Endocrinology Consultations Archive

Acute or chronic pancreatitis?

Acute or chronic pancreatitis?

How can a clinician distinguish chronic pancreatitis from acute pancreatitis in a patient with alcohol-abuse history?

BMI as a vital sign

BMI as a vital sign

Assessing BMI regularly can help prevent long-term obesity problems.

Cardiac workup for patients 
with diabetes

Cardiac workup for patients 
with diabetes

Are more aggressive approaches to cardiac work up warranted in patients with diabetes?

Blood glucose test reliability

Blood glucose test reliability

In which disease states or at what stages of chronic kidney disease is the HbA1c test no longer reliable?

Treatment options for women with facial hair

Treatment options for women with facial hair

What is the best, safest and most cost-effective treatment for women with excess body hair?

Bisphosphonate treatment for a fragility fracture

Bisphosphonate treatment for a fragility fracture

A fragility fracture is defined as a fracture resulting from a fall from a standing height or less.

Is estrogen plus progesterone necessary for vaginal atrophy?

Is estrogen plus progesterone necessary for vaginal atrophy?

Should oral progesterone be prescribed in combination with vaginal estrogen?

Frozen shoulder susceptibility 
in diabetic patients

Frozen shoulder susceptibility 
in diabetic patients

Why are individuals with diabetes especially prone to developing frozen shoulder?

Are testosterone and belly fat linked?

Are testosterone and belly fat linked?

A patient requests her testosterone level be checked because she had heard that belly fat is related to low testosterone levels. Is there any truth to this?

Restrict fruit juice in a diabetic diet?

Restrict fruit juice in a diabetic diet?

Does fruit juice carry the same diabetes risk as other sugar-sweetened beverages?

Dietary adjustments to control Hashimoto disease

Dietary adjustments to control Hashimoto disease

Are there any studies that support eliminating foods like sugar, milk and wheat to improve Hashimoto disease symptoms?

Osteoporosis in a patient taking anti-seizure medication

Osteoporosis in a patient taking anti-seizure medication

Are dual-energy x ray absorptiometry scans safe for patients taking anti-seizure medication?

Thyroid hormone and bone density

Thyroid hormone and bone density

Can thyroid hormone replacement therapy affect bone density?

What's causing elevated creatine levels?

What's causing elevated creatine levels?

A patient has elevated creatine and fasciculations. Could an electrolyte imbalance be the cause?

Interventions for prediabetes

Interventions for prediabetes

Two clinicians disagree on a diagnosis after reviewing two-hour oral glucose tolerance test results. Who is correct?

How much insulin does it take to lower blood sugar?

How much insulin does it take to lower blood sugar?

A patient with newly diagnosed diabetes has a hemoglobin (Hb) A1c of 12.2% and glucose 350 mg/dL, despite increasing insulin (glargine [Lantus]) to 25 units. What else can be done to lower blood sugar?

Causes of thinning hair in a postmenopausal woman

Causes of thinning hair in a postmenopausal woman

Could a vegetarian diet be contributing to an older woman's alopecia?

Reversing childhood obesity

Reversing childhood obesity

How should a primary care clinician follow-up after performing a lipid profile on an obese pediatric patient?

Breastfeeding with a positive thyroid peroxidase

Breastfeeding with a positive thyroid peroxidase

Could positive thyroid peroxidase adversely affect a mother's milk supply?

Contraception options for women older than age 50 years

If follicle-stimulating hormone is >20 mIU/mL, most clinicians counsel patients against contraception, as the risk of pregnancy is virtually nil.

Gynecomastia in a patient on dialysis

A 69-year-old man with multiple health conditions develops gynecomastia after hemodialysis. Are the two related?

The role of vitamin D in post-fracture symptoms

Can vitamin D deficiency play a role in post-fracture pain?

Raising vs. lowering bedtime insulin

How can a clinician determine whether it's appropriate to raise or lower bedtime insulin in a patient experiencing difficulty controlling morning glucose levels?

Treating hypothyroidism in primary care

Can a patient with new-onset hypothyroidism be started on levothyroxine 50 µg/day without endocrine referral?

Osteoporosis medications in patients with kidney disease

Is it safe to restart osteoporosis medications in patients with stage 5 chronic kidney disease?

Managing subclinical hypothyroidism

What is the preferred thyroid management for a woman aged 34 years who presents with an enlarged thyroid, no nodules and irregular menstrual periods for the past six months?

How is microalbumin:creatinine ratio interpreted?

How is microalbumin:creatinine ratio interpreted?

When is it appropriate to refer diabetic and hypertensive patients to a renal specialist?

Maturity onset diabetes 
of the young 

What is maturity onset diabetes of the young (MODY)? How does it differ from types 1 and 2 diabetes?

Next step for endometrial hyperplasia

How would you proceed with a 64-year-old woman who has complex endometrial hyperplasia and secretory changes?

