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...
What are the indications, if any, for trending ACTH and cortisol levels in patients with adrenal insufficiency on steroid replacement therapy?
We don't usually monitor ACTH or cortisol levels for patients on steroid replacement. We follow blood pressure, electrolytes (if primary) and clinical symptoms.
Prior to gender affirming surgery, do you hold estrogen (or convert to transdermal) to minimize postoperative VTE risk?
I'd divide this into 2 sub-questions: what to do in a patient who has a history of thrombosis, and what to do in a patient without a history of thrombosis. In a patient with prior thrombosis, I would generally have them on indefinite anticoagulation alongside ongoing estrogen use. We know that trans...
Would you ever recommend radiofrequency ablation over surgery or radioiodine for a patient with an autonomously functioning thyroid nodule?
This answer can be very patient-specific, of course, in terms of preference, co-morbidities (is surgery safe), and risk of the nodule and size. I don't often do RAI for toxic adenoma /toxic MNG if the patient is a good surgical candidate or tolerates anti-thyroidals well without incident. I also hav...
What TSH cut off do you use to determine the need for levothyroxine supplementation in a pregnant patient with positive TPO antibodies?
Current ATA pregnancy guidelines recommend measuring TPO antibodies to determine the need for levothyroxine initiation in mildly hypothyroid pregnant women. However, the most recent data do not support this approach. The upcoming revision to the ATA pregnancy guidelines will no longer factor in TPO ...
What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?
This is an important question to keep an eye on, given the broadening use and effectiveness of GLP-1 agonists for various conditions, especially diabetes, and for weight loss. Unfortunately, as is so often the case, major clinical trials in this area do not reflect the heterogeneity of older adults ...
Is it a good practice to prescribe clonidine to take as needed for occasional severe blood pressure elevations?
Prescribing as needed clonidine is not part of my routine BP management. If the BP is uncontrolled consistently then long-acting medications can be uptitrated or dose adjusted. As needed clonidine may be helpful in the initial evaluation period or when making medications changes. It is important for...
When do you consider changing a patient's levothyroxine dose during hospitalization due to abnormal TFTs, but without clinical evidence of thyrotoxicosis or hypothyroidism?
Thank you for your question. I think this is something we commonly get in the hospital, and we often overreact to it. This was a "Things We Do For No Reason" some time back, and I think they outline the issues well.When people are acutely ill, TSH testing is unreliable. The times when TSH testing is...
Is there a role for cinacalcet in the management of PTHrP-mediated hypercalcemia?
Cinacalcet is a calcimimetic, meaning that it mimics calcium and interacts with the calcium sensor in the parathyroid glands, which is a signal to decrease the production of PTH. Cinacalcet will not decrease the production of PTHRP in cancer cells. However, cinacalcet will decrease the production of...
How do you decide when to treat hypocalcemia in hospitalized patients?
When I think about when to treat hypocalcemia in hospitalized patients, I anchor the decision on three things: symptoms, the absolute calcium level, and the trajectory. First, it’s important to confirm true hypocalcemia: either a serum calcium <8 mg/dL or an ionized calcium <1.1 mmol/L, and to consi...