Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
In patients with secondary osteoporosis due to primary hyperparathyroidism, should parathyroidectomy be recommended in the setting of recent prior bisphosphonate use?
I would recommend parathyroid surgery in a person with confirmed primary hyperparathyroidism and osteoporosis as the bone density will increase in most patients after surgery. Many of the patients with osteoporosis may have received bisphosphonates. In rare situations, a patient may have received a ...
Would you give a second round of therapeutic RAI in a patient with PTC s/p total thyroidectomy and I-131 ablation who is found to have recurrent disease in cervical lymph nodes s/p repeat neck dissection?
There is very limited clinical information provided. Thoughts and possible direction for further work up. RAI is not routinely indicated after cervical "recurrence" in a previously RAI-treated patient. Also depends on the extent of residual cancer status post-recent neck dissection surgery. What wa...
Aside from lifestyle measures such as calcium intake, vitamin D repletion, and weight-bearing exercises and ruling out all secondary causes, what is the preferred approach to managing osteoporosis in young women with Z score of less than -2.5 and planning to get pregnant soon?
It is very helpful to have some knowledge as to the reason for the Z score of <2.5. Young women with low BMI can have a low Z score just due to the unloading of the skeleton. Increasing body weight can often improve BMD in these women. Presumably, she has a normal menstrual cycle. If not, the instit...
When do you refer a patient with MODY3 to GI/Hepatology for monitoring/management of hepatic adenomas?
As you know, maturity-onset diabetes of the young type 3 (MODY 3) is a consequence of heterozygous germ-line mutations in HNF1A. In addition, hepatocellular adenoma (HCA) may be caused by somatic HNF1A mutations. There are approximately a dozen cases reported of individuals with MODY 3 and HCA (1). ...
Should patients who develop primary hyperparathyroidism after 5 years of Prolia treatment for osteoporosis be referred for parathyroidectomy?
There are other reasons to treat primary hyperparathyroidism surgically beyond osteoporosis, what is response to treat as far as BMD?
Would you recommend switching a diabetic CKD patient on oral semaglutide to the subcutaneous form since the benefits in CKD have primarily been reported in studies using subcutaneous GLP-1 receptor agonists?
Personally, I would not do so today. Obviously, the patient was prescribed oral semaglutide (SEMA) as opposed to injected SEMA for some reason. Assuming that the reason persists (e.g., preference for oral, greater availability) and the response with respect to A1c and weight has been reasonable, I w...
Does norethindrone suppress FSH, LH completely?
I don't think progesterone alone would suppress LH and FSH completely so other pituitary hormones should be checked and if low, check MRI of sella. Also check for other exogenous hormone use/OTC supplements.