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C l e v e l a n d C l inic R E SOUR C E G u i d e Physician Directory Referring Physician Center CME Opportunities: Live & Online View all Cleveland Clinic staff For help with service-related issues, online at clevelandclinic.org/staff. information about our clinical special- Outcomes Data ists and services, details about CME Cleveland Clinic’s Center for Continuing Education’s website offers convenient, complimentary learning opportunities, from patient simulations, webcasts and podcasts to a host of medical publications and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org. View the latest clinical Outcomes books from Cleveland Clinic’s Endocrinology & Metabolism Institute at opportunities and more, email [email protected], or call 216.448.0900 or 888.637.0568. clevelandclinic.org/quality/outcomes. EMI Referrals Endocrinology & Metabolism Institute 216.444.6568 or 800.223.2273, ext. 46568 Bariatric Surgery 216.445.2224 or 800.223.2273, ext. 52224 F o r Y o u r P a tient s DrConnect is a secure online service providing our physician colleagues with real-time information about the treatment their patients receive at Cleveland Clinic. To receive your next patient report electronically, establish a DrConnect account at clevelandclinic.org/drconnect. Complimentary assistance for out-of-state patients and families: 800.223.2273, ext. 55580, or email [email protected]. Complimentary assistance for national and international patients and families: 001.216.444.8184 or visit MyChart ® Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that connects patients to portions of their medical record at any time of day or night. Patients may view test results, renew prescriptions, review past appointments and request new ones. 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Updates for physicians on practices, advances and research from Cleveland Clinic’s Endocrinology & Metabolism Institute clevelandclinic.org /ic. Request Medical Records Critical Care Transport Worldwide Endocrine Notes Medical Concierge Global Patient Services Track Your Patient’s Care Online The Cleveland Clinic Foundation Endocrinology & Metabolism Institute Endocrine Notes 9500 Euclid Avenue / AC311 Cleveland, OH 44195 11-END-008 In This Issue: 2New Entity: Primary Hyperparathyroidism with Normal PTH 4A Rare Case of Acromegaly Diagnosed During Pregnancy 6Robotic Approach Preferred for Adrenalectomy 8 STAMPEDE Substudy Asks Whether Gastric Bypass Reverses Beta Cell Dysfunction 9STAMPEDE II Study Now Enrolling Patients 10Bariatric Surgery Now Standard Treatment for Morbidly Obese Diabetic Patients 11Gastric Plication Holds Promise for Extreme Weight Loss 12Adult Growth Hormone Deficiency: Study Compares Glucagon Stimulation Test to Insulin Tolerance Test 14Publications 18 Live and Online CME 19Current Clinical Trials 20Staff Directory 2011 Endocrinology & Metabolism Institute | Staff Directory Contact Us General Patient Referral 24/7 hospital transfers or physician consults – 800.553.5056 Endocrinology & Metabolism Institute Appointments/Referrals 216.444.6568 or 800.223.2273, ext. 46568 Bariatric Surgery Appointments/Referrals 216.445.2224 or 800.223.2273, ext. 52224 On the Web at clevelandclinic.org/endonotes Endocrinology & Metabolic Institute Locations Main Campus 9500 Euclid Ave./F20 Cleveland, Ohio 44195 216.444.6568 Endocrinology & Metabolic Institute Diabetes Center 10685 Carnegie Ave. Cleveland, Ohio 44106 216.444.6568 Ashtabula County Medical Center 2420 Lake Ave. Cleveland, Ohio 44404 440.997.6969 Cleveland Clinic Beachwood Family Health and Surgery Center 26900 Cedar Road Beachwood, Ohio 44122 216.839.3000 Cleveland Clinic Independence Family Health Center 5001 Rockside Road Crown Center II Independence, Ohio 44131 216.986.4000 Cleveland Clinic Lorain Family Health and Surgery Center 5700 Cooper Foster Park Road Lorain, Ohio 44053 440.204.7400 Cleveland Clinic Solon Family Heath Center 29800 Bainbridge Road Solon, Ohio 44139 440.519.6800 Cleveland Clinic Willoughby Hills Family Health Center 2570 SOM Center Road Willoughby Hills, Ohio 44094 440.943.2500 Cleveland Clinic Wooster Family Health Center 1740 Cleveland Road Wooster, Ohio 44691 