Coffee, no sugar | Endocrinology | 02-2010
Caffeine stimulates the sympathetic nervous system and can cause symptoms of tachycardia, sweating and tremor, symptoms which are also caused by hypoglycemia. In fact hypoglycemia causes those symptoms through the ...
Metformin in prediabetes | Endocrinology | 02-2010
Randomized controlled trials for example, the Diabetes Prevention Program have demonstrated that metformin can help in the prevention of type 2 diabetes. But lifestyle intervention diet, exercise and weight loss ...
Tracking early diabetes | Endocrinology | 02-2010
See my answer above on metformin in pre-diabetes. As for microvascular screening, the best tests are the same ones that we use to screen patients with diabetes i.e. referral to ...
Vitamin D: how high can you go? | Endocrinology | 01-2010
Oral vitamin D supplementation cholecalciferol vitamin D3 is effective for vitamin D supplementation in individuals with low vitamin D, as long as they have normal absorption. Severe nutritional deficiency 25-OH-D ...
TSH is usually enough | Endocrinology | 01-2010
Yes, TSH thyroid-stimulating hormone is the screening test of choice to detect hyper- or hypothyroidism. A T3 T4 may be ordered if TSH is mildly elevated or suppressed, to determine ...
The long and the short of insulin | Endocrinology | 12-2009
Analogue insulins are based on the human insulin molecule in which modifications have been made to either produce a faster onset and duration of action such as aspart, lispro, glulisine ...
Long-term narcotics reduce testosterone | Endocrinology | 12-2009
Yes, long-term narcotic use has been associated with hypothalamic hypogonadism. Suggested mechanisms include suppression of the hypothalamic gonadal axis, and direct suppression of adrenal androgen production.
Postponing the inevitable? | Endocrinology | 12-2009
Hormone replace therapy does delay the symptoms of menopause, but with HRT, one is able to wean off the hormones slowly when the time comes, and hopefully minimize the menopausal ...
Thyroid gland is not a thermostat | Allergy | 11-2009
I wouldn t advocate thyroid replacement therapy for this indication because of the potential risks of subclinical hyperthyroidism, atrial fibrillation and osteoporosis. There s no evidence that use of thyroid ...
No need to know the genetic cause of hypothyroidism | Endocrinology | 08-2009
It isn t necessary to know the exact level of genetic defect in thyroxine synthesis as it doesn t affect therapy. Therapy for these disorders is based on levothyroxine replacement, ...
Pineal gland cysts: common and mostly harmless | Endocrinology | 08-2009
Pineal gland cysts are a common finding with a reported prevalence of 25 to 40 in autopsy series. The majority are benign and asymptomatic. Rarely they can enlarge and compress ...
Vitamin D for glycemic control | Endocrinology | 08-2009
There s evidence to suggest that vitamin D3 is important in the prevention of islet cell death. Vitamin D is required for the production of insulin, and improves insulin sensitivity. ...
Thyroid warning signs | Endocrinology | 06-2009
A thyroid nodule within a multinodular goitre should be biopsied if it s greater than 1 cm in size. Additional ultrasound features such as microcalcification, irregular borders, and rapid growth ...
Hollywood-hyped hormones | Endocrinology | 06-2009
The movement towards bioidentical hormones has been popularized over the last few years primarily through celebrity promotion. Bioidentical hormone therapy refers to the management of menopausal symptoms caused by hormone ...
Diagnostic clues in diabetes | Endocrinology | 06-2009
A low C-peptide supports the observation that the patient has deficient insulin production. It s not specific to type 1 diabetes. Islet cell antibodies are present in 80 of individuals ...
The many forms of testosterone | Urology | 05-2009
The advantages of the intramuscular form Delatestryl would be cost cheapest treatment , time-tested, and adjustable dosage usually 200 mg q1wk , while the disadvantages would be the pain, the ...
Testing for Cushing’s | Endocrinology | 03-2009
You may screen for Cushing rsquo s syndrome with a dexamethasone suppression test or with a 24-hour urine cortisol. Either screening test would be fine.
Why is my patients’ hemoglobin glycated? | Endocrinology | 01-2009
HbA1c values are influenced by red cell survival therefore, falsely high values can occur when red cell turnover is low, resulting in a disproportionate number of older red cells. This ...
What might one-sided gynecomastia signify? | Oncology, Endocrinology | 12-2008
Oncologist response Gynecomastia has been reported to have an incidence of between 5 and 9 from autopsy studies but in other groups 40 of normal men have palpable breast tissue. ...
