Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you prescribe testosterone to a post-menopausal woman for low libido and/or fatigue symptoms assuming all other work up is unremarkable?
I have never prescribed testosterone to women for decreased libido, if the other workup is normal. In addition, if you explain the side effects, such as increasing hirsutism, most women opt out of taking testosterone for this purpose.
What goes into your decision making when choosing between oral and intravenous bisphosphonate therapies for osteoporosis?
From my perspective if you are going to give a bisphosphonate IV is preferred since it is convenient and there is no risks of GI side effects and issues of compliance. I do not think there is any significant difference in causing ONJ and subtrochanteric femoral fractures. However my preference is De...
How do you manage an implanted insulin pump or continuous glucose monitoring device during radiation?
We do not have an official written policy yet, but honestly, we probably should develop one, since these devices are becoming more prevalent. For CGMs, we ask the patient to place the device far from the treatment site while under treatment and to verify function with finger stick glucose measuremen...
In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?
If LDL levels are already below 70, I don’t target a lower goal. The SPARCL trial showed that reducing LDL to this range has an NNT of about 45 to prevent one stroke, which I find to be modest at best. From my perspective, lowering LDL further (<30-50 range) shifts the focus to treating a number rat...
Can autoimmune thyroiditis present with recurrent angioedema and bronchospasm?
There is an association between angioedema and autoimmune thyroid disease, although the incidence is not known. Activated CD4+ T lymphocytes, monocytes, and eosinophils. The incidence of thyroid autoimmunity in chronic urticaria is similar to the background population, but there is a cluster of angi...
Do you recommend structured Tai Chi for patients with osteopenia and osteoporosis?
Tai Chi is an excellent modality for prevention of falls, but only has a modest effect in improving bone density directly. Therefore, I would strongly recommend this for individuals at high risk for falling. Benefits require at least several sessions a week for a minimum of 12 weeks (preferably 6 mo...
What therapies do you offer patients who have osteoporosis and CKD and have had adverse reactions to several oral bisphosphonate therapies and denosumab?
Without further details as to the severity of CKD, the severity of the osteoporosis, and the specific intolerance issues with denosumab (and/or BPs), this is a very difficult question to provide specific advice. Some general comments can be offered: CKD stage 4-5 is essentially without fracture data...
For transgender females taking estrogen therapy, what is the approach to assessing the need for breast cancer screening with mammography?
Breast tissue grown with the use of hormone therapy in trans women is histologically the same as the breast tissue of cisgender women. For a trans woman of average risk, it is recommended to start screening with an annual mammogram 5 years after beginning hormone therapy, at age 40. There is not muc...
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...