330.287.4500 Lakewood Hospital Professional Building 14601 Detroit Road Lakewood, Ohio 44107 216.529.5300 Medina Hospital Professional Building 4087 Medina Road, Ste. 400 Medina, Ohio 44256 330.725.3713 Cleveland Clinic Stephanie Tubbs Jones Health Center 13944 Euclid Ave. East Cleveland, Ohio 44112 216.767.4242 Cleveland Clinic Strongsville Family Health and Surgery Center 16761 SouthPark Center Strongsville, Ohio 44136 440.878.2500 Cleveland Clinic Twinsburg Family Health and Surgery Center 8701 Darrow Road Twinsburg, Ohio 44087 330.888.4000 South Pointe Charles Miner Medical Building 20600 Harvard Road Warrensville Heights, Ohio 44122 216.295.1010 Cleveland Clinic Florida 2950 Cleveland Clinic Blvd. Weston, Fla. 33331 877.463.2010 Endocrine Notes Chairman, Endocrinology & Metabolism Institute James B. Young, MD Endocrine Notes updates physicians on clinical practices, advances and research from Cleveland Clinic’s Managing Editor Cora M. Liderbach Endocrinology & Metabolism Institute. It is written for Art Director Mike Viars purposes only. It does not provide a complete overview of Marketing Bill Sattin, PhD Mary Anne Connor physicians and should be relied upon for medical education the topics covered and should not replace the independent judgment of a physician about the appropriateness or risks of a procedure for a given patient. © 2011 The Cleveland Clinic Foundation Leila Khan, MD Specialty Interest(s): General endocrinology, diabetes, calcium/bone disorders Location(s): Main campus; Willoughby Hills Family Health Center Office: 216.445.1598 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500 Leann Olansky, MD Specialty Interest(s): Diabetes and diabetes complications, gestational diabetes, general endocrinology Location(s): Main campus; Stephanie Tubbs Jones Health Center Office: 216.444.2642 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Stephanie Tubbs Jones Health Center, 216.767.4242 M. Cecilia Lansang, MD, MPH Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus Office: 216.445.5246 | Fax: 216.445.1656 Appointments: 216.444.6568 Richard Shewbridge, MD Specialty Interest(s): Endocrinology, diabetes, thyroid disorders, hyperlipidemia, osteoporosis Location(s): Medina Office: 330.725.3713 | Fax: 330.725.2141 Appointments: 330.725.3713 Melissa Li-Ng, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Solon Family Health Center Office: 216.444.1949 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Solon, 440.519.6800 Vinni Makin, MD Specialty Interest(s): General endocrinology, diabetes, hirsutism, acne, thyroid disorders Location(s): Main campus; Solon Family Health Center Office: Main campus, 216.444.0539; Solon, 440.519.6800 | Fax: Main campus, 216.445.1656; Solon, 440.519.6908 Appointments: Main campus, 216.444.6568; Solon, 440.519.6800 Adi Mehta, MD Specialty Interest(s): Diabetes mellitus, thyroid disorders, gynecologic endocrinology, endocrine complications of pregnancy, menopause, lipid disorders, general and adolescent endocrinology Location(s): Main campus; Beachwood Family Health Center (Reproductive Endocrinology only) Office: 216.445.5312 | Fax: 216.445.7261 Appointments: Main campus, 216.444.6568; Beachwood, 216.839.3000 Guy Mulligan, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Twinsburg Family Health and Surgery Center; South Pointe/Charles Miner Medical Building Office: 330.888.4000 | Fax: 330.963.4561 Appointments: Main Campus, 216.444.6568; Twinsburg, 330.888.4000; South Pointe, 216.295.1010 Mario Skugor, MD Co-director, Thyroid Center Associate Director, Endocrinology Fellowship Program Specialty Interest(s): Osteoporosis and calcium metabolism, obesity and diabetes, multiple endocrine neoplasia syndromes, thyroid disorders, thyroid cancer Location(s): Main campus Office: 216.445.0739 | Fax: 216.445.1656 Appointments: 216.444.6568 David Shewmon, MD Specialty Interest(s): General endocrinology, diabetes, high cholesterol, osteomalacia, osteoporosis, pituitary tumors, thyroid conditions, thyroid cancer Location(s): Wooster Family Health Center Office: 330.287.4690 | Fax: 330.287.4876 Appointments: 330.287.4690 Mariam Stevens, MD Specialty Interest(s): Diabetes, gestational diabetes, goiter, Graves’ disease, Hashimoto’s