Publications by authors named "Babu Ambika"

12 Publications

  • Page 1 of 1

Variability in quantitative expression of receptors in nonfunctioning pituitary macroadenomas--an opportunity for targeted medical therapy.

Endocr Pract 2014 Jan;20(1):15-25

Department of Internal Medicine, Division of Endocrinology, John Stroger Hospital of Cook County, Chicago, Illinois Rush University Medical Center, Chicago, Illinois.

Objective: The surgical removal of a nonfunctioning pituitary macroadenoma (NFP-Mac) is often incomplete. The appropriate treatment of recurrent/residual NFP-Macs is not well established. Our objective was to detect and quantify receptors that may serve as potential targets for medical therapy for NFP-Macs with postsurgical residuals.

Methods: Several classes of pituitary receptors were analyzed by quantitative reverse transcriptase-polymerase chain reaction in 17 adult NFP-Mac patients who underwent surgery.

Results: The median age was 50 years, and 76% of patients were male. On magnetic resonance imaging, the mean NFP-Mac diameter was 3.3 ± 1.02 cm. Somatostatin receptor (SSTR) and dopamine receptor (DR) subtypes were found in almost all tumors. Based on previous studies, we postulated a cutoff of ≥ 2,000 receptor copies at which a response to therapy may occur. This cutoff was found in SSTR3 in 3 patients, SSTR2 in 2 patients, SSTR1 and SSTR5 in 1 patient each, DR(2_total) in 13 patients, DR(2_short) (considered the most responsive to dopamine agonists) in 10 patients, and DR(2_long), DR5, DR4, and DR1 in 7, 3, 2, and 1 patient, respectively. Tumor size, invasiveness score, immunochemistry, gender, age, clinical symptoms, and postoperative residual tumor growth did not correlate with the type or copy number of receptor mRNAs.

Conclusion: NFP-Macs with significant postsurgical tumor residuals contain several DR and SSTR subtypes, some with high copy numbers. The receptor composition of NFP-Macs may guide future clinical research into targeted treatment strategies to reduce residual tumor volume. Such studies would determine the potential threshold of receptor levels for response to therapy for existing dopaminergic agonists and somatostatin analogs.
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http://dx.doi.org/10.4158/EP12411.ORDOI Listing
January 2014

Thyroid: an unusual hideout for sarcoidosis.

Endocr Pract 2013 Mar-Apr;19(2):e40-3

Department of Internal Medicine, John H. Stroger Jr., Hospital of Cook County, Chicago, IL 60612, USA.

Objective: To present a case of dysphagia secondary to a progressively increasing nontoxic multinodular goiter caused by sarcoidosis.

Methods: We summarize the clinical presentation and pertinent pathology in a patient with sarcoidosis involving the thyroid gland. A review of literature regarding this topic is also presented.

Results: A 54-year-old man was noted to have asymptomatic nontoxic thyromegaly. Biopsy of right thyroid nodule was benign while the biopsy from the isthmus nodule was nondiagnostic. He presented with acute onset of dysphagia two months later and the work-up for gastrointestinal causes was negative. Chest imaging showed left-sided lymphadenopathy, and biopsy of a lymph node showed sarcoidosis. Two years after the initial presentation a repeat biopsy of the isthmus nodule was again reported as nondiagnostic. Because he had persistent dysphagia, he underwent total thyroidectomy with resolution of dysphagia. Histopathological examination of the thyroid revealed non necrotizing granulomas consistent with sarcoidosis.

Conclusion: This case brings to light this uncommon etiology of a nontoxic multinodular goiter. Involvement of the thyroid gland by sarcoidosis is very rare. It has been reported in 4.2 to 4.6% of patients with sarcoidosis. In patients with pulmonary or extrapulmonary sarcoidosis and associated thyromegaly, possible involvement of the thyroid by this process should be considered.
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http://dx.doi.org/10.4158/EP12131.CRDOI Listing
November 2013

Clinical potential of sodium-glucose cotransporter 2 inhibitors in the management of type 2 diabetes.

