General Internal Medicine&nbsp;&nbsp;&nbsp;

How should we approach the management of PCOS in transgender men seeking virilization?

What is the optimal management of pain and loss of function due to pathologic compression fractures?

Assume no epidural/cord compromise. Is kypho/vertebroplasty, radiation therapy, or conservative management (brace, antiresorptive therapy) the superio...

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

How do you counsel patients with metabolic syndrome who decline statin therapy and have low coronary calcium scores regarding their long term CVD risk?

What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?

When and how should we be stopping GLP-1 Receptor Agonist/Dual Agonist therapy?

Do you recommend increased screening for hypercortisolism in older patients given recent evidence that older patients do not commonly display hallmark symptoms of Cushing's Disease?

Nye, Endocrinology Advisor 2025

Do you routinely use anti-resorptive medications in patients who have osteoporosis and longstanding hypoparathyroidism?

Can rapid weight loss following GLP1 R agonist therapy lead to postprandial hypoglycemia and if so, what are the treatment options outside of dietary modifications?

When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?

How should we approach the recommendation of intermittent fasting for weight loss in patients with pre-existing cardiovascular conditions, given the observed association of increased CV mortality with eating durations of less than 8 hrs?

Chen & Zhong, AHA/ASA Journals 2024

How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?

Normal Vitamin D, bone scan showed osteoarthritis.

Do you recommend the use of SGLT2 inhibitors to reduce the risk of liver cirrhosis in patients with Type 2 diabetes mellitus?

Do you recommend routinely monitoring pancreatic markers such as amylase and lipase while receiving GLP1 R agonist or dual agonist therapies to determine their risk of pancreatitis?

Is a target TSH closer to the mid normal range justified in older individuals (age 70 or above) without any known cardiac ischemia or dysrhythmia or osteoporosis?

Is this recommended TSH target of 7 or higher based on the fact that globally iatrogenic hyperthyroidism is common in older individuals on levothyroxi...

Should GLP-1 agonists be held during chemotherapy?

Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?

Do you recommend combined baseline cortisol and DHEA-S testing to improve the efficiency and accuracy of adrenal insufficiency diagnosis?

What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?

How do you handle elevated blood calcium levels from lithium?

Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?

When cinacalcet is used to treat hypercalcemia in primary hyperparathyroidism, does it also normalize low serum phosphorus levels?

In patients with differentiated thyroid cancer, do you consider pathology characteristics not found in the ATA risk stratification guidelines (ie microscopic margins or multifocal cancer) when determining recurrence risk and management?

Is there a role for cinacalcet suppression testing when evaluating patients for suspected primary hyperparathyroidism who also have recurrent calcium containing kidney stone disease?

Is there a role for calcitriol in dialysis patients regardless of PTH level?

Calcitriol has important non-bone effects and dialysis patients can’t make it and are generally deficient in it. Nephrologist typically stop all...

What is the likelihood of recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients who develop immunotherapy induced adrenal insufficiency?

Would you expect cinacalcet to lower calcium levels in a patient with Familial Hypocalciuric Hypercalcemia (FHH)?

If a patient who has Familial Hypocalciuric Hypercalcemia (FHH) is misdiagnosed as PHPT (Primary Hyperparathyroidism) and treated with Cinacalcet, wil...

Do you recommend adjusting the duration of a drug holiday based on the specific bisphosphonate used when treating osteoporosis?

Does papillary thyroid cancer with extensive squamous differentiation require specialized treatment beyond RAI and TSH suppression?

Patient has 1.1 cm follicular variant PTC with extensive squamous differentiation. Neg 2/2 nodes. Already had total thyroidectomy. Would you recommend...

What 24 hr urine calcium cut off value do you use for recommending parathyroidectomy in patients with asymptomatic hyperparathyroidism?

Changes in criteria for hyperparathyroid surgery. In the 2022 5th International conference on asymptomatic hyperparathyroidism, the experts have chang...

Are recurrent UTIs a contraindication to SGLT2i use?

How do you assess and adjust treatment in patients who develops hypothyroidism after being on lithium for several years?

Is GLP-1 therapy a viable treatment option for a patient with Type 2 Diabetes complicated by atherosclerotic heart disease and cholelithiasis?

If not, would you consider a prophylactic cholecystectomy?

In a young male patient with hypogonadotropic hypogonadism and fertility goals, would starting testosterone replacement therapy affect fertility chances?