disease, hirsutism, hyperthyroidism, hypoglycemia, hypothyroidism, polycystic ovary syndrome, thyroid disease, thyroid nodule Location(s): Independence Family Health Center Office: 216.986.4000 | Fax: 216.986.4995 Appointments: 216.986.4000 Robert Zimmerman, MD Director, Cleveland Clinic Diabetes Center Vice Chairman, Department of Endocrinology, Diabetes and Metabolism Program Director, Endocrinology Training Program Specialty Interest(s): Diabetes, thyroid disorders, growth hormone in adults Location(s): Main campus Office: 216.444.9428 | Fax: 216.445.1656 Appointments: 216.444.6568 Department of Endocrine Surgery Bariatric and Metabolic Institute Eren Berber, MD Director, Robotic Endocrine Surgery Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), laparoscopic solid-organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumors, pancreatic neuroendocrine tumors, robotic thyroid and parathyroid surgery, laparoscopic and robotic adrenalectomy and liver surgery Location(s): Main campus Office: 216.445.0555 | Fax: 216.636.0662 Appointments: 216.444.6568 Kresimira (Mira) Milas, MD Director, Thyroid Center Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), thyroid cancer, multiple endocrine neoplasia syndromes, hereditary thyroid disorders Location(s): Main campus Office: 216.444.4985 | Fax: 216.636.0662 Appointments: 216.444.6568 Jamie Mitchell, MD Specialty Interest(s): Endocrine surgery (thyroid, parathyroid and adrenal), laparoscopic solid organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumors Location(s): Main campus; Independence Family Health Center; Solon Family Health Center Office: 216.445.9713 | Fax: 216.636.0662 Appointments: Main campus, 216.444.6568; Independence, 216.986.4000; Solon, 440.519.6800 Joyce J. Shin, MD Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, neuroendocrine tumors, thyroid/parathyroid ultrasound, intra-abdominal ultrasound, laparoscopic radiofrequency thermal ablation of liver tumors Location(s): Main campus; Willoughby Hills Family Health Center Office: 216.636.9365 | Fax: 216.636.0662 Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500 Allan Siperstein, MD Department Chair Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, laparoscopic thermal ablation of liver tumors, pancreatic endocrine tumors Location(s): Main campus Office: 216.444.5664 | Fax: 216.636.0662 Appointments: 216.444.6568 Christian Nasr, MD Co-director, Thyroid Center Specialty Interest(s): Thyroid nodules, thyroid cancers, flushing syndromes Main campus; Lorain Family Health and Surgery Center (Thyroid cancer only) Office: 216.445.1788 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Lorain, 440.204.7400 Stacy Brethauer, MD Specialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, hernia repair, endoscopy, surgery for GERD, hiatal hernia, solid-organ endoluminal surgery, single-incision laparoscopic surgery Location(s): Main campus Office: 216.444.9244 | Fax: 216.445.1586 Appointments: 216.445.2224 Derrick Cetin, DO Specialty Interest(s): Bariatric medicine, medical weight management, nutrition sciences, obesity management, preoperative evaluation, diabetes care Location(s): Main Campus Office: 216.445.4255 | Fax: 216.636.1588 Appointments: 216.445.2224 Bipan Chand, MD Specialty Interest(s): Advanced laparoscopy and endoscopy, endoscopy in the obese patient, gastric surgery focusing on reflux disease, hiatal hernia, bariatric operations and gastric cancer, biliary and spleen surgery, natural orifice transluminal endoscopic surgery (NOTES), endoluminal surgery Location(s): Main campus Office: 216.444.6668 | Fax: 216.445.1586 Appointments: 216.445.2224 Karen Cooper, DO Specialty Interest(s): Bariatric medicine, family medicine, kinesiology and nutrition sciences, exercise instruction Location(s): Main campus Office: 216.445.1114 | Fax: 216.445.1586 Appointments: 216.445.2224 Matthew Kroh, MD Specialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgery Location(s): Main campus Office: 216.445.9966 | Fax: 216.444.2153 Appointments: 216.445.2224 Tomasz Rogula, MD, PhD Specialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgery Location(s): Main campus; Strongsville Family Health and Surgery Center Office: 216.445.0255 | Fax: 216.445.1586 