Diabetes Metab Syndr Obes 2012 31;5:313-27. Epub 2012 Aug 31.

Division of Endocrinology, John, Stroger Jr Hospital of Cook County and Rush University, Chicago, IL, USA.

Background: The kidney plays an important role in glucose metabolism, and has been considered a target for therapeutic intervention. The sodium-glucose cotransporter type 2 (SGLT2) mediates most of the glucose reabsorption from the proximal renal tubule. Inhibition of SGLT2 leads to glucosuria and provides a unique mechanism to lower elevated blood glucose levels in diabetes. The purpose of this review is to explore the physiology of SGLT2 and discuss several SGLT2 inhibitors which have clinical data in patients with type 2 diabetes.

Methods: We performed a PubMed search using the terms "SGLT2" and "SGLT2 inhibitor" through April 10, 2012. Published articles, press releases, and abstracts presented at national and international meetings were considered.

Results: SGLT2 inhibitors correct a novel pathophysiological defect, have an insulin-independent action, are efficacious with glycosylated hemoglobin reduction ranging from 0.5% to 1.5%, promote weight loss, have a low incidence of hypoglycemia, complement the action of other antidiabetic agents, and can be used at any stage of diabetes. They are generally well tolerated. However, due to side effects, such as repeated urinary tract and genital infections, increased hematocrit, and decreased blood pressure, appropriate patient selection for drug initiation and close monitoring after initiation will be important. Results of ongoing clinical studies of the effect of SGLT2 inhibitors on diabetic complications and cardiovascular safety are crucial to determine the risk-benefit ratio. A recent decision by the Committee for Medicinal Products for Human Use of the European Medicines Agency has recommended approval of dapagliflozin for the treatment of type 2 diabetes as an adjunct to diet and exercise, in combination with other glucose-lowering medicinal products, including insulin, and as a monotherapy for metformin-intolerant patients. Clinical research also remains to be carried out on the long-term effects of glucosuria and other potential effects of SGLT2 inhibitors, especially in view of the observed increase in the incidence of bladder and breast cancer. SGLT2 inhibitors represent a promising approach for the treatment of diabetes, and could potentially be an addition to existing therapies.
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http://dx.doi.org/10.2147/DMSO.S22545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437808PMC
October 2012

Medical image. A rare but fatal complication of end stage renal disease: calcific uremic arteriolopathy.

N Z Med J 2012 Mar 30;125(1352):106-9. Epub 2012 Mar 30.

Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA.

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March 2012

Safe and simple emergency department discharge therapy for patients with type 2 diabetes mellitus and severe hyperglycemia.

Endocr Pract 2009 Nov-Dec;15(7):696-704

Department of Endocrinology and Metabolism, John H. Stroger Jr. Hospital of Cook County and Rush University Medical Center, Chicago, Illinois, USA.

Objective: To investigate the safety and effectiveness of 2 simple discharge regimens for use in patients with type 2 diabetes mellitus (DM2) and severe hyperglycemia, who present to the emergency department (ED) and do not need to be admitted.

Methods: We conducted an 8-week, open-label, randomized controlled trial in 77 adult patients with DM2 and blood glucose levels of 300 to 700 mg/dL seen in a public hospital ED. Patients were randomly assigned to receive glipizide XL, 10 mg orally daily (G group), versus glipizide XL, 10 mg orally daily, plus insulin glargine, 10 U daily (G+G group). The primary outcome was to maintain safe fasting glucose and random glucose levels of <350 and <500 mg/dL up to 4 weeks and <300 and <400 mg/dL, respectively, thereafter and to have no return ED visits (responders).

Results: Baseline characteristics were similar between the 2 treatment groups. The primary outcome was achieved in 87% of patients in both treatment groups. The enrollment mean blood glucose values of 440 and 467 mg/dL in the G and G+G groups, respectively, declined by the end of week 1 to 298 and 289 mg/dL and by week 8 to 140 and 135 mg/dL, respectively. Homeostasis model assessment of beta-cell function and early insulin response improved 7-fold and 4-fold, respectively, in responders at the end of the 8-week study.

