Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
What is the evidence, if any, for the use of low dose naltrexone in the treatment of autoimmune thyroiditis?
I do not prescribe naltrexone for thyroid disease because I have not found data to support its use. In theory, low dose naltrexone (LDN) could decrease inflammation and thus potentially block development of overt hypothyroidism in TPO positive patients. But, at this time, it is anecdotal, with no ha...
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...
What are the main differences between TRYNGOLZA and Redemplo?
TRYNGOLZA (olesarsen) and Redemplo (plozasiran) both work to reduce apoC-III production, a known inhibitor of LPL activity, thus leading to significant triglyceride lowering. Olezarsen is an antisense oligonucleotide, and plozasirin is an siRNA. Both lower triglycerides by 40-60% and both are FDA-ap...
Do you use FRAX score or BMD scores to determine whether patients with primary hyperparathyroidism would benefit from parathyroidectomy to reduce fracture risk?
I use FRAX for all patients. Basing a diagnosis of osteoporosis simply by a patient having one T-score >2.5 SD below the mean of young normal persons diagnoses only 1/3 of women older than 50 who experience a fracture of the spine, hip or wrist. FRAX uses femoral neck BMD values, as well as other re...
Do you foresee any added benefit of triple agonist therapy (GLP-1, GIP and glucagon) for glycemic control in patients with Type 1 diabetes mellitus?
This is actually a speculative question, given that there is no available data to address this. But what data do we have that might inform a decision to use a triple agonist in the T1DM patient population? A recent NEJM Evidence article (Shah et al., PMID 40550013) looked at the use of semaglutide, ...
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 get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
For patients on weekly insulin (AWIQLI), do you recommend reducing their dose prior to major surgery?
Thanks for the question. AWIQLI (insulin icodec) has a half-life of 8 days. Insulin efsitora, which has a half-life of 19 days, was just approved. Both are approved only for people with type 2 diabetes. These weekly basal insulins have the potential to improve compliance and reduce the burden of inj...
Is there a role for monitoring PTH levels in patients with advanced chronic kidney disease who are receiving denosumab in order to assess for adynamic bone disease?
It is more important to monitor PTH and bone-specific alkaline phosphatase prior to the initiation of denosumab. If PTH and bone-specific alkaline phosphatase are suggestive of adynamic bone disease, I would recommend a bone biopsy to rule out adynamic bone disease prior to the initiation of denosum...