Appointments: Main campus: 216.445.2224; Strongsville: 440.878.2500 Philip Schauer, MD Department Chair Specialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, colon surgery, weight management, hernia surgery, biliary surgery, surgery for GERD Location(s): Main campus Office: 216.444.4794 | Fax: 216.445.1586 Appointments: 216.445.2224 Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations. Dear Colleagues, I am pleased to present the 2011 edition of Endocrine Notes from Cleveland Clinic’s Endocrinology & Metabolism Institute. Inside, we offer highlights from our multidisciplinary team’s most recent work: • Our report on a new parathyroid disease entity: primary hyperparathyroidism with normal PTH levels. • A rare case of acromegaly that was diagnosed during pregnancy. • A report on our experience with robotic adrenalectomy, which has become the preferred surgical approach. • A STAMPEDE substudy examining the clinical and metabolic factors involved in remission and non-remission of diabetes after gastric bypass surgery. • Information about the STAMPEDE II trial. • The designation of bariatric surgery as a first-line treatment for type 2 diabetes in the morbidly obese and the promise that gastric plication holds for drastic weight reduction. • A study evaluating the glucagon stimulation test as an alternative to the insulin tolerance test for determining growth hormone deficiency in adults. The Endocrinology & Metabolism Institute is one of 26 Cleveland Clinic institutes that group related specialties together to provide integrated, patient-centered care. Collaboration among endocrinologists, endocrine surgeons, bariatricians, bariatric surgeons and a cardiologist allows us to transcend the traditional borders between disciplines to improve patient care. Throughout our institute, our staff remains committed to Cleveland Clinic’s core ideology: “Patients First.” Our institute comprises: • The Department of Endocrinology, Diabetes and Metabolism, which manages specialized centers of care for patients with diabetes, thyroid disorders and pituitary disorders. • The Department of Endocrine Surgery, which performs the highest number of surgical procedures in the region. • The Bariatric and Metabolic Institute, which has been designated a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery. I hope that you find this issue of Endocrine Notes useful for your practice. Your comments and questions are always welcome. Please feel free to contact me at 216.444.6568 or 800.223.2273, ext. 46568. Sincerely, James B. Young, MD Chairman, Endocrinology & Metabolism Institute Professor of Medicine and Executive Dean, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University George and Linda Kaufman Chair Physician Director, Institutional Relations and Development 800.223.2273, Endocrine Notes ext. 46568 |1| clevelandclinic.org/endonotes 2011 Primary Hyperparathyroidism With Normal PTH Levels: A Modern Parathyroid Disease Entity Primary hyperparathyroidism (PHP) is not rare. One percent of the population and 2 percent of women over age 55 develop this condition. When they do, they normally manifest the classical picture of high calcium and high parathyroid hormone (PTH) measurements in the blood. But atypical presentations are becoming more appreciated; a case in point is normocalcemic PHP. Ten percent of patients will have normal calcium levels and high PTH, making PHP hard to differentiate from other causes of elevated PTH. In Cleveland Clinic’s Department of Endocrine Surgery, we $QXQXVXDOÀQGLQJ have described another entity of PHP, which we have desig- We conducted a review of 843 patients who had undergone nated normohormonal primary hyperparathyroidism (NHPHP). initial bilateral parathyroid exploration at Cleveland Clinic Patients with this entity have high calcium levels but normal- between January 2005 and December 2010. Of the study to-low PTH levels – as low as 5 pg/mL. Knowledge of this population, 46 patients (5.5 percent) were found to have subgroup may help the diagnosis of PHP to be made earlier. We feel it is appropriate to accept this atypical biochemistry SURÀOHLQWKHIDFHRIDQRWKHUZLVHTXLWHXVXDO3+3SUHVHQtation. These patients have clearly enlarged