Should we be considering transsphenoidal surgical resection as first-line therapy for prolactinomas?

Wu, PMID 38253861

How do you approach management of osteoporosis in patients post lung transplant?

What factors would lead you to extend the duration of antithyroid drug therapy in a patient with Graves' disease who is clinically euthyroid at 12 months but has risk factors for recurrence?

How do you approach a patient with biochemical evidence of primary hyperparathyroidism, but normal parathyroid scan?

Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?

After what time frame off GLP-1 RA therapy should you restart at the lowest starting dose?

Patients may have to stop glp1 a therapy due to supply issues or for other reasons. If they are off for 4 weeks, is it ok to restart at the same dose ...

How do you approach treatment of depression in Graves' Disease?

Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?

Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?

How do you manage antipsychotic-induced prolactinemia?

What is your experience with using anabolic therapy for treatment of osteoporosis in patients with EtOH cirrhosis and is one agent preferred over another (PTH analogue vs Evenity)?

Lack of large scale efficacy or safety data for PTh analogue or Evenity in this patient population.

Should we be aiming for normalization of both late-night salivary cortisol and 24hr urinary free cortisol levels when monitoring response to Cushing's disease treatment?

Is it safe to continue administering Prolia per schedule for osteoporosis treatment shortly after a patient has undergone extensive spinal surgery?

How do you counsel patients on the likelihood of resolution of their hypertension post adrenalectomy for primary hyperaldosteronism?

Zarnegar R, et al. The aldsoteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. PMI...

Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?

Prattichizzo et al., PMID 39468384

Would you increase or maintain the same initial dose of methimazole for treatment of hyperthyroidism if symptoms and thyroid tests improve but are not normalized?

Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?

Would you recommend statin initiation in a young adult patient (age < 40) with type 1 diabetes mellitus and LDL cholesterol levels greater than 100 without any cardiovascular risk factors?

Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?

Do you routinely check vitamin K levels in post-bariatric surgery patients?

There seems to be little guidance on vitamin replacement in these patients. Vitamin K level < 50 yet PT/INR is normal. Is the vitamin K assay usefu...

Is tall cell variant papillary thyroid cancer automatically categorized as intermediate risk regardless of other histopathological features and should consequently be treated with RAI?

A female in her early 70s, total thyroidectomy, left 1.4 cm and right 0.7 cm tall cell variant papillary thyroid cancer with clear margins and negativ...

Would elevated bone mineral density/T-score be enough to make a diagnosis of osteopetrosis?

Does the presence of osteoporosis change the extent of workup that should be performed for an older patient with otherwise serologically low-risk MGUS?

Would your considerations change for a man vs a woman?

Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?

Butler et al., PMID 38587237

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

Would you recommend RAI ablation therapy to patients with PTC who are s/p hemi-thyroidectomy and decline completion thyroidectomy despite meeting criteria based on pathology results?

What is the likelihood of recovery of parathyroid gland function for patients who underwent total thyroidectomy, found to have embedded parathyroid glands intra-operatively and then subsequently had them re-implanted into neck muscle?

When do you recommend plasmapheresis/plasma exchange for management of severe hypertriglyceridemia?

Would you order a repeat DEXA scan 1 year later for a kidney transplant patient who had an initial DEXA scan within the first 6 months post-transplant showing osteopenia but no history of fractures, and who has been stable on glucocorticoid-free immunosuppressive therapy?

Is there a role for levothyroxine in managing the symptoms of a patient with euthyroid Hashimoto’s thyroiditis?

Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?

For a patient whose sodium remains 142 despite water deprivation from 8 pm to 8 am, with urine osm of about 500, is further testing needed?

Is there a role for use of GLP1 R agonist or dual agonist therapy for management of post bariatric hypoglycemia and dumping syndrome?

How do you determine osteoporosis treatment response when patients have discrepant DEXA scan results during monitoring (eg improved BMD of the hip and spine but worsening BMD of the femoral neck)?

How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?

Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?

Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?

Clinical scenario where an indeterminate pathology on initial FNA was followed by a “benign” result on a 2nd FNA.

How do you counsel patients on semaglutide or tirzepatide in light of potential cancer risks?

Do you avoid using these agents only in patients with history of medullary thyroid cancer or pancreatic cancer? Are there other cancer risks we should...

How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?

Do anabolic agents have a role?

Do you recommend checking both TSI and TBII antibodies for Graves' disease diagnosis and monitoring?

