Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?
The secondary stroke prevention trial showed that high/moderate-intensity statin therapy combined with ezetimibe and titrated to achieve LDLc <70 were equally effective (compared to goal LDLc <100). Overall, the most important determinant of risk reduction is the achieved LDLc, and so moderate inten...
Do you initiate a dopamine agonist empirically in a patient with a pituitary microadenoma and a mildly elevated prolactin between 30 and 100 ng/mL, or do you pursue further workup to distinguish a true microprolactinoma from stalk effect before committing to treatment?
If it is a microadenoma, the risk of this being stalk effect is minimal to none. If the patient needs prolactin normalization (is a male with hypogonadism or a non-post menopausal woman) treatment is needed. While dopaminergic therapy is the most used approach, the most recent Pituitary Society Cons...
What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?
The biggest difference between osteoporosis and CKD-MBD has to do with the underlying bone mineral laboratories. Generally, with osteoporosis, bone chemistries are relatively normal; there may be a decrease in Vit D. However, with CKD-MBD, there is usually an increase in PTH, potentially abnormaliti...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...
For patients <65 with significant intermittent steroid exposure who otherwise do not have risk factors for osteoporosis, when, if ever, do you recommend considering DEXA screening?
The FRAX guidelines recommend answering "Yes" for glucocorticoid use when a patient has received the equivalent of prednisone ≥5 mg daily for more than 3 months. However, many patients with rheumatoid arthritis have been treated with intermittent courses of corticosteroids over several years, which ...
When should patients with diabetes mellitus be screened for osteoporosis?
Hip fracture risk is higher in patients with diabetes (T1DM almost 7 times and T2DM 38% higher than controls without diabetes) (Vestergaard, PMID 17068657), and BMD scores underestimate true risk. That has led the ADA to suggest considering treatment for bone densities with T-score <-2.0, rather tha...
How many days prior to elective major surgery do you recommend holding oral GLP 1 R agonist therapy?
Zero. Or, I suppose, if you're having surgery early in the morning, one.This has gone back and forth, but the most recent guidance from the ASA (with other societies concurring) has been that most patients can continue their GLP medications as normal preoperatively, with higher-risk people being rec...
How do you approach osteoporosis screening in men?
While osteoporosis is more prevalent in postmenopausal women, it is often under-recognized in men. The risk of mortality after hip fracture is higher in men, and that risk may extend over 10 years after injury. Men who sustain a wrist fracture are more likely to have severe osteoporosis and a higher...
How do you decide between adding oral orforglipron or starting prandial insulin in a patient with type 2 diabetes above goal on basal insulin?
This is a timely question in that it is clinically relevant, and in June 2026, the ACHIEVE-5 trial was published online in JAMA, which studied adding orforglipron to basal insulin.If the patient is judged to be significantly insulinopenic--thin, low dose of basal insulin requirement, and high postpr...
Do you recommend the use of CGM for monitoring of postbariatric hypoglycemia given recent evidence of reduced accuracy in dynamic postprandial conditions?
I have always been concerned about accurately detecting hypoglycemia in patients because of the higher MARD in the hypoglycemic range with most CGM sensors. A recent review found the MARD in hospitalized patients to be 15% in the hypoglycemic range, which is much higher than in the euglycemic or hyp...