Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should a short trial of androgen therapy be used in patients with primary adrenal insufficiency suffering from persistent fatigue and hypoactive sexual desire despite sufficient glucocorticoid and mineralocorticoid replacement?
Considering that adrenal glands are an important source of androgens in women, this approach, especially in symptomatic patients, seems reasonable. I usually use DHEA supplements starting at 25 mg daily and then adjust the dose based on the DHEAS and testosterone levels. Most patients require 12.5 t...
Can osilodrostat be used indefinitely in poor surgical candidates with cushing syndrome from adrenal adenoma?
There is no restriction on the duration of therapy with osilodrostat. One of the goals is to improve the clinical condition of the patient, so the patient can become a surgical candidate.
In adult women with NCCAH, is there a benefit in using supratherapeutic doses of prednisone in addition to clomiphene to improve fertility rates?
In NC-CAH, subfertility is mild compared with the classical form. Most women with nonclassic 21-hydroxylase deficiency have normal ovulation and ability to conceive, but miscarriages occur in up to 25% of their pregnancies. In women with NC-CAH who are infertile or have a history of prior miscarriag...
Should testosterone replacement be stopped in elderly men who suffered acute stroke even when testosterone levels have been stably in the low-to-mid normal range?
Recent data are reassuring with regard to the cardiovascular safety of physiologic testosterone replacement in older men. The TRAVERSE study of 5,246 men 45 to 80 years of age who had preexisting or a high risk of cardiovascular disease and were randomly assigned to a testosterone gel or placebo sho...
Would you recommend prescribing testosterone replacement therapy to reduce osteoporosis fracture rates in men with hypogonadism?
100% yes. Especially if improved quality of life may be realized. Practitioners need to understand that TRT supersedes physiologic testosterone when it comes to quality-of-life benefits, especially INJ testosterone. That's assuming even normal testosterone to begin with. Clinical real-world benefits...
Does your goal rate of correction in patients with chronic hypoosmolar hyponatremia differ based on the degree of hypoosmolarity?
Certainly the lower the PNa is, any increase in PNa will have a greater effect on serum osmolality, so yes the lower the PNa the more careful I am. I would suggest never to be complacent, but for instance if the PNa was 105 I would make sure not to increase it by more than 6 in 24 hours, but if it w...
What is your approach to treating premenopausal woman with OI with a new compression fracture?
Young women with idiopathic premenopausal osteoporosis likely have low bone formation. I was not told her BMD but I will assume it is low. An antiresorptive does not make much sense because she is producing enough estrogen to keep her cycles going. There has been some published data with the use o...
Is there any indication for obtaining adrenal imaging in patients with MEN2 who have normal plasma or urinary metanephrines?
Excellent question. Patients with pheochromocytoma-paraganglioma can present with intermittent catecholamine production.It is important to measure metabolites (O-methylated metabolites) based on work by Eisenhofer et al., PMID 15644397: intratumor metabolism of catecholamines to free metanephrines.P...
For a patient with osteopenia or osteoporosis, how long can intravenous zoledronic acid be maintained if there are not adverse events?
I generally prescribe Zoledronate annually for three years for patients with osteoporosis who are at increased fracture risk. I will occasionally add an additional treatment 18-24 months after the third infusion if there has been a positive response to the original treatment regimen and I feel that ...
Can subclinical hypothyroidism cause myxedema coma?
While the patient's signs and symptoms mimic myxedema coma, he does not have, by definition, "myxedema" (severe hypothyroidism). The patient's normal FT4 can't be explained by his taking his levothyroxine that morning, given the 7-day half-life of levothyroxine. If he hadn't been taking his medicati...