Endocrine

Diseases 2.0: Uric acid stones linked to diabetes

July 3, 2008
Diseases 2.0: Uric acid stones linked to diabetes

Diseases 2.0 – Bringing you the latest updates on disease pathophysiology and treatment

Commentary By David Goldfarb, M.D. Professor of Medicine, NYU Medical Center, Chief Nephrology Section VA New York Harbor

At the recent meeting of the National Kidney Foundation in Dallas, Dr. Orson Moe reviewed the links between diabetes and uric acid stones . Uric acid stones are most often caused by low urine pH. With a low urine pH, even relatively little uric acid can precipate, as it forms the protonated form, which…

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A Brief Glance at the Relationship between Varicocele and Infertility

March 19, 2008
A Brief Glance at the Relationship between Varicocele and Infertility

Commentary by Melissa Freeman MD, PGY-2

A 30 year-old male resident presents to his primary care physician for a routine physical examination. A small, nontender left-sided scrotal mass is felt. The patient states that this asymptomatic mass has been present for one year and was evaluated by a prior physician who felt that further work-up was unnecessary. He is sent for a testicular ultrasound which reveals a grade II varicocele. His testosterone level was low and he later had a semen analysis which was abnormal.…

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How do you approach male patients with osteoporosis?

February 28, 2008
How do you approach male patients with osteoporosis?

Commentary by Carrie Mahowald MD

Case: GS, a 65 year old man with only a history of severe OA, is seen in pre-op clinic for medical clearance before his hip replacement. On his pre-op x-ray, an incidental finding of a lumbar vertebral compression fracture is noted. After his hip replacement, how would you work him up for osteoporosis?

Osteoporosis, defined as low bone mass and the deterioration of bone micro-architecture which leads to the compromise of bone strength and the increased risk of fracture,…

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Grand Rounds: “Insulin Resistance: Implications for Obesity, Type 2 Diabetes”

February 26, 2008
Grand Rounds: “Insulin Resistance: Implications for Obesity, Type 2 Diabetes”

Commentary by Melissa Freeman MD, PGY2

This week’s Grand Rounds was delivered by Dr. Gerald Shulman, M.D., Ph.D., F.A.C.P. Professor of Internal Medicine and Cellular & Molecular Physiology and Investigator at the Howard Hughes Medical Institute of Yale University School of Medicine. Dr. Shulman has been a pioneer in unraveling the molecular mechanisms of insulin resistance.

For many years, Dr. Shulman and his colleagues have employed nuclear magnetic resonance spectroscopy (MRS) on muscle and liver cells to make noninvasive cellular discoveries. C13…

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Bedside Rounds Series: Goiter

February 21, 2008
Bedside Rounds Series: Goiter

Commentary by Kristin Remus MD, PGY-3, and Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

The purpose of the physical diagnosis series is to review the origins, pathophysiology and actual techniques of common physical diagnoses. Our hopes are to renew interest in an area of medicine that is occasionally overlooked due to the current use of laboratory values and imaging tests frequently used to make a diagnosis.

Goiter
In the industrialized world, enlarged thyroid, or “goiter”, occurs in 10% of women and…

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A New Path for the ACCORD (The Action to Control Cardiovascular Risk in Diabetes) trial: Does Being Sweeter Save Lives?

February 8, 2008
A New Path for the ACCORD (The Action to Control Cardiovascular Risk in Diabetes) trial: Does Being Sweeter Save Lives?

Commentary by Melissa Freeman MD, Endocrinology Section Editor

The ACCORD trial is an ongoing 5-year, North American, randomized study that began in 2001 to evaluate potential interventions to decrease cardiovascular (CV) events in adults living with DM2.  The trial enrolled 10,251 adults, aged 40- 82, with DM2 for 10 or more years, and a history of CV disease or two CV risk factors in addition to DM2. All participants were randomized at enrollment into intensive versus standard glucose control. In addition, participants were…

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Clinical Question: Pharmacology

December 28, 2007
Clinical Question: Pharmacology

Is there evidence to support the use of Lantus® (human insulin analog glargine) administered Q12h in Type 1 Diabetes?

Commentary by Kathy Lee, Pharmacy Resident 

The goal of diabetes management is to reduce the risk of long-term complications by maintaining near-normal glycemic control, in addition to reducing other risk factors. Patients with type 1 diabetes have an absolute deficiency in insulin and require exogenous insulin replacement. Lantus®, human insulin analog glargine, is the only long-acting insulin that exhibits a “peakless” action profile with…

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Inpatient Diabetes Management: Case 7

December 20, 2007
Inpatient Diabetes Management: Case 7

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to our final case of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last few months, we have been presented individual cases followed by some management questions and answers.

Case 7: All our patients go home…
Mr. Smith, Mr. Jones, Mr. Mejia, Mr. Gary, Ms. Samson, and Ms. Longshore are…

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Inpatient Diabetes Management: Case 6

November 8, 2007
Inpatient Diabetes Management: Case 6

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to Case 6 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last several weeks, we have been presenting individual cases followed by some management questions and answers.

Case 6: The Case of Ms. Longshore

Ms. Longshore is a 21 year old female with type 1 diabetes who was admitted to the…

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Targeting Triglycerides

October 31, 2007
Targeting Triglycerides

Commentary by Josh Remick MD, PGY-3

Hypertriglyceridemia is defined by the NCEP guidelines for treatment as a fasting triglyceride level greater than 200 mg/dL after the target LDL-C level has been achieved (1). When triglyceride levels are greater than 1000 mg/dL, the risk of pancreatitis increases and treatment with fibrates should be started immediately. Many physicians would also argue for treatment of a triglyceride level greater than 500mg/dL. However, it is the triglyceride level between 200 and 500 mg/dL that is a bit more difficult to…

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Inpatient Diabetes Management: Case 5

October 25, 2007
Inpatient Diabetes Management: Case 5

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to Case 5 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last several weeks, we have been presenting individual cases followed by some management questions and answers.

Case 5: The Case of Ms. Samson

Ms. Samson is a 55 year-old woman with Lupus who was admitted to the hospital with a…

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Clinical Pharmacy Corner: How Do Sulfonylureas Work?

October 17, 2007
Clinical Pharmacy Corner: How Do Sulfonylureas Work?

Commentary by Helen Kourlas, PharmD and John Papadopoulas, PharmD, Pharmacology Section Editors

The sulfonylureas are members of a class of substituted arylsulfonylureas that have been used clinically since the 1950s. These agents are usually divided into two categories or generations. First generation agents include acetohexamide, chlorpropamide, tolazamide, and tolbutamide (the first widely utilized agent). The more potent second-generation agents include glimepiride, glipizide, and glyburide.

Sulfonylureas acutely lower plasma glucose by stimulating the release of insulin. The primary mechanism is through binding to sulfonylurea receptors (SUR-1)…

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