Questions discussed in this category
Lack of large scale efficacy or safety data for PTh analogue or Evenity in this patient population.
Zarnegar R, et al. The aldsoteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. PMI...
Prattichizzo et al., PMID 39468384
There seems to be little guidance on vitamin replacement in these patients. Vitamin K level < 50 yet PT/INR is normal. Is the vitamin K assay usefu...
A female in her early 70s, total thyroidectomy, left 1.4 cm and right 0.7 cm tall cell variant papillary thyroid cancer with clear margins and negativ...
Would your considerations change for a man vs a woman?
Butler et al., PMID 38587237
For a patient whose sodium remains 142 despite water deprivation from 8 pm to 8 am, with urine osm of about 500, is further testing needed?
Clinical scenario where an indeterminate pathology on initial FNA was followed by a “benign” result on a 2nd FNA.
Do you avoid using these agents only in patients with history of medullary thyroid cancer or pancreatic cancer? Are there other cancer risks we should...
If so, what do you typically prescribe?
Do anabolic agents have a role?
Viëtor et al., PMID 34503194
Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient...
Ferrell et al., PMID 38448791
Some data showed early enteral nutrition improves outcomes in DKA. Some thought that enteral nutrition could counteract the insulin gtt.
The new SCCM guidelines suggest an upper limit of 200 compared to the conventional 180.
With the time intervals recommended after taking each medicine, I am wondering how patients should be counseled.
At what doses do you start? and how do you titrate therapy?
Is this seen more with high dose vitamin D supplementation?
How would you adjust statin therapy in these patients?
Should uric acid levels be monitored regularly while on therapy?
If they are already on a preparation that contains animal products, would you change it?
Have you encountered changes in prolactin, testosterone, etc?
Would you consider testosterone therapy if he is otherwise asymptomatic?
How often do you recommend monitoring thyroid function tests in these situations?
Cholesterol Treatment Trialists' (CTT) Collaboration
Ahmad et al., PMID 36106278
Zha et al., PMID 35487459
What is your evaluation approach for RAI response? What cumulative dose do you use in practice for deciding a patient is RAI refractory?
Okubo et al., PMID 38442744
Yue et al., PMID 38554774
Normal Vitamin D, bone scan showed osteoarthritis
Herold et al., PMID 31180194
Dao et al., PMID 38663923
Trial has included diazoxide, decadron, verapamil and pasireotide with ongoing overnight lows.
Bergman et al., PMID 38458916
Liang et al., PMID 35900801
Chiung-Hui Peng et al., PMID 38436957
Do you base the decision off of the acuity and course of symptoms? The degree of estradiol elevation? Other factors?
Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?
Additional risk factors could be family history of VTE or thrombophilia, such as antithrombin deficiency.
Can 25 OH vitamin D be converted to activated vitamin D outside of PTH mediated mechanisms in some organs?
No evidence for acromegaly or Pagets.
Demay, et al., PMID 38828931
We know canagliflozin is not given to patients with amputations, what about other SGLT2 inhibitors
The patient is actively breastfeeding.
Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...
Bergman et al., PMID 38458916
The patient has very low urinary calcium despite calcium supplements, vitamin D used to be low now normal. Continues to have elevated PTH with normal ...
Asa et al., PMID 35291028
Would you recommend aiming for the postmenopausal range as per the lab reference range or do you have a specific goal?
Or other therapy - e.g., tolvaptan? Free water restriction may hinder QOL. Salt tablets may raise levels more quickly but have risks of edema and hype...
What techniques and doses would you prescribe to the primary and regional nodes?
Only the mCRPC population was included in the Fizazi et al. study, but the FDA approval is for prevention of skeletal related events from any solid tu...
After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...
Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?
There is literature showing small changes in both free T4 and TSH (despite steady state) in the first few hours after ingestion of L-T4. In occasional...
Patient is a 41F and overall good surgical risk candidate.
If so, when? Does surgery need to be timed with last dose of Prolia injection?
If not, what can be possible causes for a postmenopausal woman to have FSH, LH < 0.3 with low E2, and being asymptomatic and doing well otherwise? ...
A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...