Conclusion: Sulfonylurea with and without use of a small dose of insulin glargine rapidly improved blood glucose levels and beta-cell function in patients with DM2. Use of sulfonylurea alone once daily can be considered a safe discharge regimen for such patients and an effective bridge between ED intervention and subsequent follow-up.
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http://dx.doi.org/10.4158/EP09117.ORRDOI Listing
February 2010

Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism.

Surgery 2007 Jun 26;141(6):777-83. Epub 2007 Apr 26.

Department of Surgery, Rush University Medical Center, Chicago, Ill. 60612, USA.

Background: As many as 43% of patients will have normocalcemic intact parathyroid hormone (PTH) elevation after undergoing curative parathyroidectomy for primary hyperparathyroidism. This phenomenon may be due in part to an absolute or relative deficiency of vitamin D, which is under-recognized in patients with primary hyperparathyroidism.

Methods: From September 1, 2004, to September 30, 2005, 86 consecutive patients underwent parathyroidectomy for primary sporadic hyperparathyroidism (psHPT). The patients were segregated into 2 groups based on postoperative management. Group 1 was composed of 26 patients who received routine oral calcitriol and calcium carbonate postoperatively. The 60 patients in the second group (group 2) received calcium carbonate postoperatively at the discretion of the primary surgeon.

Results: A total of 85 patients (99%) achieved postoperative cure with sustained reduction in serum calcium. Within 30 days postoperatively, mean serum PTH levels normalized in both groups (41 +/- 31 vs 39 +/- 31 pg/ml; P = .91). However, at 1 to 3 months postoperatively, mean serum calcium levels remained similar (9.5 +/- 0.7 vs 9.3 +/- 0.5 mg/dl; P = .39) whereas mean serum PTH levels in groups 1 and 2 were 43 +/- 25 pg/ml and 67 +/- 45 pg/ml (P = .02), respectively. At 4 to 6 months postoperatively, mean PTH was again higher in group 2 (36 +/- 22 vs 67 +/- 35; P = .03), whereas mean serum calcium levels were normal (9.2 +/- 0.8 vs 9.6 +/- 0.4 mg/dl; P = .18). The incidence of postoperative normocalcemic PTH elevation was significantly higher in group 2 at 1 to 3 months (14% vs 39%; P = .04) and at 7 to 12 months (22% vs 83%; P = .04).

Conclusions: Vitamin D supplementation following parathyroidectomy for primary hyperparathyroidism reduces the incidence of postoperative eucalcemic PTH elevation.
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http://dx.doi.org/10.1016/j.surg.2007.01.025DOI Listing
June 2007

Cholestasis secondary to hyperthyroidism made worse by methimazole.

Am J Med Sci 2006 Jul;332(1):51-3

Department of Internal Medicine, Memorial Hospital of Sweetwater County, Rocksprings, Wyoming, USA.

A 28-year-old man presented with weight loss, jaundice, and pruritus. This was diagnosed to be secondary to Graves disease and the patient was prescribed methimazole. He returned 2 weeks later with worsening of his jaundice. Further investigation, including liver biopsy, indicated that there was superimposed methimazole-induced cholestasis. Discontinuation of methimazole and treatment of hyperthyroidism with lithium followed by radioactive iodine therapy resulted in resolution of his symptoms. This case highlights the fact that worsening cholestasis after therapy for Graves disease should raise the possibility of thionamide-induced exaggeration of liver cholestasis.
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http://dx.doi.org/10.1097/00000441-200607000-00012DOI Listing
July 2006

Metabolic syndrome and prediabetes.

Dis Mon 2006 Feb-Mar;52(2-3):55-144

Division of Endocrinology, John H. Stroger Hospital and Rush University Medical Center, Chicago, IL, USA.