Do patients with central adrenal insufficiency on maintenance hydrocortisone therapy require doubling of their corticosteroid during chemotherapy cycles?

Should we be using a cut off of 20 rather than the traditional 10 Hounsfield units to distinguish between benign and malignant adrenocortical tumors on imaging?

Viëtor et al., PMID 34503194

How frequently do you monitor for hypocalcemia in patients on romosozumab?

How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?

Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient...

Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?

Ferrell et al., PMID 38448791

What workup do you recommend for patients requiring higher-than-expected levothyroxine doses for their weight?

What is the utility of near-infrared autofluorescence (NIRAF) imaging during parathyroid surgery?

How often should TSH levels be monitored in patients with a history of Graves' disease who are in remission with negative TSI/TBII antibodies and off medical therapy?

What clinical sign or symptom do you consider to be the most specific for Cushing syndrome?

Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?

Do you recommend early oral nutrition when managing diabetic ketoacidosis?

Some data showed early enteral nutrition improves outcomes in DKA. Some thought that enteral nutrition could counteract the insulin gtt.

When do you consider using setmelanotide for treatment of hypothalamic obesity?

How do you counsel patients with elevated Thyroglobulin Peroxidase antibody levels, diffuse thyroiditis features on ultrasound, non-specific symptoms of fatigue, but normal biochemical thyroid function labs?

What is the utility of checking reverse T3 in clinical practice?

Do you recommend adding low-dose Aspirin for primary prevention in patients with Type 2 Diabetes on Eliquis for another indication?

Can you explain the block and replace approach in the treatment of thyrotoxicosis, including when it is most appropriate to use and how it compares to other treatment options?

What is the clinical significance of positive anti-thyroid antibodies in a patient that is post-thyroidectomy?

Does oral semaglutide provide similar cardiovascular risk reduction benefits as injectable semaglutide?

How do you approach mild prolactin elevations (20-80) in women with galactorrhea on nipple stimulation but regular menses and no plans for pregnancy?

What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

Do you recommend non-bypass bariatric surgeries over intestinal bypass procedures for kidney transplant-eligible candidates to prevent oxalate nephropathy, given the higher risk of kidney oxalate deposition with intestinal bypass?

How do you manage osteoporosis treatment following parathyroidectomy for primary hyperparathyroidism?

What is the upper limit of blood glucose target in hyperglycemic critically ill patients?

The new SCCM guidelines suggest an upper limit of 200 compared to the conventional 180.

How should patients time the ingestion of their alendronate and levothyroxine given issues with food/drug interactions?

With the time intervals recommended after taking each medicine, I am wondering how patients should be counseled.

Should all kidney transplant patients be started on statin therapy post operatively given their increased risk of CVD?

At what doses do you start? and how do you titrate therapy?

How soon after radioactive iodine therapy for hyperthyroidism should Methimazole be resumed?

Would you consider treating empirically for AVP deficiency in a patient who had pituitary surgery 6 months earlier and complaints of polyuria/polydipsia with dilute urine (without performing water deprivation studies)?

Would you consider PTH analogue in a patient with mildly elevated PTH?

Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?

Is this seen more with high dose vitamin D supplementation?

Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?

In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?

How would you adjust statin therapy in these patients?

What factors guide you in adjusting the dose of fludrocortisone in a patient with primary adrenal insufficiency?

How do the results of the ESPRIT trial, which evaluated the impact of an SBP target of <120 mmHg on preventing major cardiovascular events, influence your blood pressure management goals for hypertensive patients with diabetes or a history of stroke?

ESPRIT Trial

Is there any evidence that spironolactone or finasteride therapy increase blood levels of testosterone?

Do you recommend the use of bempedoic acid (Nexletol) for treatment of hyperlipidemia in patients with elevated baseline uric acid levels?

Should uric acid levels be monitored regularly while on therapy?

Which brand/preparation of levothyroxine do you recommend to treat hypothyroid patients with alpha-gal allergy?

If they are already on a preparation that contains animal products, would you change it?

Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?

When do you recommend using trabecular bone score (TBS) for managing osteoporosis?

What work up do you recommend in post bariatric surgery patients who are slowly gaining back the weight despite no changes in diet?

Would you order a fibroscan to screen for MASLD in patients with insulin resistance but normal LFTs?

How do you approach the use of GLP-1 receptor agonists for the management of patients with metabolically healthy obesity?

