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Pasireotide is a long-acting somatostatin analog that can be effective at suppressing growth hormone secretion in patients resistant to octreotide LAR and lanreotide; however, hyperglycemia is common and distribution is restricted in the United States.


Lu-DOTATATE peptide receptor radionuclide therapy is an option for certain patients with progressive medullary thyroid carcinoma metastases that are avid for 68Ga-DOTATATE on diagnostic imaging (Krenning uptake grade 3–4) and tumoral immunohistochemical staining that demonstrates SSTR2a receptor expression.


About 30% of patients with successful parathyroid surgery continue to have an elevated serum PTH postoperatively despite normal serum calcium levels; this is sometimes due to vitamin D deficiency.


Patients with osteopenia need adequate vitamin D intake to achieve serum 25-OH vitamin D levels above 30 ng/mL (75 nmol/L). Calcium supplementation is not usually required, except for patients with unusually low dietary calcium intake. Lifestyle modifications may be required, including smoking cessation, alcohol moderation, strength training, and weightbearing exercise. Pharmacologic therapy is not usually needed.


Romosozumab is an injectable monoclonal antibody that inhibits sclerostin, increasing new bone formation and decreasing bone resorption. It is reserved for very severe postmenopausal osteoporosis in patients without coronary risk, since it appears to increase cardiovascular mortality slightly.


Paroxetine is FDA-approved for treatment of vasomotor symptoms but it is not recommended for women taking tamoxifen, since it reduces the conversion of tamoxifen to its active metabolite.

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