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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


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

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

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 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

This course has been expired.