Reflux rebound after stopping PPI therapy

What is the likelihood of acid-reflux rebound in a patient stopping a proton-pump inhibitor (PPI) (pantoprazole [Protonix]) after taking the medication for one month or more?

Screening for B12 deficiency in diabetic patients

What is the treatment goal for B12 in a patient with diabetic neuropathy, given the wide range of normal (200-950 pg/mL)?

Consider many factors when assessing GI bleed risk

The risk for experiencing a serious GI event rises exponentially with increasing numbers of risk factors.

Are certain antidiabetes drugs better than others after gastric bypass?

Following gastric bypass surgery, many patients will still need metformin or glipizide (Glucotrol). Is there any evidence that one class of hypoglycemic agents is better absorbed than another?

Are ACE inhibitors and ARBs recommended for renal disease?

Tight glycemic, BP and cholesterol control, as well as weight reduction, exercise and smoking cessation can help prevent renal nephropathy.

Insulin detemir as first-line diabetes treatment

What are the effects of using insulin detemir as first-line treatment for type 2 diabetes?

Metformin's impact on levels of vitamin B12

How much B12 supplement is adequate for patients on metformin?

Treating transgender patients

What kind of screening is done when a patient wants to change sex? Are there any useful interventions to help with this transition?

C-peptide against type 2 diabetes?

Is there any role for C-peptide in the management of type 2 diabetes mellitus?

When is it OK to stop insulin?

Is it prudent to discontinue insulin in an incarcerated man with diabetes who was started on insulin while in jail, but who wishes to stop treatment?

ADHD drugs used as an appetite suppressant

Should a clinician advise a patient's parent that ADHD medicine will help with obesity?

Osteoporosis conundrum

What is the mechanism of action of teriparatide, the new parathyroid hormone (PTH) analog being used for the treatment of osteoporosis?

Treatments for granuloma annulare

A clinician contemplates dapsone for granuloma annulare. Should other treatments be considered?

What is causing this patient's syncope and abdominal symptoms?

A white woman aged 53 years has had several episodes of syncope that start with nausea, abdominal cramping, and, often, an urge to defecate.

Risks and benefits of bisphosphonate therapy

At what T-score and patient age does the benefit of bisphosphonate therapy outweigh the risk?

Blisters on swollen ankles

A black woman aged 52 years developed large (1.5-2.0 cm wide), fluid-filled blisters on her swollen ankles. There were no other symptoms, and the patient's health history was unremarkable except for anemia. What could be the cause?

Do weightlifters have higher CKs?

What is the normal range of creatine kinase (CK) for well-muscled men who lift weights?

Taking coenzyme Q10 with lipid-lowering meds

Does research support the addition of coenzyme Q10 for those on lipid-lowering medication?

Bringing up weight loss with children

What is the best way to tactfully discuss a child's excess weight with his or her parent?

Can this patient get pregnant?

A 25-year-old woman reports that from menarche until age 19 years, she menstruated only once a year.

Elevated hematocrit concerns

What are the clinical concerns for a 55-year-old, postmenopausal, Caucasian nonsmoker with a hematocrit of 52% and hemoglobin of 17 g/dL?

Maturity-onset diabetes screening

What are the most recent screening and diagnostic criteria for maturity-onset diabetes of the young?

A man who can't stay warm

A 54-year-old man from India with a history of type 2 diabetes, hypertension, and dyslipidemia, has cold hands and feet despite wearing sufficient clothing. A specialist has ruled out Raynaud's disease.

Lead-free calcium supplements?

Is there a source of calcium that is lead-free?

Alternatives to insulin

In rural health-care settings, many patients are reluctant to use insulin.

Avoiding lactic acidosis

How high can creatinine go before you must...

Musculoskeletal effects of diabetes

A 48-year-old Caucasian woman diagnosed with type 1 diabetes at the age of 10 complains of stiffness in her wrists, elbows, knees, and ankles.

Osteoporosis concerns in a premature infant

A 20-month-old girl born premature was diagnosed with necrotizing enterocolitis and underwent...

Updated Approach to New-Onset Diabetes

In light of concerns surrounding rosiglitazone (Avandia), what agent would...

Can BP Therapy Worsen Hyperglycemia?

Will using a diuretic with hydrochlorothiazide in a patient with hypertension and type 2 diabetes contribute to worsening of his hyperglycemia?

More Diabetes With Tortillas

Is there any direct relation between consumption of corn tortillas and the incidence of...

Help For Polyarthritis With Gastritis

What is the most effective treatment for polyarthritis in a patient with...

Diabetics' Alcohol Limits

Are individuals taking metformin for type 2 diabetes still allowed one or two alcoholic drinks daily?

Cholesterol goals in diabetes patients

Now that colesevelam (WelChol), a bile acid sequestrant (BAS), has been shown to decrease hemoglobin A1c (HbA1c), should it be the agent of...

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