Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?
Joint replacement surgery can be done in patients with Paget's disease. There should be no problem particularly if the patient has been treated to suppress disease activity. The best treatment is a 5 mg intravenous infusion of Recast which can suppress disease activity for 5 years or more.
How reliable is the FRAX score for assessing risk of osteoporotic fractures?
FRAX model predictions are moderately good. One commonly used measure of a prediction tool's robustness is the C-statistic, which is a generalized analogue of the area under the curve. No predictive value yields C = 0.5, while perfect prediction yields c = 1.0. There are different FRAX models for di...
Should dopamine agonist treatment stop in pregnant patients with recurrent prolactinoma despite prior surgery?
That depends on the size of the residual adenoma, the distance from the optic chiasm, and on the responsiveness of the adenoma to cabergoline. If patient had surgery, I am assuming that was poorly responsive to DA. Sometimes it is prudent to stop during the first trimester, and re-start after organo...
Should oral combined contraceptives be held prior to overnight dexamethasone suppression test to rule out Cushings?
Yes, they should be stopped for one month due to an increase in cortisol levels secondary to oral estrogen-increasing CBG. However, many women will still suppress while on OCP. Therefore, an alternative approach is to do the test while on OCP and to repeat it off OCP if the test is abnormal.
When performing adrenal vein sampling, is calculating selectivity index using androstenedione superior to using cortisol alone for determining successful catheterization?
In our experience, the measurement of androstenedione is particularly beneficial when the AVS is done without Cosyntropin stimulation. While the cortisol gradient may be <2 in such cases, we see a several-fold increase in Androstenedione gradients confirming successful catheterization.
Does biotin interfere with the measurement of other metabolites of the Vitamin D pathway outside of the 25-hydroxy Vitamin D assay?
Biotin interferes with chemiluminescent assays. Assays using LCMS to measure 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D are not affected.
Would you consider GLP1 R agonist therapy in a patient with a history of severe gallstone pancreatitis that is now post cholecystectomy?
In the context of shared decision-making, I would consider prescribing an GLP-1RA on someone with a history of severe gallstone pancreatitis post cholecystectomy. The critical issue is for the patient to understand the uncertainty about the safety of the approach and be willing to take on that risk....
What is your approach to progressive calvarial hyperostosis found in an elderly adult not caused by Pagets, acromegaly or hypercalcemia?
Does your patient have meningioma? Is the osteosclerosis generalized or localized? Localized osteosclerosis can arise from tumors (either benign or malignant) that secrete osteogenic proteins. I have had such a patient, with the unresectable meningioma secreting endothelin. Endothelin is also secret...
What specific clinical factors would drive you to recommend surgical intervention for patients with small, nonfunctional pituitary adenomas who exhibit no neurological symptoms?
I don't think there is any indication for surgery in such a case.
When and how do you taper off cabergoline therapy for treatment of microprolactinoma?
If patient does not desire fertility and microprolactinoma is stable or smaller, cabergoline can be tapered off.