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Die Klug-entscheiden-Initiative der Deutschen Gesellschaft für Innere Medizin

Empfehlungen der Deutschen Gesellschaft für Endokrinologie und der Deutschen Gesellschaft für Geriatrie

The Choosing Wisely Initiative of the German Society of Internal Medicine

Recommendations of the German Society for Endocrinology and the German Society for Geriatrics

  • Schwerpunkt: Klug entscheiden
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Zusammenfassung

Positivliste

A. Nach osteoporosetypischen Frakturen soll bei älteren Patienten in der Regel eine spezifische Osteoporosetherapie eingeleitet werden. a. Osteoporose als Erkrankung des höheren Lebensalters soll diagnostiziert und behandelt werden (Empfehlung der Deutschen Gesellschaft für Geriatrie). B. Alle Patienten mit Diabetes mellitus sollen bei Einleitung einer medikamentösen Therapie eine spezifische Schulung erhalten. C. Allen Schwangeren soll eine Jodsupplementation angeboten werden. D. Bei jüngeren und therapierefraktären Patienten soll auch nach endokrinen Ursachen einer Bluthochdruckerkrankung gesucht werden. E. Jede unklare Hyperkalzämie soll abgeklärt werden.

Negativliste

A. Eine Testosteronsubstitution soll nicht aufgrund eines einzelnen erniedrigten Testosteronwerts ohne Klinik und Ursachenabklärung eingeleitet werden. B. Bildgebende Verfahren sollen erst nach Sicherung einer hormonellen Erkrankung eingesetzt werden. C. Ein Ultraschallscreening auf Schilddrüsenveränderungen bei älteren Menschen soll nicht durchgeführt werden. D. Eine Dauertherapie mit Levothyroxin bei Struma nodosa soll nicht durchgeführt werden. E. Eine Hydrokortisontherapie bei substitutionspflichtigen Patienten soll in relevanten Stresssituationen nicht ohne Dosisanpassung bleiben.

Abstract

Positive recommendations

A. After osteoporotic fractures in the elderly, as a rule specific antiosteoporotic therapy should be initiated. a. Osteoporosis as a disease of the elderly should be diagnosed and treated (recommendation of the German Society for Geriatrics). B. All patients with diabetes mellitus should complete a specific diabetes training program when antidiabetic drug medication is initiated. C. In Germany, all pregnant women should be advised to undertake iodine supplementation. D. Endocrine causes of hypertension should be ruled out in younger patients and in patients on multiple antihypertensive drugs. E. All unclear cases of hypercalcemia should be clarified.

Negative recommendations

A. Testosterone substitution therapy should not be initiated on the basis of only one measurement of a reduced testosterone level without clinical signs and clarification of the underlying cause. B. Imaging procedures should only be used after the existence of hormonal disease has been confirmed. C. Sonographic screening for thyroid disease is not advised in the elderly. D. Long-term therapy with levothyroxine for nodular goiter should be avoided. E. In relevant stress situations hydrocortisone replacement therapy should not be continued without dose adjustment in patients with adrenal or pituitary insufficiency.

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Author information

Authors and Affiliations

  1. Klinik für Allgemeine Innere Medizin, Endokrinologie und Diabetologie, Pneumologie, Infektiologie, Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Deutschland

    J. Feldkamp

  2. Funktionsbereich Spezielle Endokrinologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    M. Schott

  3. Klinik für Geriatrie, Krankenhaus Lindenbrunn, Coppenbrügge, Deutschland

    M. Gogol

  4. Endokrinologiepraxis am Stuttgarter Platz, Berlin, Deutschland

    M. Quinkler

  5. Klinik und Poliklinik für Endokrinologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Blüher

  6. Medicover Berlin-Mitte MVZ, Berlin, Deutschland

    S. Diederich

  7. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland

    M. Reincke

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  1. J. Feldkamp
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Correspondence to J. Feldkamp.

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Interessenkonflikt

J. Feldkamp, M. Schott, M. Gogol, M. Quinkler, M. Blüher, S. Diederich und M. Reincke geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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E. Märker-Hermann, Wiesbaden

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Feldkamp, J., Schott, M., Gogol, M. et al. Die Klug-entscheiden-Initiative der Deutschen Gesellschaft für Innere Medizin. Internist 57, 532–539 (2016). https://doi.org/10.1007/s00108-016-0072-4

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