Heart Failure

Cardiovascular Clinical Consult

Adult Immunization

Hepatic Disease 

Behcet’s Disease

Rare Disorders

Pediatric Immunization

Implementing The Topcon Ocular Telehealth Platform

Weight Management

Screening

Monkeypox

Guidelines

Men's Health

Panic Disorder  

Anxiety

Eating Disorders

Depression

Substance-related Disorders

ADHD

Psychiatry 

Seasonal Allergies

Allergy

Nutrition 

Pregnancy and Birth

Women's Health

Atrial Fibrillation

Cholesterol Disorders

Cardiovascular Disease

Hypertension

Cardiology

Substance Use

Child/Adolescent

Pediatrics

Kidney Disease

Genetics

Medical Cannabis

Complimentary & Alternative Medicine

Skin Diseases

Dermatology

Thyroid Disorders 

Diabetes

Diabetes Type 2

Insulin

Endocrinology 

Oral Medicine 

Otorhinolaryngologic Diseases

Fibromyalgia

Pain

Irritable Bowel Syndrome 

Inflammatory Bowel Disease

Gastrointestinal Disorders

Geriatrics

Coronavirus

Hepatitis C

Cold, Cough, and Flu

Bacterial Conjunctivitis

Immunization

Influenza

HIV AIDS

Sexually Transmitted Diseases

Infection

Osteoporosis

Imaging 

Musculoskeletal Disorders  

Obesity

Rheumatoid Arthritis

Arthritis

Gout

Rheumatology

Technology

Colorectal Cancer

Kidney Cancer

Lung Cancer

Melanoma

Skin cancer

Prostate Cancer

Breast Cancer

Cervical Cancer

Cancer

Nephrology

Anemia

Dementia

Epilepsy

Cerebrovascular Diseases

Headache and Migraine

Parkinson Disease

Alzheimer disease

Stroke

Mental Health

Headache

Migraine

Nervous System Diseases

Sleep Disorders

Neurology

Asthma

Cystic Fibrosis

COPD

Pneumonia

Respiratory Diseases

Pulmonology

News

All News

Office Procedures

Practice Management

Media

Around the Practice

Between the Lines

ConsultantLive

Expert Interviews

Institutional Insights

Medical World News

Podcasts

Primary View

Provider Toolkits

Readout360

Conferences

Conference Coverage

Conference Listing

Resources

Image IQ

Interactive Posters

Polls

Publications

Quizzes

Subscribe

CE/CME

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Information

Patient Care Online

Facebook

LinkedIn

Clinical Focus

Allergy & Immunology

Endocrinology

Gastroenterology

Infectious Disease

Men’s Health

Pain Management

Psychiatry

Women’s Health

Business Focus

Billing and Collections

Career Planning

Coding and Documentation

Concierge Medicine

Cybersecurity

EHRs

Investing

Patient Relations

Personal Finance

Remote Patient Monitoring

Staffing

Telehealth

Value-based Care

Spotlight

Unmet Needs in Managing MDD

Interpreting Thyroid Function Tests

Using Thyroid Lab Tests

Testing & Screening to Optimize Men's Health

1rem

Authors

Left scleral icterus is the only prominent physical finding in the 86-year-old who presented with transient aphasia,  ataxia, and general asthenia. Can you dx? 

Unilateral Scleral Jaundice in an Elderly Man: An Odd Finding 

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Clinical Topics

Hard Purple Nodules: Your Dx?

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months.

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months. Your diagnosis?

“Swimsuit Area” Rash: Your Dx?


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

Malignancy Risks of Neurokinin Receptor Antagonists

The following transcript has been edited for clarity, style, and length.

 Lisa, one thing we’re always concerned about, and our patients are appropriately concerned about, is whether there’s any difference in the risk of malignancies between fezolinetant and elinzanetant. What do your findings suggest?

 That’s a great question. First, I want to emphasize that neither fezolinetant nor elinzanetant are hormones; they are non-hormonal therapies. However, the FDA required endometrial safety monitoring for both, reflecting a standard practice established for managing vasomotor symptoms with hormone therapy.

In the trials that led to the approval of fezolinetant, there was a very small signal of concern for endometrial hyperplasia and endometrial cancer, but it was minimal. So far, we haven’t seen similar findings in the elinzanetant data. That said, I wouldn’t consider these findings to exceed the normal rates of endometrial hyperplasia or cancer expected in the general population. It’s important to remember that these issues naturally occur in aging women, and the monitoring requirements are precautionary.

 Exactly. There’s often a misconception that anything related to female organs must involve estrogen. These drugs do not exert a direct estrogen effect, but because we’re dealing with the uterus and endometrium, there’s a presumption of risk. This connection drives the safety monitoring requirements, even though these medications are non-hormonal.

 I agree. And to add, elinzanetant hasn’t been approved yet, and fezolinetant has only been available for about 18 months. We need to contextualize these concerns appropriately. I wouldn’t overstate the risks of endometrial hyperplasia or cancer with either medication at this stage.

 Right, we haven’t seen significant problems so far. On another note, Lisa, I’d like to highlight the potential for these drugs to be adopted more widely—not just by OBGYNs but also by primary care providers and internal medicine practitioners. Women suffering from vasomotor symptoms deserve access to effective interventions, regardless of which type of provider they see.

One common concern among primary care practitioners is vaginal bleeding, which often makes them hesitant to prescribe certain therapies. Fortunately, with this class of medications, vaginal bleeding isn’t an issue. That’s a significant advantage.

 Absolutely, but I’d like to add another perspective. While some primary care colleagues are excited about these drugs because they don’t involve hormones, I’ve heard a troubling narrative. Some see these medications as a way to completely replace hormone therapy. That’s a misconception that really concerns me.

Menopausal hormone therapy remains the gold standard for many patients. These medications are fantastic options for women who can’t or shouldn’t take hormones, but they shouldn’t lead to the abandonment of hormone therapy altogether.

 I couldn’t agree more. Hormone therapy still plays a crucial role, and these medications are complementary, not replacements.

 Exactly. They’re valuable additions to our toolkit, but they don’t render menopausal hormone therapy obsolete.

Panelists discuss clinical trial data suggesting a small but higher incidence of endometrial hyperplasia or malignancy with fezolinetant, while no cases of endometrial hyperplasia or malignancy were observed with elinzanetant in a long-term safety study.

VMS Treatment Guidelines

: I’d like to start by saying that Lisa and I are longtime friends, and we’ve had many conversations about this. We’re both strong proponents of estrogen therapy. So, let me be clear: we are not abandoning estrogen for these new medications, even though they are fabulous. The NK3 and NK1 receptor antagonists are groundbreaking, both in their biochemistry and their clinical results.

That said, these drugs are primarily for women who can’t or won’t take estrogen. They offer a fantastic option, particularly for patients who don’t tolerate estrogen or for whom it’s contraindicated. For example, in my oncology clinic, I see many breast cancer survivors devastated by vasomotor symptoms and sleep disturbances. These medications can be life-changing for them.

Lisa, as the immediate past president of the Menopause Society, can you talk about the society’s updated guidelines on hormonal and non-hormonal therapies? I’d also encourage our viewers to visit the Menopause Society’s website, 

Panelists discuss key considerations for women taking hormonal therapy, emphasizing the importance of individualized treatment plans and shared decision-making to evaluate the risk-benefit profile of therapy.

Ali Ahmadizadeh, MD

Articles

Latest Updated Articles