Aside from adrenal insufficiency and thyroid toxicities, how do you approach other hormonal imbalances during treatment with immune checkpoint inhibitors?

Have you encountered changes in prolactin, testosterone, etc?

Do you recommend parathyroid adenoma resection or ablation for patients with primary hyperparathyroidism and recurrent nephrolithiasis who are found to have a single gland adenoma on parathyroid ultrasound and nuclear medicine imaging?

Do you recommend the use of GLP1 R agonist therapy in patients with T1DM for weight loss?

When would you treat mild anemia from low testosterone in an older male?

Would you consider testosterone therapy if he is otherwise asymptomatic?

What strategies do you employ for adjusting the dosage of levothyroxine in hypothyroid patients who experience significant weight loss or are initiated on GLP-1 receptor agonists?

How often do you recommend monitoring thyroid function tests in these situations?

For patients with central hypothyroidism and a clear etiology (such as recent head irradiation), do you recommend brain imaging prior to starting thyroid hormone replacement therapy?

Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?

Cholesterol Treatment Trialists' (CTT) Collaboration

In your practice, when do you opt to treat unilateral primary hyperaldosteronism medically rather than surgically?

For patients with metabolic syndrome, is it reasonable to wait for the effect of tirzepatide therapy on their lipid profile prior to starting statin therapy?

When do you recommend the use of oral testosterone replacement over injectable testosterone?

Ahmad et al., PMID 36106278

What is the optimal anti androgen dose of spironolactone when treating female hirsutism?

Are there any concerns with live vaccine innoculation and patients who are on denosumab?

How long does it take the hypothalamic-pituitary-gonadal axis to recover from secondary amenorrhea in the setting early onset and chronic use of oral combined contraceptive pills?

Is adequate BP control sufficient enough when titrating spironolactone therapy for primary hyperaldosteronism treatment?

Do progesterone only oral contraceptive pills affect cortisol binding globulin?

For hypothyroid patients on dual replacement therapy (levothyroxine & liothyronine), do you recommend monitoring TSH while holding off on the morning T3 dose?

What 60 minute cortisol threshold value do you use for diagnosis of adrenal insufficiency after ACTH stimulation?

Zha et al., PMID 35487459

What is your approach to management of hyperlipidemia in patients taking JAK inhibitors?

How do you counsel patients on the use of compounded weight loss medications?

What factors aside from progression do you consider most important in determining whether a patient with metastatic papillary thyroid carcinoma is radioactive iodine refractory?

What is your evaluation approach for RAI response? What cumulative dose do you use in practice for deciding a patient is RAI refractory?

Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?

How does contralateral suppression of more than 50% with cosyntropin during adrenal venous sampling influence your decision to recommend adrenalectomy in patients with primary aldosteronism?

Okubo et al., PMID 38442744

Would you recommend changing a patient from the pill form of levothyroxine to Tirosint-SOL if they are started on a proton pump inhibitor?

Yue et al., PMID 38554774

Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?

What work up do you recommend for persistent subclinical hyperthyroidism with decreased RAI uptake and negative thyroid antibody tests?

Do you recommend the use of GLP 1 R agonist therapy for obese women with PCOS who are actively trying to conceive?

Dao et al., PMID 38663923

Do you recommend a particular antiresorptive/anabolic agent for patients who are at high risk for fractures but have high risk of osteonecrosis of the jaw?

Would you recommend cinacalcet for patients with recurrent nephrolithiasis who have hypercalciuria despite thiazide diuretic use and who also have an elevated PTH level without localizing parathyroid adenoma on imaging?

What is the typical timeline for remission of autoimmune hypoglycemia?

What evaluation do you do in patients with hypertension and persistently elevated aldosterone/renin ratio (over 20) but without an elevated aldosterone level (under 10 ng/dL)?

Is Metformin contraindicated in patients using long term oxygen therapy at home?

Liang et al., PMID 35900801

How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?

What are the indications for use of inclisiran over anti-PCSK9 monoclonal antibody therapies?

Is a history of provoked DVT a contraindication to starting testosterone replacement therapy in a middle aged man with symptomatic hypogonadism who is on anti-coagulation?

How do you choose between antithyroid drugs, RAI, and surgery for hyperthyroidism patients with existing cardiovascular disease, given their varying effects on cardiovascular outcomes?

