Section of Endocrinology and Metabolism

Medicine, Italy

Section of Endocrinology and Metabolism

Medicine, Italy
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Puno-Ramos M.P.,Section of Endocrinology and Metabolism | Paz-Pacheco E.,Section of Endocrinology and Metabolism | Ang S.M.,The Medical City
Journal of the ASEAN Federation of Endocrine Societies | Year: 2015

Unilateral adrenal hemorrhages are a rare finding and when discovered they are usually due to a blunt trauma or secondary to anticoagulation therapy. We report a case of a 72-year-old Filipino male presenting with an unsuspected large adrenal mass discovered on abdominal computed tomography that was requested to evaluate a palpable soft, non-tender right lumbar mass. Characteristics of the mass on CT scan pointed to a possible adrenal neoplasm. Endocrine work up revealed a non-functioning adrenal mass. Exploratory laparotomy and resection of the retroperitoneal mass was done with a histopathologic finding of a diffuse adrenal hemorrhage. © 2015 by the JAFES.

Chua F.B.,Section of Endocrinology and Metabolism | Cinco J.E.,Section of Cardiology | Paz-Pacheco E.,Section of Endocrinology and Metabolism
Journal of the ASEAN Federation of Endocrine Societies | Year: 2017

Objective. To evaluate if magnesium supplementation, in addition to standard therapy, improves fasting blood sugar (FBS) and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) compared to placebo or other comparator. Methodology. We searched MEDLINE/PubMed, Cochrane Library, Acta Medica Philippina, Health Research and Development Information Network (HERDIN) and references of reviewed journals from 1966 to July 2015 using the following search terms: “magnesium” OR “magnesium supplementation” OR “magnesium replacement”, AND randomized controlled trial AND diabetes OR diabetes mellitus OR non-insulin dependent diabetes mellitus OR diabetic OR diab* (with MeSH, where available). Studies were retrieved and rated independently using the standards provided by The Cochrane Collaboration. High quality trials were included in a systematic review and meta-analysis. Results. Of the 689 records screened, 10 studies were included in the qualitative synthesis and 7 studies in the metaanalysis. Pooled data showed a non-significant trend towards improvement in glycemic control in the magnesiumtreated group (mean difference -0.19, CI -0.58 to 0.21). There was a stronger but still non-significant trend in T2DM patients with hypomagnesemia (mean difference -1.16, CI -2.92 to 0.6). Conclusion. Routine magnesium supplementation for improvement in glycemic control in T2DM patients cannot be recommended based on data from included studies in this meta-analysis. © 2017 by the JAFES.

Holt E.H.,Section of Endocrinology and Metabolism
Current Opinion in Oncology | Year: 2010

Purpose of review Thyroid cancer is the fastest rising type of cancer among women in North America. Care of the pregnant patient with thyroid cancer is, therefore, of concern to obstetricians, internists and endocrine specialists. Guidelines for the care of the pregnant patient with thyroid disease were released by the Endocrine Society in late 2007, and a symposium on thyroid dysfunction and pregnancy was hosted by the American Thyroid Association in April 2009. With this increasing interest in thyroid disease and pregnancy, a variety of important studies have been published recently. Recent findings: In addition to guidelines published by the Endocrine Society, recent research has focused on detection and management of hypothyroidism in pregnancy, and consequences of hypothyroidism for the fetus and child. Impact of radioactive iodine therapy on subsequent fertility has been described. The risk of adverse outcomes due to thyroid surgery during pregnancy was evaluated in analysis of a large inpatient database. summary: Identification of hypothyroidism during pregnancy continues to be challenging due to the need for well established trimester-specific normal ranges. Physicians may reassure patients about the effects of radioactive iodine therapy on fertility, although men may wish to cryopreserve sperm prior to treatment. Thyroid surgery during pregnancy was associated with a two-fold increased risk of surgical complications. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Sancak S.,Section of Endocrinology and Metabolism | Hardt A.,University of Leipzig | Singer J.,University of Leipzig | Kloppel G.,University of Kiel | And 7 more authors.
Thyroid | Year: 2010

Background: There is a plethora of partly contradictory reports on somatostatin receptor (SSTR) expression in thyroid tumors. Therefore, our goal was to systematically determine SSTR2 expression in benign cold thyroid nodules (CNs), hot thyroid nodules (HNs), papillary carcinomas (PCs), and Graves' disease (GD) in comparison with intraindividual control tissues by means of immunohistochemistry. Methods: Tissue sections from 19 HNs, 10 CNs, 17 PCs and their surrounding tissues, and 8 GD thyroids were immunostained for SSTR2. Membranous SSTR2 staining was quantitated by evaluating 10 high-power fields (HPFs) systematically distributed along the largest diameter of the tissue section. Results: The area covered by thyroid epithelial cells in 10 HPFs expressed as median (in mm2) was 0.53 for CNs, 0.44 for HNs, 1.5 for PCs, 1.3 for GD, and 0.3 for the surrounding tissues. The SSTR2 staining density determined by dividing the area of SSTR2 positively stained thyroid epithelial cells (in mm2) by the area of all thyroid epithelial cells (in mm2) in 10 HPFs was 0.1662 for CNs, 0.0204 for HNs, 0.0369 for PCs, and 0.0386 for GD. Conclusions: SSTR2 expression is inhomogeneous in thyroid disease, with the highest density detected in CNs. It remains to be determined whether this finding could be of pathophysiologic or therapeutic relevance. The high SSTR2 density in CNs should be considered in the interpretation of SSTR scintigraphy-positive findings. © 2010 Mary Ann Liebert, Inc.

