Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
Should GLP1 R agonist therapy be offered to women at high risk for breast cancer given recent data showing protective benefits?
Obesity is a key modifiable risk factor for breast cancer. While it is true that some observational studies have suggested that the use of GLP-1 RA is associated with a lower incidence of breast cancer (McDonald et al., PMID 42227662), this is an association. The authors of this study correctly poin...
Do you raise your TSH target in a postmenopausal woman on long-term levothyroxine who develops osteoporosis to minimize the bone effects of even mild over-replacement?
I do not adjust the TSH target of the normal range in postmenopausal females with osteoporosis. There are 2 caveats. With aging and menopause, with the decrease in estrogen-stimulated TBG production, many aging females will need a small decrease in Levothyroxine dose to keep the TSH in the normal ra...
Which other GLP-1 R agonist, if any, would you consider re-trialing in patients who had severe gastrointestinal side effects with Ozempic?
I am curious if you mean someone who has not tolerated the lowest dose of Ozempic, or higher doses. I have had patients who have not tolerated semaglutide but who can tolerate tirzepatide (or dulaglutide or even liraglutide if a daily injection is OK). I have also used "click counting," which is uni...
What is your approach to treating concomitant hypernatremia and hyperglycemia in patients with encephalopathy?
The risk-benefit assessment begins by identifying the primary physiologic problem. In patients with concomitant hypernatremia and hyperglycemia, the dominant abnormality is usually a profound free water deficit from osmotic diuresis. My goal is to restore normal physiology by replacing that free wat...
Which blood pressure medications do you favor using to manage ongoing hypertension post adrenalectomy for hyperaldosteronism?
If primary hyperaldosteronism is cured by adrenalectomy, it would be the usual management of HTN; otherwise, I would use spironolactone.
In postmenopausal osteoporosis, would you switch to romosozumab (rather than a PTH/PTHrP analog) if a patient fractures while on denosumab?
This is an interesting question because it raises the subject of how one defines "treatment failure" among patients who are using bone-strengthening medications. I remind patients that our drugs are most effective at preventing spinal fractures with efficacy that can exceed 70% relative risk reducti...
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...
What is your approach to patients with persistent low libido despite normal testosterone levels after use of exogenous testosterone replacement therapy?
The key point is understanding a man’s mental health and relationship status. I will always screen for depression and strongly encourage sex therapy. My unvalidated but effective screening question is asking when their last vacation was and how their libido and erections were. It’s surprising how ma...
What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?
From the 2025 ADA Standards of Care, section 10 discusses Cardiovascular Disease and Risk Management. With proper blood pressure technique, the recommended blood pressure treatment goal is less than 130/80 mmHg if this can be achieved safely. Several randomized controlled trials are referenced with ...