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http://dx.doi.org/10.1016/j.disamonth.2006.03.001DOI Listing
July 2006

Cervical blastomycosis masquerading as a thyroid mass.

Endocr Pract 2005 Jan-Feb;11(1):65-8

Division of Endocrinology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA.

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http://dx.doi.org/10.4158/EP.11.1.65DOI Listing
August 2005

Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea.

Arch Intern Med 2005 Feb;165(4):447-52

Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.

Background: Sleep-disordered breathing (SDB) is a prevalent condition associated with significant comorbidities, including hypertension, obesity, cardiovascular disease, and insulin resistance. It has been previously shown that the severity of insulin resistance is related to the severity of SDB.

Methods: Using a 72-hour continuous glucose monitoring system, we studied changes in interstitial glucose levels and measured hemoglobin A1c levels in 25 patients with type 2 diabetes mellitus before and after continuous positive airway pressure (CPAP) treatment for SDB.

Results: With a mean +/- SD CPAP treatment period of 83 +/- 50 days, the mean +/- SD 1-hour postprandial glucose values were significantly reduced for breakfast (191 +/- 68 mg/dL to 130 +/- 41 mg/dL [10.6 +/- 3.8 mmol/L to 7.2 +/- 2.3 mmol/L]), lunch (196 +/- 70 mg/dL to 138 +/- 49 mg/dL [10.9 +/- 3.9 mmol/L to 7.7 +/- 2.7 mmol/L]), and dinner (199 +/- 66 mg/dL to 137 +/- 48 mg/dL [11.0 +/- 3.7 mmol/L to 7.6 +/- 2.7 mmol/L]). In the 17 patients with a baseline hemoglobin A1c level greater than 7%, there was a significant reduction in hemoglobin A1c level (9.2% +/- 2.0% to 8.6% +/- 1.8%). Furthermore, in subjects who used CPAP for more than 4 h/d, the reduction in hemoglobin A1c level was significantly correlated with days of CPAP use. There was no such correlation in subjects who used CPAP for 4 h/d or less.

Conclusions: These findings suggest that SDB is pathophysiologically related to impaired glucose homeostasis, and that CPAP can be an important therapeutic approach for diabetic patients with SDB.
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http://dx.doi.org/10.1001/archinte.165.4.447DOI Listing
February 2005

Cushing's syndrome from ectopic production of corticotropin by a metastatic gastrinoma.

Endocr Pract 2003 May-Jun;9(3):229-32

Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Rush University, 1725 West Harrison Street, Suite 250, Chicago, IL 60612-3824, USA.

Objective: To present a case of a young woman with new-onset diabetes mellitus resistant to insulin attributable to Cushing's syndrome caused by ectopic production of corticotropin by a metastatic gastrinoma.

Methods: We summarize the clinical presentation and the pertinent laboratory values in a patient with Cushing's syndrome. A review of the literature regarding ectopic production of corticotropin by gastrinomas is also presented.

Results: A 26-year-old woman with dehydration, severe hyperglycemia, and hypokalemia was seen in consultation. The patient required large doses of insulin to control plasma glucose, and further work-up confirmed the presence of Cushing's syndrome caused by ectopic production of corticotropin from a metastatic gastrinoma.

Conclusion: This case is unusual in that the patient was relatively young and the clinical presentation of Cushing's syndrome was dominated by uncontrolled diabetes, insulin resistance, and hypokalemia. At the time of this diagnosis, the patient already had evidence of multiple liver metastatic lesions from a pancreatic gastrinoma. The rapid occurrence of difficult-to-treat diabetes and hypokalemia should raise the suspicion of Cushing's syndrome from ectopic production of corticotropin. In fact, patients with metastatic pancreatic tumors and poorly controlled diabetes with hypokalemia should undergo evaluation for Cushing's syndrome, even in the absence of the typical stigmas, because of rapid development of the disease and high levels of corticotropin.
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http://dx.doi.org/10.4158/EP.9.3.229DOI Listing
May 2004
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