Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is the newly approved oral PCSK9 Inhibitor, Lipfendra, as clinically efficacious as injectable versions of the drug such as Repatha?
Enlicitide, Lipfendra, was shown in recent clincal trials (NEJM, feb 2026 - Navar, et al) to reduce LDLc by 57% compared with placebo.In their phase 3 clinical trials, Alirocumab (Praluent) (NEJM 2015 - Robinson, et al) lowered LDLc 62%, Evolocumab (Repatha) (NEJM 2014 - Blom et al) lowered LDLc 57%...
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...
Would you start romosozumab in an active smoker?
This is not simple! But we are good at assessment of risk vs benefit (or benefit vs risk!)First I would reassess fracture risk, prior treatments, reason to consider romo. Then I would do a deep dive into risk assessment for cardiovascular disease: how much do they smoke, prior cardiovascular disease...
How is your office streamlining the administrative process for eligible Medicare patients attempting to participate in the Bridge Program for GLP-1 agonists that started July 1st?
As an obesity medicine practice, we are very fortunate to have hired our own pharmacist to manage dose titrations, and she has helped to ensure a smooth transition to the Bridge Program. Additionally, I created an Epic SmartPhrase to guide everyone as to the specific exclusions, BMI requirements, an...
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.
What is your approach to IV fluid management for the treatment of hypercalcemia of malignancy?
At this point, I believe one can use either saline or lactated Ringer's. There is some evidence that low-chloride-containing solutions have advantages in general, which may well be the case, but we need more data on that. The amount of calcium in LR is very small and should not make a difference (1....
What is the preferred first-line non-insulin agent in patients with ketosis-prone diabetes during "remission" and evidence of preserved beta cell function?
Ketosis-prone diabetes (KPD) is an atypical form of diabetes that has been found in various racial and ethnic groups (Asian Indian, South American, West African, African American and others). People with KPD may present with DKA without the autoimmune findings of Type 1 diabetes. After the DKA episo...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
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...