Grazia Castagna M.,Section of Endocrinology and Metabolism | Cevenini G.,University of Siena | Theodoropoulou A.,Section of Endocrinology and Metabolism | Maino F.,Section of Endocrinology and Metabolism | And 5 more authors.
European Journal of Endocrinology | Year: 2013

Background: In differentiated thyroid cancer (DTC) patients at intermediate risk of recurrences, no evidences are provided regarding the optimal radioactive iodine (RAI) activity to be administered for post-surgical thyroid ablation. Methods: This study aimed to evaluate the impact of RAI activities on the outcome of 225 DTC patients classified as intermediate risk, treated with low (1110-1850 MBq) or high RAI activities (R3700 MBq). Results: Six to 18 months after ablation, remission was observed in 60.0% of patients treated with low and in 60.0% of those treated with high RAI activities, biochemical disease was found in 18.8% of patients treated with low and in 14.3% of patients treated with high RAI activities, metastatic disease was found in 21.2% of patients treated with low and in 25.7% of patients treated with high RAI activities (PZ0.56). At the last follow-up (low activities, median 4.2 years; high activities, median 6.9 years), remission was observed in 76.5% of patients treated with low and in 72.1% of patients treated with high RAI activities, persistent disease was observed in 18.8% of patients treated with low and in 23.5% of patients treated with high RAI activities, recurrent disease was 2.4% in patients treated with low and 2.1% in patients treated with high RAI activities, deaths occurred in 2.4% of patients treated with low and in 2.1% of patients treated with high RAI activities (PZ0.87). Conclusion: Our study provides the first evidence that in DTC patients at intermediate risk, high RAI activities at ablation have no major advantage over low activities. © 2013 European Society of Endocrinology.

Kuemmerle N.B.,Dartmouth Hitchcock Medical Center | Rysman E.,Catholic University of Leuven | Lombardo P.S.,Dartmouth Hitchcock Medical Center | Flanagan A.J.,Dartmouth Hitchcock Medical Center | And 14 more authors.
Molecular Cancer Therapeutics | Year: 2011

Many types of cancer cells require a supply of fatty acids (FA) for growth and survival, and interrupting de novo FA synthesis in model systems causes potent anticancer effects. We hypothesized that, in addition to synthesis, cancer cells may obtain preformed, diet-derived FA by uptake from the bloodstream. This would require hydrolytic release of FA from triglyceride in circulating lipoprotein particles by the secreted enzyme lipoprotein lipase (LPL), and the expression of CD36, the channel for cellular FA uptake. We find that selected breast cancer and sarcoma cells express and secrete active LPL, and all express CD36. We further show that LPL, in the presence of triglyceride-rich lipoproteins, accelerates the growth of these cells. Providing LPL to prostate cancer cells, which express low levels of the enzyme, did not augment growth, but did prevent the cytotoxic effect of FA synthesis inhibition. Moreover, LPL knockdown inhibited HeLa cell growth. In contrast to the cell lines, immunohistochemical analysis confirmed the presence of LPL and CD36 in the majority of breast, liposarcoma, and prostate tumor tissues examined (n = 181). These findings suggest that, in addition to de novo lipogenesis, cancer cells can use LPL and CD36 to acquire FA from the circulation by lipolysis, and this can fuel their growth. Interfering with dietary fat intake, lipolysis, and/or FA uptake will be necessary to target the requirement of cancer cells for FA. ©2011 AACR.

Ching Sun G.E.,Section of Endocrinology and Metabolism | Ching Sun G.E.,Louisiana State University Health Sciences Center | Kashyap S.R.,Cleveland Clinic | Kashyap S.R.,Case Western Reserve University | Nasr C.,Cleveland Clinic
Cleveland Clinic Journal of Medicine | Year: 2014

The pathophysiology of type 2 diabetes mellitus conveys increased cancer risk, and any antidiabetic drug may alter that risk in a favorable or unfavorable way. This article discusses the links between diabetes and cancer, the different agents available for treating diabetes, and the cancer risk associated with these therapies.

