Testosterone testing and use has increased over the past decade, particularly in the United States, with dramatic shifts from injections to gels. Substantial use is seen in men without recent testing and in US men with normal levels. Given widening use despite safety and efficacy questions, prescribers must consider the medical necessity of testosterone before initiation.
Transitioning from microscopic to endoscopic pituitary surgery can be achieved with a low incidence of DI. An elevated serum sodium level in the first 5 postoperative days using standard monitoring can predict the chance of developing permanent DI. Patients having no elevated serum sodium measurements, defined as >145 mmol/L, in the first 5 days postoperatively will rarely, if ever, develop permanent DI, thereby validating short postoperative inpatient stays with minimal risk of readmission for DI management. Those with a single serum sodium measurement greater than 145 mmol/L have a 15% risk of developing permanent DI.
In Brief
Care of patients with diabetes should include an assessment of bone health. It is now clear that patients with type 1 diabetes have lower bone mineral density (BMD) and higher risk of fractures. Evidence is accumulating that patients with type 2 diabetes who have complications are also at increased risk of certain types of osteoporotic fractures despite having a higher BMD when compared to patients with type 1 diabetes. Therapeutic interventions are key to preventing fractures, both by improving bone density and decreasing the risk for falls.
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