Chiung-Hui Peng et al., PMID 38436957

In obese men presenting with gynecomastia, elevated estrogens, and hypogonadism, what clinical factors would push you to obtain testicular and/or adrenal imaging to rule out an estrogen-producing tumor?

Do you base the decision off of the acuity and course of symptoms? The degree of estradiol elevation? Other factors?

Is there any contraindication for use of Invisalign teeth aligners in patients undergoing treatment for osteoporosis?

Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?

Do you adjust the dose or the timing of levothyroxine ingestion in patients on anti-acid medications?

How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?

Additional risk factors could be family history of VTE or thrombophilia, such as antithrombin deficiency.

Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?

Is active smoking a contraindication to starting menopausal hormone therapy (HRT) in a post-menopausal woman with severe vasomotor symptoms and no other cardiovascular risk factors?

Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?

Do you recommend using anastrazole in men developing gynecomastia while on testosterone replacement treatment for hypogonadism depending on pre-treatment estradiol level?

Do you recommend stopping a SGLT2i indefinitely if a patient with chronic kidney disease and diabetes develops euglycemic diabetic ketoacidosis?

Do you recommend parathyroid imaging testing for patients with recurrent nephrolithiasis who are incidentally found to have an elevated PTH but who do not have hypercalciuria, hypercalcemia, hypovitaminosis D, or chronic kidney disease?

Do you use the homeostatic model assessment (HOMA) to assess for insulin resistance and change your clinical management of patients?

What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?

Would you add cholecalciferol or ergocalciferol to calcitriol therapy in patients with post operative hypoparathyroidism who have low 25 OH vitamin D levels?

Can 25 OH vitamin D be converted to activated vitamin D outside of PTH mediated mechanisms in some organs?

For a patient with idiopathic hypercalciuria and a history of calcium kidney stones who has not normalized 24-hr urine calcium level on thiazide diuretic, is there evidence for targeting a certain urine calcium level for decreased future risk of nephrolithiasis and osteoporosis?

When performing adrenal vein sampling, is calculating selectivity index using androstenedione superior to using cortisol alone for determining successful catheterization?

What is your approach to progressive calvarial hyperostosis found in an elderly adult not caused by Pagets, acromegaly or hypercalcemia?

No evidence for acromegaly or Pagets.

Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?

Should dopamine agonist treatment stop in pregnant patients with recurrent prolactinoma despite prior surgery?

What specific clinical factors would drive you to recommend surgical intervention for patients with small, nonfunctional pituitary adenomas who exhibit no neurological symptoms?

When and how do you taper off cabergoline therapy for treatment of microprolactinoma?

What is your approach to managing patients with new laboratory evidence of hypopituitarism (e.g. very low plasma ACTH level and low morning serum cortisol) and a remote history of trans-sphenoidal surgery for NFPA?

Should GLP1 R agonists be used as first line glucose lowering agents in patients with ESKD and DM2?

In patients presenting with classical findings of primary hyperparathyroidism (i.e mild hypercalcemia, high 24hr urine calcium, elevated 1,25 Vit D but normal PTH), can spontaneous normalization of calcium be explained by episodic hypersecretion of PTH?

Under what circumstances would you test for hypercortisolism in a patient with insulin resistance?

Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?

What are the clinical indications and major limitations of lipoprotein apheresis?

How reliable is the FRAX score for assessing risk of osteoporotic fractures?

Is there any role for 25-OH Vitamin D testing in patients older than 75 years old in the general population?

Demay, et al., PMID 38828931

Does biotin interfere with the measurement of other metabolites of the Vitamin D pathway outside of the 25-hydroxy Vitamin D assay?

How would you approach a finding of osteoporosis (Z score -4.5) in a recently postpartum patient who had DEXA sent for long-term low-dose glucocorticoid use?

The patient is actively breastfeeding.

Are you offering GLP-1 agonists to patients with CKD and diabetes mellitus?

Is there any evidence regarding bone density gains/fracture reduction in the setting of treatment with romosozumab after a two year course of teriparatide?

Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...

What is the utility of an oral calcium loading test to differentiate FHH from secondary hyperparathyroidism due to low calcium intake?

The patient has very low urinary calcium despite calcium supplements, vitamin D used to be low now normal. Continues to have elevated PTH with normal ...

Should weight loss medications be used in women who are gaining excessive weight during pregnancy?

What range of musculoskeletal complaints have you seen with romosozumab use?

What specific markers or symptoms guide your decision to adjust or stop prophylactic calcium supplementation and calcitriol in managing postoperative hypoparathyroidism following thyroidectomy?

