Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
Would you consider a history of pancreatitis an indication for parathyroidectomy in patients with mild hypercalcemia secondary to primary hyperparathyroidism?
The association of pancreatitis with primary hyperparathyroidism (PHPT) has been a classic one, although an uncommon complication of PHPT. Studies vary in reporting an incidence of pancreatitis between 4-16% in patients with PHPT (usually single institution consecutive series). I think most people f...
When treating osteoporosis, does your duration of maintenance bisphosphonate therapy post anabolic therapy with PTH analogue change based on C-telopeptide levels?
I have treated many patients with teriparatide and conducted non-clinical studies on PTH/PTHrP receptors. Despite the fact that there are no PTH/PTHrP receptors on osteoclasts, when PTH stimulates osteoblast activity, the normal coupling via osteoprotegerin is intact, and about 4 weeks after one det...
How do we decide between Gallium-DOTATATE PET/CT and MIBG scans when evaluating a patient for suspected pheochromocytoma?
Mostly availability and feasibility. Gallium-DOTATATE is very sensitive.
In patients with severe osteoporosis, history of retinal artery occlusion, and hypercalciuria, would you favor PTH analogue therapy or Evenity?
Assuming that PTH and vitamin D are normal, neither. Chlorthalidone is the treatment of choice in this scenario. Chlorthalidone is usually better than HCTZ, as HCTZ often must be given BID, whereas chlorthalidone can be given daily. I have seen very large improvements in BMD with thiazide therapy, o...
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 ...
Do you avoid the use of GLP-1 R agonist therapy for treatment of obesity in patients with known gastroparesis?
Short answer: yes. Gastroparesis is a well-known side effect of GLP-1 RA therapy. It is dose-dependent, so some patients may tolerate smaller doses but not the highest ones. A recent head-to-head trial of semaglutide vs tirzepatide in obesity (Aronne et al., PMID 40353578) found similar rates of gas...
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...
How do you counsel patients with diabetes regarding the risks of cannabis use?
Cannabis use is becoming increasingly more common among patients with diabetes, with 10% recording use in the past month in a survey from 2022 (Han et al., PMID 39037352). Severe medical problems have been associated with cannabis use, including addiction(CUD), increased cardiovascular events, and a...
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...