Samaropoulos X.F.,Section of Endocrinology and Metabolism | Hairston K.G.,Section of Endocrinology and Metabolism | Haffner S.M.,University of Texas at San Antonio | Lorenzo C.,University of Texas at San Antonio | And 4 more authors.
Obesity | Year: 2013

Objective: Some obese individuals appear to be protected from developing type 2 diabetes mellitus and cardiovascular disease (CVD). This has led to characterizing body size phenotypes based on cardiometabolic risk factors specifically as obese or overweight, and as metabolically healthy (MH) or metabolically abnormal (MA) based upon blood pressure, lipids, glucose homeostasis, and inflammatory parameters. The aim of this study was to measure the prevalence of and describe fat distribution across these phenotypes in a minority population. Design and Methods: Hispanic participants (N = 1054) in the IRAS Family Study were categorized into different body size phenotypes. Computed tomography (CT) abdominal scans were evaluated for measures of nonalcoholic fatty liver disease (NAFLD) and abdominal fat distribution. Statistical models adjusting for familial relationships were estimated. Results: Seventy percent (70%) of the Hispanic cohort was overweight (32%) or obese (38%). Forty-one percent (n = 138) of overweight participants and 19% (n = 74) of obese participants met criteria for MH. Adjusted analyses showed the MH phenotype was associated with lower visceral adipose tissue (VAT) and higher liver density (indicating lower fat content) in obese participants (p = 0.0005 and p = 0.0002, respectively), and lower VAT but not liver density in overweight participants (p = 0.008 and p = 0.162, respectively) compared to their MA counterparts. Odds of NAFLD were reduced in MH obese (OR = 0.34, p = 0.0007) compared to MA obese. VAT did not differ between MH obese or overweight and normal weight groups. Conclusions: These findings suggest that lower levels of visceral and liver fat, despite overall increased total body fat, may be a defining feature of MH obesity in Hispanic Americans. Copyright © 2013 The Obesity Society.

PubMed | Washington University in St. Louis and Section of Endocrinology and Metabolism
Type: | Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists | Year: 2016

Objective The study examined whether vitamin D insufficiency is a predictor of prevalent and/or incident common chronic conditions in African American men (AAM) and Caucasian men (CAM). Methods 1,017 men were recruited at an urban VA medical center and followed prospectively for a mean of 5.4 years. Prevalent and incident chronic conditions evaluated were: obesity, type 2 diabetes (T2D), cancer, depression, dementia, and cardiovascular disease (CVD, including coronary artery disease [CAD], cerebrovascular accident [CVA], and congestive heart failure [CHF]). Univariate and multivariate regressions were performed to examine the association between 25(OH) vitamin D and these chronic illnesses. Results This analysis was limited to 955 men (65.5% AAM, 27.2% CAM, 6.4% Hispanic) who had at least 1 year follow up (range 1.0 - 7.1 years). Univariate analysis of the entire group showed that 25(OH)D correlated negatively with body mass index (BMI). There was no correlation between 25(OH)D and prevalent CVD (including separate analyses for CAD, CVA and CHF), cancer, depression, dementia, all-cause mortality or incident cancer, CAD or CVA. Independent predictors of prevalent common conditions included increasing age, BMI, smoking, alcohol and polysubstance use but not 25(OH)D levels. Conclusion The study does not support previously suggested associations of low vitamin D levels with prevalent common chronic conditions or increased risk for cancer, CAD and CVA in a population of men with high burden of chronic disease. The finding that smoking, alcohol and polysubstance use are predictors of chronic conditions is an important reminder for addressing these risks during patient encounters.

PubMed | Section of Endocrinology and Metabolism
Type: Journal Article | Journal: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme | Year: 2011

Whereas the majority of hot thyroid nodules are caused by somatic TSH-receptor mutations, the percentage of TSH-receptor mutation negative clonal hot nodules (HN) and thus the percentage of hot nodules likely caused by other somatic mutations are still debated. This is especially the case for toxic multinodular goiter (TMNG). 35 HNs [12 solitary hot nodules (SHN), 23 TMNG] were screened for somatic TSHR mutations in the exons 9 and 10 and for Gs mutations in the exons 7 and 8 using DGGE. Determination of X-chromosome inactivation was used for clonality analysis. Overall TSHR mutations were detected in 14 out of 35 (40%) HNs. A nonrandom X-chromosome inactivation pattern was detected in 18 out of 25 (72%) HNs suggesting a clonal origin. Of 15 TSHR or Gs mutation negative cases 13 (86.6%) showed nonrandom X-chromosome inactivation, indicating clonal origin. The frequency of activating TSHR and/or Gs mutations was higher in SHNs (9 of 12) than in TMNGs (6 of 23). There was no significant difference for the incidence of clonality for HNs between TMNGs or SHNs (p: 0.6396). Activating TSHR and/or Gs mutations were more frequent in SHNs than in TMNG. However, the frequency of clonality is similar for SHN and TMNG and there is no significant difference for the presence or absence of TSHR and/or Gs mutations of clonal or polyclonal HNs. The high percentage of clonal mutation-negative HNs in SHN and TMNG suggests alternative molecular aberrations leading to the development of TSHR mutation negative nodules.

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