parathyroids, preoperative iPTH values within the normal reference range (10-60 mg/mL at Cleveland Clinic, or the normal range at the testing laboratory). All 46 had hypercalcemia, with values up to 12.5 mg/dL. NLGQH\VWRQHVDQGRVWHRSRURVLVDV\RXZRXOGÀQGLQD A review of medical histories found that PHP had been classical patient. This is a real subtype of the disease. discovered incidentally in 74 percent of patients. However, 70 percent had at least one symptom of PHP, 50 percent had abnormal bone density studies, 17 percent had a history 3DUDWK\URLG6XUJHU\ of nephrolithiasis, and 37 percent reported neuropsychiatric symptoms such as fatigue, irritability, altered mood, poor concentration or declining memory. None had a family history of PHP or hypercalcemia. Preoperative localization studies accurately detected parathyroid disease in 80 percent. 6XEJURXSVLGHQWLÀHG The study also noted three subgroups of NHPHP: 6XEJURXS, consisted of 7 patients with preoperative iPTH values < 40 pg/mL, the lowest measuring 5 pg/mL. 6XEJURXS,, consisted of 19 patients, all having SUHRSHUDWLYHL37+YDOXHVSJP/ 3UHDQG3RVWRSHUDWLYHL37+9DOXHVDPRQJ 3DWLHQWVZLWK1+3+3DQG7\SLFDO3+3 (YLGHQFHIRU/RZHU37+6HW3RLQWVLQ1+3+3 6XEJURXS,,, consisted of 20 patients who occasionally demonstrated iPTH values > 60 pg/mL, even though most ZHUHSJP/ Endocrine Notes |2| 2011 By Mira Milas, MD, and Lucy B. Wallace, MD Other than the preoperative iPTH values, there were no VWDWLVWLFDOO\VLJQLÀFDQWGLIIHUHQFHVDPRQJWKHVHVXEJURXSVRU 3+3FRYHUVDEURDGVSHFWUXPRIODERUDWRU\YDOXHV LQFOXGLQJSDWLHQWVZLWKQRUPDOFDOFLXPOHYHOV$ DQGZLWKQRUPDO37+OHYHOV1+3+3 classical PHP patients for any of the following features: age, gender, degree of hypercalcemia, 24-hour urinary calcium value and vitamin D levels, rate of parathyroid adenoma (74 percent) versus multi-gland disease (24 percent), and size of abnormal parathyroids. All NHPHP patients had resolution of hypercalcemia following surgery. diagnosis of PHP. NHPHP patients had multiple additional data points of serum calcium and iPTH before proceeding to surgery. Some were given more elaborate tests, such as A few distinct subgroup differences are interesting to PTHrp measurement, SPEP, selective venous sampling or CT highlight. For example, patients in subgroups I and II were scanning to evaluate for malignancy. The additional testing more commonly diagnosed by the endocrine surgeon after did not elucidate other etiologies of hypercalcemia, and all being referred for thyroid disease, as compared with patients patients had PHP. who had higher iPTH values. Subgroup I had the lowest prevalence of bone loss and neuropsychiatric symptoms. Preoperative localization studies failed to detect abnormal parathyroid glands more often in patients with lower iPTH values, despite a similar prevalence of parathyroid adenomas and abnormal gland volumes. $GLVWLQFWSKHQRW\SH Given such differences among the subgroups, we initially wondered whether we were simply diagnosing PHP at an Having performed this study and having this data to reference, we are comfortable recommending an imaging workup DQGVXUJHU\WR1+3+3SDWLHQWVZKRÀWWKHK\SHUSDUDWK\URLG GLVHDVHSURÀOH:HGRQRWDVVXPHWKDWRWKHUFDXVHVRI hypercalcemia will be more likely so that expensive additional tests will be mandatory for all. However, we believe that additional testing should be performed selectively based on an individual patient’s medical history. The study suggests that when patients have high calcium earlier phase of disease evolution. However, when we found levels but iPTH levels < 60 pg/mL and even < 40 pg/mL, similar degrees of hypercalcemia, morphology of parathyroid the diagnosis of primary hyperparathyroidism should be disease and abnormal gland volume among all subgroups, considered, particularly if no other etiology of hypercalcemia we became convinced that NHPHP is a real entity – a FDQEHLGHQWLÀHG$OWKRXJKDPLQRULW\RISDWLHQWVKDYHWKLV distinct phenotype of PHP. SURÀOHWKH\DUHKLJKO\OLNHO\WRKDYHDSDUDWK\URLGWXPRU In our publication, we suggest several possible explanations for the NHPHP phenomenon. One hypothesis is derived from PTH patterns before and after surgery (illustrated in the graph on page 2.) These patterns suggest that some patients may have parathyroids that simply function at a lower “set-point” for PTH. and surgery is curative. $ERXWWKHDXWKRUV Dr. Milas is Director of the Thyroid Center; Dr. Wallace worked with her and other Cleveland Clinic endocrine surgeons on this study as a fellow in the Department of Endocrine Surgery. )XUWKHUWHVWVRUGHUHGWKRXJKWIXOO\ At Cleveland Clinic, the usual practice is to proceed to For more information, please contact Dr. Milas at VXUJHU\RQFHWZRVHWVRIODERUDWRU\GDWDFRQÀUPWKH 216.444.4985 or at [email protected]. 