Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?
Yes, olezarsen does lower triglycerides due to other causes of hypertriglyceridemia. It is currently in trials in patients with severe hypertriglyceridemia without Familial Chylomicronemia Syndrome (FCS).
Do you consent patients for diabetes insipidus following SRS or fractionated radiation for pituitary tumors?
This, and more broadly hypopituitarism of any type, is an important consideration and likely under-addressed topic in consent.Untreated hypopituitarism in adult life is associated with reduced all-cause life expectancy, and by one study 2x mortality rate compared with age/sex matched controls. [1]Th...
Do you recommend checking both TSI and TBII antibodies for Graves' disease diagnosis and monitoring?
The two assays correlate with one another to a great degree, but they are not identical. The TRAb or TBII test measures all antibodies directed against the TSH receptor that could be stimulatory, neutral, or blocking. The TSI test only measures stimulatory antibodies, and is therefore clinically mor...
What is the likelihood of recovery of parathyroid gland function for patients who underwent total thyroidectomy, found to have embedded parathyroid glands intra-operatively and then subsequently had them re-implanted into neck muscle?
Recovery of parathyroid function after total thyroidectomy in which parathyroid tissue was found embedded in the thyroid depends upon many factors. How many glands were found in the thyroid? Was the surgery extensive, and thus perhaps led to compromise of the vascular supply of the parathyroid gland...
When interpreting a 24-hour urinary calcium, which is more accurate: 24 hour urine calcium (mg/day) or 24-hour calcium-to-creatinine ratio (mg/g)?
In my opinion, the answer is unequivocal, i.e. calcium to creatinine ratio is the only way to interpret a 24-hour urine calcium. It is essentially impossible to collect an exact urine sample of 24 hours. The only way to do this, which is often unrealistic, is for the patient to empty the bladder and...
How do you counsel patients on the use of compounded weight loss medications?
It is a difficult question that is being asked more frequently, recently, because of the shortage of these drugs. I handle it the same way that I used to handle when patients asked about the use of herbs as food supplements. The important fact is that we don't know the reliability of these products....
What triggers you to choose urgent thyroidectomy versus therapeutic plasma exchange versus continued medical management for refractory thyroid storm despite 12-24 hours of guideline-concordant therapy?
A very important factor is the comfort level of the ICU doctors and the Anesthesiologists at the institution. We usually do not recommend proceeding with urgent thyroidectomy given the increased risks, unless FT4 and TT3 are normalizing. Usually, a combination of PTU (or Methimazole), stress dose st...
Do you use bone turnover markers to assess medical adherence in patients treated for osteoporosis?
I find the bone remodeling markers very helpful. First and foremost, I want to be sure that if I am going to put a patient on an antiresorptive medication that the patient has evidence for high bone turnover over i.e., increased osteoclastic activity. If the bone remodeling markers for both bone for...
Should we be using a cut off of 20 rather than the traditional 10 Hounsfield units to distinguish between benign and malignant adrenocortical tumors on imaging?
A higher CT density cut-off of 20 (even 30 in most cases) may be used to rule out ACC. However, some metastatic lesions can have a non-contrast CT density between 10 and 20 HU. A combination of a tumor size <4 cm and CT density <20 HU is pretty good in excluding almost all malignant lesions.