare as sole cause of hyperprolactinemia when level is higher than 100 ng/mL. Importantly, even real hyperprolactinemia may appear mo...
In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?
First of all, I don't think testing for inherited thrombophilia is warranted in a patient with no personal or family history of thrombosis. Given the multigenic nature of thrombophilia and our limited ability to test for it, it's difficult if not impossible to determine an individual's risk of throm...
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
I utilize the Endocrine Society's guidelines for identifying secondary erythrocytosis secondary to gender affirming hormone therapy (GAHT) (PMID 28945902). For initial monitoring, at baseline and then every 3 month hematocrit for the first year and 1-2 times yearly thereafter is typically implemente...
What role does external beam radiotherapy play in the treatment of well differentiated papillary thyroid cancer when a total thyroidectomy and lymph node dissection cannot be performed?
Following a partial thyroidectomy (meaning less than a near-total extirpation and gross residual disease), the role of RAI is unproven and the likelihood of morbidity is real. In terms of XRT, and in a patient with reasonable co-morbidities, I would offer XRT to 60-66 Gy. Keep an eye on spinal cord ...
When is the best time to start denosumab in men with metastatic prostate cancer?
The data supporting the use of bone modifying agents (BMAs) such as denosumab or zoledronic acid are certainly the most solid for men with castration-resistant prostate cancer (i.e. progresion of disease through inital LHRH analog therapy) (Saad, JNCI 2004; 94: 1458–68; Fizzazi Lancet Oncol 2011; 37...
Should bone-directed agents, such as denosumab or zoledronic acid, be given when patients are being treated with radium-223?
In ALSYMPCA, bisphosphonate use at study entry was associated with a delay in symptomatic skeletal events (Sartor, et al. Lancet Oncol 2014; 15(7) 738-46). Based on this, osteoclast-targeted agents (i.e. zoledronic acid and denosumab) should be offered to patients with mCRPC that will receive radium...
Based on the recent disease-free survival results from ABCSG-18 presented at San Antonio, do you favor the use of Denosumab in the adjuvant setting?
I'll give you the simple answer first - YES. In those receiving AI adjuvant therapy (whether postmenopasual or pre with ovarian suppression/ablation). We've struggled with how (and whether) to use bisphosphonates in the adjuvant setting. The meta-analysis found a significant improvement of similar m...
How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?
The presence of antibodies makes measuring the thyroglobulin level essentailly inaccurate. PET imaging may have a role though clear data on its utlity is limited (and it's expensive). Physical exams and Ultrasonography is the best way of monitoring the disease state from a surveillance point. For sy...