Weight gain on insulin — what’s the score? | Endocrinology | 11-2008
The reason patients gain weight with insulin is because the treatment corrects the glycosuria that occurs with hyperglycemia, i.e. patients now store the calories that they were wasting in urine. ...
Therapy for teens with Graves’ disease | Endocrinology | 10-2008
In general, adolescents are treated with an antithyroid drug, such as methimazole, for 2-3 years. If remission isn t achieved, they re then referred for radioactive iodine therapy. You can ...
Thoughts on thiazolidinediones | Endocrinology | 09-2008
TZDs are still a useful option for controlling hypoglycemia, but their use must be tailored to the individual. TZDs shouldn't be used in patients with any kind of heart failure ...
Sitagliptin: useful in diabetes combo? | Endocrinology | 07-2008
Sitagliptin is approved for use with metformin in Canada. It has, however, been prescribed safely with all other oral hypoglycemic agents.
Diabetes -- when to test fasting blood sugar | Endocrinology | 06-2008
Once a patient is diagnosed with diabetes, it's not necessary to repeat an FBS every 3-6 months. An HbA1c, however, is indicated. The FBS can be useful to verify the ...
When hypothyroidism lies below the radar | Endocrinology | 05-2008
For patients who have subclinical hypothyroidism combined with thyroid autoimmunity or hypercholesterolemia or heart disease, treatment is warranted. For others, a trial of 3-6 months of watchful waiting for symptoms ...
Do inhaled steroids affect bone growth in kids? | Pediatrics | 05-2008
Most of the research has involved severely asthmatic children who were on high-dose inhaled steroids for years. Pediatric respirologists would argue that taking these kids off medication would have far ...
Do inhaled steroids affect bone growth in kids? | Endocrinology | 05-2008
A meta-analysis Sharek PJ, Bergman DA. Pediatrics 2000 106 1 E8 found a mean reduction in growth velocity of 1.51 cm year 95 CI, 1.15-1.87 in children treated with inhaled ...
When to treat high TSH in the elderly | Endocrinology, Geriatrics | 02-2008
Within our own laboratory group, a normal TSH level ranges between 0.35 and 5.0 mU L. TSH levels 15 are considered elevated, and suppressed if 0.1. There would be little ...
Steroids: when to test the pituitary-adrenal axis | Endocrinology | 01-2008
Long-term use of corticosteroids will diminish a person's hypothalamic-pituitary-adrenal axis by suppressing corticotropin-releasing hormone CRH from the hypothalamus and adrenocorticotropic hormone ACTH production from the pituitary. This results in atrophy ...
Is meat a risk factor for osteoporosis? | Rheumatology | 09-2007
The contribution of protein consumption, particularly meat proteins, as a risk factor for osteoporosis was suggested by early epidemiologic observations suggesting that societies with lacto-vegetarian diets had lower rates of ...
Anorexia nervosa: why the excess cholesterol? | Gastroenterology | 11-2006
Rapid weight loss, from whatever cause, can induce cholesterol gallstones as opposed to pigment stones by at least two mechanisms. There may be excessive secretion of cholesterol in the bile ...
Lipids and the positive power of nuts | Cardiology | 09-2006
Nuts may be beneficial to the heart, despite previous concerns that their high fat content makes them unsuitable for those at high risk of cardiovascular disease. Certain substances may explain ...
Amiodarone: looking out for the thyroid | Cardiology | 09-2006
Antiarrhythmic agents such as amiodarone are being used less frequently, but they're still important agents for many patients in particular, to prevent atrial fibrillation and serious arrhythmias in those who ...
Are anabolic steroids advisable in older men? | Urology | 02-2006
I'm not aware that medical bodies have an official stand on this. As a urologist who deals with prostate enlargement and cancer, I'll simply state my understanding of the facts. ...
Sparing the side effects of spironolactone | Cardiology | 01-2006
For patients with New York Heart Association NYHA Class III or IV heart failure, the Randomized Aldactone Evaluation Study RALES has reliably shown a mortality benefit when using spironolactone in ...
Is TSH suppression after cancer lifelong? | Oncology | 10-2005
Most people would suppress TSH for everyone but the very low risk. If you do so, it would be indefinitely. BC amp lt br amp gt amp lt br amp ...
The skinny on caffeine | Psychiatry | 06-2005
I'll let my endocrinologist colleague comment on the effects of caffeine on insulin and weight loss. In psychiatric terms, excessive use of caffeine can lead to anxiety and even panic ...
Rickets: on the lookout | Rheumatology | 03-2005
The best tests are 25-OH vitamin D3, 1,25- OH 2 vitamin D lt sub gt 3 lt sub gt , parathyroid hormone PTH , and serum calcium phosphorus, the latter ...
