Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?
I think a young male with multiple minimal trauma vert fractures and low BMD is appropriate to consider anabolic therapy. Of course, a thorough workup needs to be done to determine if there are any treatable causes of bone loss. If it is determined that he has “idiopathic osteoporosis” then treatmen...
Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?
I would offer a third year of a PTH analogue if the BMD response is less than a -2.5 T Score. I would follow quarterly serum calcium levels and a BMD for 1 year to assess the effects.
Would you consider transitioning patients older than 75 years of age with coronary disease from statins and/or other lipid-lowering agents to PCSK9 inhibitors given concerns for polypharmacy, provided their LDL levels remain at or below goal?
We do not have any data to suggest PCSK9i are better than statins, and all of the PCSK9i outcomes data are on top of statins. Data show generally that lower is better, and there isn’t a “floor” to benefit. That said, if I have someone on statin + ezetimibe who then gets LDL-C very low on a PCSK9i, I...
How do you manage patients who are positive for the 21-hydroxylase antibody but have no clinical or laboratory evidence of adrenal insufficiency?
I educate the patients about the signs and symptoms of adrenal insufficiency, evaluate their HPA axis at intervals, and monitor for other autoimmune disorders.
Under what circumstances would you administer subcutaneous hydrocortisone instead of IV hydrocortisone to a patient with adrenal insufficiency?
A subcutaneous route may be used instead of intramuscular injection (preferred) at home while the patient is transferred to a medical facility for further treatment. The IV route is always used in the ER setting in a patient during an adrenal crisis.
How do you manage microprolactinomas in women who are resistant to dopamine agonists, especially considering potential tumor growth during pregnancy?
Surgery should be considered in small prolactinomas (even independently from DA resistance), but this should be done by a competent neurosurgeon who specializes in pituitary surgery, meaning s/he does 50 pituitary surgeries per year or more. In expert hands, the cure rate for microprolactinomas is i...
How do you counsel younger patients regarding long-term radiologic monitoring of non-functional adrenal adenomas?
I do not think biology is so black and white. The risk of malignancy in adrenal masses according to size is a spectrum and certainly not zero just because at one point in time it is less than 5 cm (how about 4.5 cm?). Unless the radiologist can confidently diagnose a myelolipoma I think clinical jud...
Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?
If the first biopsy was AUS and the second biopsy was Bethesda II, benign, the molecular test is not warranted. It is agreed that a second biopsy of a nodule that was AUS (Bethesda III) will be benign about 40% of the time. If the first biopsy was follciular neopasm/suspicioyus for FN (Bethesda IV),...
Would you recommend the use of an ACE inhibitor to patients with Type 1 diabetes mellitus who are normotensive but have persistent moderate proteinuria?
My answer would be “yes”. ADA Standards of Care 2025 notes “ACE inhibitors and ARBs remain a mainstay of management for people with CKD with albuminuria”. Specifically, Figure 11.2 shows first-line drug therapy to be RAS inhibitor at maximum tolerated dose for treatment of albuminuria or HTN. RAS bl...
Do you recommend using intermediate-acting insulin over long-acting insulin for the management of steroid-induced hyperglycemia?
It depends on the dose of the steroids being used and whether the steroid use is for a short period or for prolonged chronic use. If the dose of the steroid is high and the use is intended for a short time, use of a short acting insulin may be preferred to combat the hyperglycemia, If the steroid us...