Would you consider exploratory surgery in a young patient with normocalcemic hyperparathyroidism that meets one or more criteria for parathyroidectomy but has no localized pathology on advanced neck imaging?

In what clinical scenarios should we use the 2-day 2mg DST instead of the 1mg overnight DST for screening of Cushing syndrome?

Should all thyroid cancer patients have thyroglobulin levels measured pre-operatively?

Is ABI (Ankle Brachial index) lower limb arterial doppler not recommended if patient already has arterial stents in the legs, and if so, what other imaging modality would you consider as first-line?

Should serum calcitonin for surveillance of medullary thyroid cancer be done fasting ?

Is Macrilen (macimorelin Dx) still available in the US for diagnosis of adult growth hormone deficiency (AGHD)?

When and for whom should we consider adding bempedoic acid to the lipid lowering regimen?

Do you recommend obtaining a DEXA scan for patients with recurrent nephrolithiasis and hypercalciuria of unknown etiology?

What is your approach to differentiating primary from secondary hyperparathyroidism in recurrent kidney stone formers who also have chronic kidney disease, an elevated PTH, and hypercalcemia?

Should patients with non-functional pituitary macroadenomas with persistent, but tolerable, headaches be recommended for surgery?

Given the new 2022 WHO classification of pituitary tumors, should we be regularly counseling our patients about the risk of malignancy for what we previously referred to as pituitary adenomas but now classified as pituitary neuroendocrine tumors (PitNETs)?

Asa et al., PMID 35291028

What is your approach to differentiating diabetes insipidus from primary polydipsia in the outpatient setting?

In patients with hypertension and suspected primary aldosteronism who have undergone negative confirmatory testing, what follow-up and monitoring strategies would you recommend to ensure early detection of potential aldosteronism?

Do you routinely check a TSH level in patients with recurrent kidney stones who have hypercalciuria of unknown cause?

Which patient population would benefit most from cellulose and citric acid (Plenity) therapy for weight loss?

Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

Seethapathy et al., NEJM

What is your approach to managing osteoporosis in patients with end stage kidney disease?

Does preoperative use of somatostatin receptor ligand improve remission rates after surgery for acromegaly?

What is your approach to determining recurrent versus RAI-refractory differentiated thyroid cancer in patients presenting with metastatic disease several years after surgery?

How do you adjust your HbA1c goal for managing diabetes in elderly patients with multiple chronic illnesses but no limitations in performing self-care tasks?

Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?

Would you refer a patient for parathyroidectomy if they have normal calcium levels, mild hyperparathyroidism, and evidence of osteopenia?

Do you recommend osteoporosis medication in postmenopausal females on anastrozole with very low Vitamin D (4.5)?

After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...

How do you counsel patients with non-statin associated inflammatory myopathies about statin use?

When do you check macroprolactin in the evaluation of hyperprolactinemia?

Following abaloparatide use for osteoporosis treatment, how long do you consolidate with bisphosphonates before considering a drug holiday?

Should patients with hypothyroidism hold their morning levothyroxine dose before going to the lab to check free T4/TSH?

There is literature showing small changes in both free T4 and TSH (despite steady state) in the first few hours after ingestion of L-T4. In occasional...

Is there a role for Vitamin D supplementation in the treatment of Hashimoto’s thyroiditis?

After completing 12 months romosozumab, what is the next best treatment option for patients with severe osteoporosis, high risk for fracture, and normal kidney function?

How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?

Would you do active surveillance or completion thyroidectomy in a patient with 1.6 cm tall cell PTC with posterior margin’s indeterminate and 7 mm isoechoic solid nodule on other side?

Patient is a 41F and overall good surgical risk candidate.

How do you counsel a patient with hypothyroidism who complains of persistent hypothyroid symptoms despite achieving normal TSH values with levothyroxine?

Should patients who develop primary hyperparathyroidism after 5 years of Prolia treatment for osteoporosis be referred for parathyroidectomy?

If so, when? Does surgery need to be timed with last dose of Prolia injection?

How do you distinguish between primary and tertiary hyperparathyroidism in a patient with ESRD?

Does norethindrone suppress FSH, LH completely?

If not, what can be possible causes for a postmenopausal woman to have FSH, LH < 0.3 with low E2, and being asymptomatic and doing well otherwise? ...

What is your daily correction goal for those patients being treated for hypernatremia?

Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?

A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...

Would you recommend switching a diabetic CKD patient on oral semaglutide to the subcutaneous form since the benefits in CKD have primarily been reported in studies using subcutaneous GLP-1 receptor agonists?

How long do you wait before reassessing a 24 hour urine calcium level in patients with recurrent nephrolithiasis, hypercalciuria, and osteoporosis who are initiated on bisphosphonate therapy?

Under what circumstances would you refer a patient with mild autonomous cortisol secretion without features of Cushing syndrome for adrenalectomy?

What is the next step in management of a thyroid nodule that was biopsied and classified as Bethesda III, but Afirma genetic testing reveals parathyroid signature?

Patient does not have hypercalcemia.

Should Orlistat be considered in the management of hypertriglyceridemia?

Do patients with an elevated IGF-1 level and features of acromegaly need to have confirmatory growth hormone suppression testing with OGTT?

Can a diagnosis of acromegaly be made with just an elevated IGF-1 level in patients with features of acromegaly?

Is intermittent fasting effective for weight loss?

In a patient with low-risk papillary thyroid carcinoma in 1 thyroid lobe s/p hemithyroidectomy, how would a diagnosis of Graves' orbitopathy (euthyroid biochemically) affect your classification and TSH target for thyroid-cancer treatment?

Conflicting data exists on whether Graves' disease would increase the aggressiveness of the concomitant thyroid cancer vs having no effect/correlation...

Would you treat an isolated elevated total cholesterol in a post-menopausal patient who is otherwise healthy and has no significant CV risk factors?

How long should T3 be continued in hypothyroid patients who received no symptomatic benefit after starting T3/T4 combination therapy?

Would you give a second round of therapeutic RAI in a patient with PTC s/p total thyroidectomy and I-131 ablation who is found to have recurrent disease in cervical lymph nodes s/p repeat neck dissection?

What dose of RAI would you consider giving if recommended?

Do you treat hypercalciuria in post menopausal osteoporosis with normal serum calcium and PTH?

Aside from lifestyle measures such as calcium intake, vitamin D repletion, and weight-bearing exercises and ruling out all secondary causes, what is the preferred approach to managing osteoporosis in young women with Z score of less than -2.5 and planning to get pregnant soon?

Should thyroid hormone replacement be initiated in patients with very prolonged critical illness with associated low thyroid hormone levels?

Is thyrotropin receptor antibody a good biomarker to predict development of thyroid eye disease?

Should oral combined contraceptives be held prior to overnight dexamethasone suppression test to rule out Cushings?

If so, how long should OCPs be held to reliably trust the dex suppression test results?

Can combined oral contraceptive use cause falsely elevated 24-hour urine-free cortisol?

Is there enough evidence now to use injectable semaglutide as a foundational therapy for symptomatic heart failure with preserved ejection fraction in the setting of overweight or obesity?

In patients with secondary osteoporosis due to primary hyperparathyroidism, should parathyroidectomy be recommended in the setting of recent prior bisphosphonate use?

Should testosterone replacement be stopped in elderly men who suffered acute stroke even when testosterone levels have been stably in the low-to-mid normal range?

Would you recommend prescribing testosterone replacement therapy to reduce osteoporosis fracture rates in men with hypogonadism?

What is your protocol to starting/stopping glucocorticoid replacement in Cushing disease patients after their transsphenoidal resection surgery?

Have the results of the ancillary study of the VITAL trial, demonstrating that Vitamin D3 supplementation did not reduce the incident rate of fractures in generally healthy midlife and older adults, changed how you prescribe Vitamin D?

PMID 35939577

How do you manage osteoporosis in patients with anorexia nervosa (who often are young women < 40)?

Should metformin be used in women with PCOS for weight loss?

Should patients with mild subclinical hypothyroidism (TSH < 10 mIU/L) be treated with thyroid hormone replacement to improve their lipid profile?

Is it possible to have undetectable cortisol levels in secondary adrenal insufficiency?

Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortiso...

What is your approach to using bisphosphonates in those with severe hypercalcemia and chronic kidney disease?

How often would you repeat testing in a patient suspected of Cyclic Cushing's?

And is there a preferred diagnostic test? Whenever cyclic hypercortisolemia is suspected, it is advised that evaluation should be repeated for months,...

Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?

Is it possible for certain individuals with osteoporosis to be a denosumab "non-responder"?

