Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Which antidiabetic agents would you recommend to treat hyperglycemia secondary to PI3K and AKT inhibitor therapy?
SGLT-2 inhibitors and metformin are the preferred agents of choice for hyperglycemia with PI3K and AKT inhibitor therapy.
Would you consider a shorter course of Romosozumab (3 months) followed by maintenance therapy given recent evidence that it is noninferior to 12 months of therapy for treatment of severe osteoporosis?
A recent publication led by Leder et al (Lancet Diabetes Endocrinol 2026;14: 216–22) demonstrated that a brief 3-month course of romosozumab followed by denosumab was noninferior to a full 12-month course of romosozumab given in the standard manner. This is consistent with earlier (nonrandomized) ob...
How do you recommend educating patients with a diagnosis of PCOS with the new name change to PMOS?
This is a great question. For many years, I have been talking to people about how the presence or absence of ovarian cysts didn't really mean anything in their PCOS diagnosis. So, to me, the new name makes a lot more sense. I talk to people about the underlying issue in PMOS which is the underlying ...
Have any studies shown that testosterone replacement therapy lowers the incidence of prostate cancer in hypogonadal men, or is the evidence still largely neutral?
This is a broad question to which I will give a broad answer.For men with hypogonadism (symptoms and signs of androgen deficiency, reproducibly low serum testosterone with an accurate, reliable assay) and no reversible cause, the epidemiological data overall do not show evidence of increased risk of...
In patients with iron deficiency due to history of gastric bypass or IBD, would you consider oral iron therapy if the iron deficiency anemia is mild?
Oral iron can often be effective in iron deficiency, as long as absorption is intact. If you are concerned about absorption, performing an oral iron challenge can be useful in allowing you to avoid long trials of oral iron that will be ineffective. Simply check an iron panel at baseline, then admini...
In patients with newly diagnosed Graves' disease who are started on methimazole therapy, when do you recommend repeating thyroid ultrasounds to monitor incidental thyroid nodules that meet FNA criteria?
I have an ultrasound in my exam room. My clinical practice is to perform an ultrasound as part of the diagnostic algorithm. I generally do not check TSI since I can make the diagnosis of Graves with the US and also exclude a concomitant nodule that needs biopsy. If you need to refer to Radiology for...
Should teprotumumab be used in patients with active, moderate Graves thyroid eye disease in the absence of proptosis?
Proptosis is not the only manifestation of TED. Diplopia and lid retraction are a big deal, and Tepezza can help with this.
How do you approach the use of GLP-1 receptor agonists for the management of patients with metabolically healthy obesity?
I want to define my understanding of the term “metabolically healthy obesity”. Generally, this is meant to describe patients with a BMI in the obese range but without hypertension, dysglycemia or dyslipidemia. Obesity is associated with a wide range of medical conditions beyond those three such as o...
Do you start a statin concurrently with icosapent ethyl for patients with moderate hypertriglyceridemia and high ASCVD risk, or do you prefer to start a statin alone and monitor triglyceride levels?
Statin therapy can lower TGs modestly (up to 20%) and are the first line therapy for ASCVD risk reduction. Therefore I usually initiate statin therapy first and reassess lipids prior to considering use of icosapent ethyl. Additionally IPE adds pill burden (need to take 4 g a day), so I prefer to wai...
How often do you monitor pituitary adenomas once established as non-functioning?
That depends on the size and location (close to the chiasma?). Without pathology, which may help determine aggressiveness (mitotic rate, Ki67), it is impossible to predict the growth rate. For macros, I repeat an MRI in 6 months, and, if no change, I double the interval. For micros, there is recent ...