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Endocrinology Update Winter 2017

As the rates of diabetes mellitus (DM) continue to rise, health systems and providers are being challenged to meet the demands of high-quality, high-value care, particularly for those patients at highest risk. This is occurring while new tools for managing diabetes are being introduced to providers and patients at an exponential rate.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Recognize molecular mechanism mediating the effects of physical activity 
  • Expand their differential diagnosis of hypercalcemia to include ectopic-PTH secreting neuroendocrine tumor and thus be able to recognize this rare etiology if it presents 
  • Improve their management of and be able to choose effective treatments for hypercalcemia

Reading Resources:

  1. Booth, F.W., Roberts, C.K., and Laye, M.J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology 2, 1143-1211.
  2. CDC (2017). Center for Disease Control and Prevention: Physical activity and health.
  3. Febbraio, M.A. (2017). Exercise metabolism in 2016: Health benefits of exercise - more than meets the eye! Nature reviews. Endocrinology.
  4. Neufer, P.D., Bamman, M.M., Muoio, D.M., Bouchard, C., Cooper, D.M., Goodpaster, B.H., Booth, F.W., Kohrt, W.M., Gerszten, R.E., Mattson, M.P., et al. (2015). Understanding the Cellular and Molecular Mechanisms of Physical
  5. Activity-Induced Health Benefits. Cell metabolism 22, 4-11.
  6. Petriz, B.A., Gomes, C.P., Almeida, J.A., de Oliveira, G.P., Jr., Ribeiro, F.M., Pereira, R.W., and Franco, O.L. (2017). The Effects of Acute and Chronic Exercise on Skeletal Muscle Proteome. Journal of cellular physiology 232, 257-
  7. 269.Rai, M., and Demontis, F. (2016). Systemic Nutrient and Stress Signaling via Myokines and Myometabolites. Annual review of physiology 78, 85-107.
  8. Whitham, M., and Febbraio, M.A. (2016). The ever-expanding myokinome: discovery challenges and therapeutic implications. Nature reviews. Drug discovery 15, 719-729.
  9. Kandil E, Noureldine S, Khalek M, Daroca P, Friedlander P. Ectopic Secretion of Parathyroid Hormone in a Neuroendocrine Tumour: A Case Report and Review of the Literature. Int J Clin Exp Med. 2011; 4(3): 234–240.
  10. VanHouten JN, Yu N, Rimm D, et al. Hypercalcemia of Malignancy Due to Ectopic Transactivation of the Parathyroid Hormone Gene. J Clin Endocrinol Metab. 2006; 91(2): 580–583.
  11. Nussbaum SR, Gaz RD, Arnold A. Hypercalcemia and Ectopic Secretion of Parathyroid Hormone by an Ovarian Carcinoma With Rearrangement of the Gene for Parathyroid Hormone. N Engl J Med. 1990; 323(19): 1324–1328.
  12. Vacher-Coponat H, Opris A, Denizot A, Dussol P, Berland Y. Hypercalcemia Induced by Excessive Parathyroid Hormone Secretion in a Patient With a Neuroendocrine Tumour. Nephrol Dial Transplant. 2005; 20(12): 2832–2835.
  13. Doyle MA, Malcolm JC. An Unusual Case of Malignancyrelated Hypercalcemia. Int J Gen Med. 2014; 7: 21–27.
  14. Silverberg SJ, Rubin MR, Faiman C, Peacock M, Shoback DM, Smallridge RC, Schwanauer LE, Olson KA, Klassen P, Bilezikian JP. Cinacalcet Hydrochloride Reduces the Serum Calcium Concentration in Inoperable Parathyroid
  15. Carcinoma. J Clin Endocrinol Metab. 2007; 92(10): 3803–3808.
  16. Vellanki P, Lange K, Elaraj D, et al. Denosumab for Management of Parathyroid Carcinoma-mediated Hypercalcemia. J Clin Endocrinol Metab. 2014; 99: 387-90.
  17. Baron R, Ferrari S, Russell RG. Denosumab and Bisphosphonates: Different Mechanisms of Action and Effects. Bone. 2011; 48: 677–92

Disclosures:

All contributing authors report no relationships with proprietary entities producing health care goods or services.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 2/13/2017 | Last Modified On: 2/13/2017 | Expires: 2/13/2018

Additional Resources

Presenters

Jason Ng, MD

Jason Ng, MD Clinical Assistant Professor of Medicine Clinical Lead, Diabetes Technology Unit
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Patrick McCarthy, RN, CDE

Patrick McCarthy, RN, CDE View Full Profile

Linda Siminerio, RN, PhD

Linda Siminerio, RN, PhD Dr. Siminerio’s primary research topics include diabetes education, diabetes translation into community interventions, pediatric diabetes care and education, and the psychosocial and behavioral aspects of diabetes.
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Shane Otto Lebeau, MD

Shane Otto Lebeau, MD UPMC Endocrinology and Diabetes Center
Falk Medical Building
3601 Fifth Ave.
Suite 3B
Pittsburgh, PA 15213
Office Phone: (412) 586-9700
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Elena Morariu, MD

Elena Morariu, MD UPMC Endocrinology and Diabetes Center
Falk Medical Building
3601 Fifth Ave.
Suite 3B
Pittsburgh, PA 15213
Office Phone: 
(412) 586-9700
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Mary Korytkowski, MD

Mary Korytkowski, MD University of Pittsburgh Physicians
Center for Diabetes and Endocrinology
Office Address(es):
Center for Diabetes and Endocrinology
3601 Fifth Avenue, Suite 3B
Pittsburgh, PA 15213
Phone: (412) 586-9700
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Kelly McCoy, MD

Kelly McCoy, MD Associate Professor of Surgery
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Erin E Kershaw, MD

Erin E Kershaw, MD Dr. Erin Kershaw practices at UPMC and is currently an Assistant Professor of Medicine in the Division of Endocrinology at The University of Pittsburgh in Pittsburgh, PA. Dr. Kershaw obtained her Bachelor of Arts degree with honors from Cornell University, Ithaca, NY in 1991. She obtained her ...
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