Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
Would atypical fractures of the hip in a parent (treated with bisphosphonate) be considered when calculating the FRAX score for a patient with osteopenia?
There is no data regarding this question so my response is only my opinion. I would not include a parental hip fracture secondary to bisphosphonate use in the FRAX prediction model since such fractures are not (by definition), typical hip fractures (femoral neck or intertrochanteric regions). Howeve...
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...
What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?
This patient has a low to low normal TSH, with weight loss and fatigue so I would approach this as mild hyperthyroidism, or T3 thyrotoxicosis. Sertraline has been associated with abnormal TFTs, usually an elevated TSH and low T4, not with increased T3 levels. Assess the patient for any other sympto...
Do you treat hypercalciuria in post menopausal osteoporosis with normal serum calcium and PTH?
I ABSOLUTELY recommend treating! This is the sine qua non of secondary osteoporosis with the osteoporosis being a direct consequence of the underlying hypercalciuria. Thiazides are great in this setting. I use chlorthalidone in preference to HCTZ because it has a longer half-life and can be used onc...