Elevated prolactin in teen | Obstetrics Gynecology | 01-2005
It's not particularly uncommon to find elevated prolactin levels in an otherwise healthy woman. My first course of action is to repeat the blood test, ensuring that no breast stimulation ...
Prescribe ASA for all diabetics? | Cardiology | 11-2004
All diabetic adults over age 30 should consider taking a baby aspirin or 81 mg ASA a day for vascular protection, unless contraindicated. As you're well aware, vascular disease is ...
Monofilament for diabetic feet | Neurology | 11-2004
All diabetic patients will eventually display clinical and electrophysiologic evidence of diabetic neuropathy. One of the problems is how to best monitor and document its development and severity. Neurologists traditionally ...
Might metformin matter? | Cardiology | 07-2004
This requires clinical judgement, as metformin is an extremely important agent for blood sugar management, especially in overweight diabetics. Patients with renal insufficiency and or liver dysfunction are prone to ...
First-line Rx for diabetics with nephropathy | Nephrology | 05-2004
The simple answer to this interesting question is that I would use a renin-angiotensin-aldosterone-system RAAS blocker. In the past few years, the question of which RAAS-blocker ACE inhibitor or ARB ...
Dealing with osteoporosis in aging men | Rheumatology | 02-2004
Bone density decline also occurs in men as they age, and the cause for the majority is idiopathic. The exact relationship between reduced hormone levels and bone mineral density BMD ...
Managing hot flushes after hormone Tx for prostate cancer | Urology | 02-2004
Steroid antiandrogens, like cyproterone and megestrol, can alleviate hot flushes, but they may also cause phlebitis. Given this potential risk, some men opt against treatment. For patients who decide to ...
HbA1c accuracy in hemoglobinopathies | Hematology | 09-2003
Glucose in the blood combines with the hemoglobin Hb in circulating red cells, changing it to glycosylated Hb, or HbA1c. Since this reaction is nearly irreversible, the longer the red ...
Is melatonin use safe in sleep deprivation? | Neurology | 07-2003
Sleep and sleep deprivation, with their corresponding neuroendocrine influences, are evolving areas of neurologic understanding. These are complex processes, and the length of a amp quot normal night's sleep amp ...
Follow-up options for benign thyroid lumps | Imaging | 06-2003
Thyroid nodules are extremely common, with estimates that 40-50 of the North American population have at least one or more of these growths. The prevalence rises with advancing age, exposure ...
Lifestyle vs drugs for metabolic syndrome | Cardiology | 05-2003
There s no simple answer to your question -- you ll need to use clinical judgement. It s essential to realize that metabolic syndrome is common -- evident in up ...
High CVD risk, low LDL-C will statins help? | Cardiology | 04-2003
You've obviously been keeping up with the literature. I'd consider this patient at high risk for future vascular events, in view of his age, hypertension, diabetes and microalbuminuria, so I'd ...
Do antidepressants affect cortisol in depression? | Psychiatry | 12-2002
Even experts find this a difficult question to answer. About 50 of depressed individuals have an increase in cortisol. As the depression improves, the cortisol levels drop -- but this ...
WHAT'S THE SCOOP ON DIABETIC NEUROPATHY? | Neurology | 10-2002
This patient probably has diabetic neuropathy. Patients with diabetes will often show features of peripheral nerve dysfunction, which becomes more common the longer they've had diabetes. We're still not sure ...
MEDULLARY THYROID CARCINOMA: ALL IN THE FAMILY? | Oncology | 02-2002
Medullary carcinoma of the thyroid can occur sporadically or can be part of the multiple endocrine neoplasia type 2 MEN-II hereditary syndrome. Associated conditions include pheochromocytoma, parathyroid hyperplasia, multiple mucosal ...
WHAT PROLACTIN LEVEL DEMANDS AN MRI? | Imaging | 12-2001
All patients with serum prolactin levels over 100 ng ml normal amp lt 20 ng ml should undergo pituitary imaging evaluation to assess for a functioning adenoma. MRI is the ...
KIDS WHO JUST WON'T EAT | Pediatrics | 02-2001
There are several medications which, as a side effect, may stimulate appetite, but I don't feel there's any role for appetite stimulants in children. If a child's weight gain is ...
HOW LONG FOR NORMAL TSH IN GRAVES'? | Endocrinology | 02-1999
The TSH can take several months to normalize once the free T4 and free T3 levels reach the normal range. This may be in part due to pituitary insensitivity to ...