Assuming follow-up IV bisphosphonate x2 infusions to prevent rebound fractures
Patient does not have hypercalcemia.
Can a diagnosis of acromegaly be made with just an elevated IGF-1 level in patients with features of acromegaly?
Are oral bisphosphonates contraindicated with all types of bariatric procedures?
Conflicting data exists on whether Graves' disease would increase the aggressiveness of the concomitant thyroid cancer vs having no effect/correlation...
What level or additional signs/symptoms trigger a workup? What does your workup typically consist of?
What dose of RAI would you consider giving if recommended?
I have a longstanding patient with diabetes and a consistently significant difference between CGM average and that predicted by serum A1c. The CGM avg...
Does it depend on location of radiation, length of radiation, and time since radiation?
If so, how long should OCPs be held to reliably trust the dex suppression test results?
Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortiso...
And is there a preferred diagnostic test? Whenever cyclic hypercortisolemia is suspected, it is advised that evaluation should be repeated for months,...
I’ve seen several such patients who have no secondary causes for bone loss, on adequate calcium/vitamin D, and compliant with denosumab who do n...
Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigu...
For example, patients who have been maintained on 5mg of prednisone for years without previous tapering attempts and the rheumatic disease is not acti...
Should this patient population be treated differently?
At our institution, we have started using EPIC to screen many patients for osteoporosis and ou...
There is a current recommendation from the anesthesia society to hold one dose of GLP-RA prior to general anesthesia. Given the long half-life of the ...
The female patient is in her late 70s with cardiac disease (likely due to chronic hyperthyroidism that was missed due to non-suppressed TSH). I’...
NCCN cervical cancer guidelines added a new statement - Patients who have received prior pelvic radiation therapy and have osteoporosis may benef...
Elderly male with primary hypothyroidism, HTN, and progressive worsening cognition over several months. PCP has been increasing LT4 dose as outpatient...
Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC?
No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.
Do you attempt to taper fully or maintain at a low dose?
With studies showing non inferiority to zoledronic acid q 3 months in support of bone metastatic disease, would you consider extrapolating this data a...
If so, how often do you check these labs?
Do you look into their stage/risk to decide? Since patients can experience bone loss after stopping denosumab, how do you plan to discontinue?
The patient has no personal history of VTE, but has positive family history of VTE.
Any prophylactic anticoagulation options?
How would manage...
If a patient has been treated sucessfully for Graves but has persistent symptoms of diplopia, is radiation therapy helpful? Or is this just a dry and ...
Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?
Which agents would you select and for how long would you treat them?
For pts w/ eGFR between 30-60
Does the degree of resectability affect your management?
Would you hold these agents in the setting of invasive dental procedures?
Without a discrete mass to biopsy, is there any utility of any blind biopsies to rule out IgG4 related disease, infectious or neoplastic process?
Would you consider keeping the patient on denosumab or would switch to an anabolic agent?
Are there specific features that suggest drug-induced uveitis versus de novo uveitis?
Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).
Is there a role for earlier use of anabolic agents to promote bone healing in patients that develop AFFs?
Does denosumab effect knee replacement or hip replacement? Should replacement occur right before or after injection?
Is there concern for impaired healing? Do you pause therapy and for how long?
Do you encourage patients to take a break from/stop taking Fosamax or similar medications for their osteopenia or osteoporosis in order to prevent dev...
My understanding is that this risk is exceedingly rare even with treatment in and around the stalk and hypothalamus.
Should it be started at the initial diagnosis of bone mets?
What factors if any would influence your decision and what would your approach be?
Is there any evidence that this improves outcomes over a more simple and cost effective follow up of careful physical examination and checking a perio...
Does it matter whether the intracranial lesions have been treated with whole brain or SRS/SRT?
Do you extrapolate the results of OPTIMIZE-2 and CALGB 70604 showing that an every 12 week dosing of zolendronic acid is noninferior to ever...
Do you treat patients who are clinically hypothyroid but biochemically euthyroid?
If a patient had a recurrence that was pathologically proven despite negative idodine scans, what imaging scans would you follow up with for surveilla...
In the case of a partial resection with focal perineural invasion, but no lymphadenectomy due to severe fibrosis from prior radio-ablation for hyperth...
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