Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is there a role for monitoring PTH levels in patients with advanced chronic kidney disease who are receiving denosumab in order to assess for adynamic bone disease?
It is more important to monitor PTH and bone-specific alkaline phosphatase prior to the initiation of denosumab. If PTH and bone-specific alkaline phosphatase are suggestive of adynamic bone disease, I would recommend a bone biopsy to rule out adynamic bone disease prior to the initiation of denosum...
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
For patients on weekly insulin (AWIQLI), do you recommend reducing their dose prior to major surgery?
Thanks for the question. AWIQLI (insulin icodec) has a half-life of 8 days. Insulin efsitora, which has a half-life of 19 days, was just approved. Both are approved only for people with type 2 diabetes. These weekly basal insulins have the potential to improve compliance and reduce the burden of inj...
What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?
This is an important question to keep an eye on, given the broadening use and effectiveness of GLP-1 agonists for various conditions, especially diabetes, and for weight loss. Unfortunately, as is so often the case, major clinical trials in this area do not reflect the heterogeneity of older adults ...
Does cinacalcet reduce hypercalciuria in primary hyperparathyroidism?
Thank you for asking, and please remember that cinacalcet is an excellent temporary treatment option because it does not protect bone. Cinacalcet is usually prescribed when parathyroidectomy is absolutely not an option (rare, given the surgical talent) or must be delayed. There are patients with rec...
What is the correct dose of Lugol's iodine solution and duration of therapy for preparing a thyrotoxic patient for surgery and minimizing the risk of thyroid storm?
Potassium iodide (KI) can be given 3 times per day in a full glass of water or juice (bitter) for 10 days before Graves' hyperthyroidism surgery as follows: Lugol's solution (8 mg iodide/drop): 5-7 drops Saturated solution of potassium iodide (SSKI) (50 mg iodide/drop): 1-2 drops Minor calculated ...
What are the main differences between TRYNGOLZA and Redemplo?
TRYNGOLZA (olesarsen) and Redemplo (plozasiran) both work to reduce apoC-III production, a known inhibitor of LPL activity, thus leading to significant triglyceride lowering. Olezarsen is an antisense oligonucleotide, and plozasirin is an siRNA. Both lower triglycerides by 40-60% and both are FDA-ap...
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...
How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?
Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...