I’ve seen several such patients who have no secondary causes for bone loss, on adequate calcium/vitamin D, and compliant with denosumab who do n...

Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?

What further work-up (if any) should be considered in patients with pituitary microadenoma and stigmata of Cushing's disease but low ACTH and repeatedly normal plasma, urinary, and salivary cortisol levels?

What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?

Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigu...

Is there an indication for adrenalectomy in patients with subclinical Cushing syndrome and adrenal nodule?

Should lipid lowering therapy be started in patients with isolated elevation in lipoprotein (a) and minimal cardiovascular risk?

Despite low T scores (-2.5 or worse), what is the actual fracture risk in relatively younger patients (early 50s to mid 60s) with low BMD?

Should this patient population be treated differently? At our institution, we have started using EPIC to screen many patients for osteoporosis and ou...

Would you start osteoporosis treatment in patients with low FRAX scores but have T scores lower than -2.5?

What is the best treatment of isolated elevated DHEA-S in a woman with clinical androgen excess (without PCOS, neoplasm, etc)?

For a TSH producing microadenoma, would you recommend surgery vs methimazole if the patient is elderly and the tumor is relatively small?

The female patient is in her late 70s with cardiac disease (likely due to chronic hyperthyroidism that was missed due to non-suppressed TSH). I’...

Should insulin be started early (prior to optimization of other anti-hyperglycemic medications) in patients with mild-to-moderate diabetes and hypertriglyceridemia refractory to statin and fibrates?

Should thyroxine hormone be started in women having fertility concerns with high-normal TSH and negative TPO antibody?

How should very low T scores (worse than -3) be interpreted in very thin patients (BMI < 18)?

Can subclinical hypothyroidism cause myxedema coma?

Elderly male with primary hypothyroidism, HTN, and progressive worsening cognition over several months. PCP has been increasing LT4 dose as outpatient...

In adult women with NCCAH, is there a benefit in using supratherapeutic doses of prednisone in addition to clomiphene to improve fertility rates?

Which medications do you deem necessary to stop prior to measuring plasma renin and plasma aldosterone when evaluating a patient for possible primary aldosteronism?

Would you give transdermal hormone replacement therapy to a woman with remote history of provoked pulmonary embolism?

Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC?

Should a short trial of androgen therapy be used in patients with primary adrenal insufficiency suffering from persistent fatigue and hypoactive sexual desire despite sufficient glucocorticoid and mineralocorticoid replacement?

What is the next best anti-hypertensive medication to start after mineralocorticoid receptor antagonists in patients with primary aldosteronism?

What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?

Is there any indication for obtaining adrenal imaging in patients with MEN2 who have normal plasma or urinary metanephrines?

Should patients with asymptomatic GH deficiency be treated with GH replacement therapy if they have prior known severe CAD?

Does caution have to be used in GH replacement therapy in any and all types of cancer history?

Is a significant rise in cortisol post cosyntropin stimulation sufficient to rule out adrenal insufficiency in patients with low albumin?

Can osilodrostat be used indefinitely in poor surgical candidates with cushing syndrome from adrenal adenoma?

Does your goal rate of correction in patients with chronic hypoosmolar hyponatremia differ based on the degree of hypoosmolarity?

Should a toe-brachial index be obtained in lieu of resting ABI as an initial screen for PAD in high-risk patients such as those with longstanding diabetes or advanced age with stiffened vessels?

In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?

No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.

Do you recommend stopping Vitamin D supplementation in a patient with hypercalcemia and a low 25(OH)D level?

In which patients with chronic kidney disease and low 25-OH vitamin D levels do you prefer weekly ergocalciferol to daily cholecalciferol supplementation?

Do you treat low 25-OH vitamin D levels in those with end stage kidney disease?

What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?

How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?

Do you treat secondary erythrocytosis caused by SGLT2 inhibitor?

What recommendations do you have for a transgender female patient with history of prothrombin gene mutation who is interested in starting gender affirming hormone therapy?

The patient has no personal history of VTE, but has positive family history of VTE. Any prophylactic anticoagulation options? How would manage...

For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?

For pts w/ eGFR between 30-60

How do you counsel male-to-female transgender patients on the VTE risk of hormonal therapy?

How do you approach prophylaxis against glucocorticoid-induced osteoporosis in patients with end-stage renal disease on dialysis?

Do you routinely offer a bisphosphonate or denosumab to multiple myeloma patients without skeletal lesions?

Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).