Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you select bisphosphonate versus denosumab when initiating treatment prompted by opportunistic CT findings of low L1 attenuation and a prevalent vertebral fracture?
Actually, I prefer calcitonin. It has few side effects and does not have the jaw necrosis risk.
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
Do you consider the albuminuria reduction seen in FINE-ONE sufficient to start finerenone without hard kidney outcome data in a patient with CKD and type 1 diabetes?
The FINE-ONE trial showed that 6 months of therapy with finerenone in patients with T1DM and albuminuria decreased albumin excretion compared to placebo. On the basis of this, the FDA approved finerenone in September 2026 as the first new therapy for CKD in T1DM in 30 years. There has been much hoop...
Would you favor oral bisphosphonates over intravenous formulations for patients with hormone sensitive prostate cancer and androgen deprivation therapy (ADT) related osteopenia?
If kidney function is normal, either would do. Therapy depends on the risk level. (See Cosman et al., PMID 39073912.)
Do you start a GLP-1 receptor agonist to reduce decompensation risk in an older adult with MASLD and compensated cirrhosis?
If they have an approved indication and can get coverage, I would. Need to follow a bit more closely to ensure not rapid weight loss and protein focused with resistance exercise to avoid worse lean mass loss.
How do you prevent hyponatremia in a patient with arginine vasopressin deficiency on chronic desmopressin?
Adequate instruction is very important in order to minimize the risk of hyponatremia in patients with AVP-D (central DI). Patients need to understand that, rather than taking desmopressin on a fixed schedule, it is very important to allow the medication to wear off for at least 30 minutes once a day...
Do you recommend repeat TSH testing after a patient switches from brand-name to generic levothyroxine?
Yes. Because the FDA allows for variability in generics and the fact that some patients are very sensitive to small changes in their levothyroxine dose, I do repeat TSH after a patient switches levothyroxine formulations.
How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?
Phentermine has been available since 1959 and remains an affordable and effective medication option added to a full lifestyle-based weight management plan. In people who are generally healthy and without contraindications to the medication, I have had patients used in at least intermittently for sev...
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...
How do you proceed when the calcium-to-creatinine clearance ratio is between 0.01 and 0.02 in a patient with suspected primary hyperparathyroidism?
If has had normal calcium levels in the past, it is not FHH which is genetic, but likely to be due to negative calcium balance, either deficient intake or absorption.