800.223.2273, ext. 46568 |3| clevelandclinic.org/endonotes A Rare Case of Acromegaly Diagnosed During Pregnancy Pregnancy in patients with acromegaly is rare, with less than 150 cases reported in the literature. Currently, there are no guidelines regarding the diagnosis or management of acromegaly during pregnancy. The diagnosis and monitoring of acromegaly during pregnancy are complicated by the presence of a placental growth hormone (GH) source, resulting in physiologic changes in pituitary GH secretion and insulin-like growth factor-1 (IGF-1) production. Commercial assays cannot distinguish between pituitary GH and placental GH. Fertility is decreased in women with acromegaly due to altered gonadotropin secretion, but the following case illustrates that when pregnancy does occur, its outcome is usually favorable. Metabolic complications are uncommon, and most patients do not experience an increase in the size of their pituitary adenomas. &DVHKLVWRU\DQGSUHVHQWDWLRQ A 30-year old woman, G2P1, 13 weeks’ gestation, was referred to specialists in Cleveland Clinic’s Endocrinology & Metabolism Institute and Ob/Gyn & Women’s Health Institute. She presented with clinical features suggestive of acromegaly, including worsening headache, coarse facial features, acne, increased jawline, and enlargement of the hands and feet over two years. The IGF-1 level of 816 ng/mL was elevated (nonpregnant reference range: 138-410). A pregnancy two years earlier was uneventful. The labs revealed a prolactin of 99 ng /mL (2.0-17.4); a repeat IGF-1 of 1,085 ng/mL; and basal and nadir GH of 13.9 and 12.8 ng/mL, respectively, during oral glucose tolerance testing. Glucose levels, blood pressure and visual field tests were normal. Pituitary MRI without contrast revealed a 1.5 cm macroadenoma with no impingement on the optic chiasm. 0DQDJLQJV\PSWRPVGXULQJSUHJQDQF\ Severe headache prompted therapy, but the patient was unable to tolerate the dopamine receptor agonist bromocriptine. She was then started on 50 μg of the Endocrine Notes |4| 2011 By Vicky Cheng, MD, and Laurence Kennedy, MD somatostatin analog octreotide every eight hours at 19 weeks’ gestation, which resulted in significant headache relief and clinical improvement. The IGF-1 level decreased to 671 ng/mL and remained relatively stable during the rest of the pregnancy, while the GH level progressively increased, peaking at 43.9 ng/mL at 33 weeks’ gestation. At 38 ½ weeks’ gestation, the patient delivered a healthy baby girl (3355 g). Breastfeeding was unsuccessful due to lack of milk production. At one week postpartum, while the patient remained on octreotide, the GH level declined inexplicably to 1.13 ng/mL. At four weeks postpartum, the GH and IGF-1 levels were 15.2 ng/mL and 1090 ng/mL, respectively. are unaffected. Even without treatment, research to date shows that little change in the size of pituitary adenomas and no worsening of visual fields during pregnancy are to be expected. Scheduling surgery after delivery Pituitary MRI at four weeks postpartum showed that the Dopamine agonists and somatostatin analogs appear to be patient’s adenoma was stable. She underwent transsphe- safe during pregnancy, but because safety data are sparse, noidal resection of the adenoma, which immunostained their usage is generally reserved for symptomatic patients. positively for GH, but surgery failed to achieve a biochemical cure. Postoperatively, the GH level was 7.5 ng/mL, and the IGF-1 level was 892 ng/mL. She was started on a long-acting somatostatin analog. The use of the GH receptor antagonist pegvisomant seems promising during pregnancy when somatostatin analogs and surgery fail to control tumor growth. However, experience with pegvisomant is extremely limited, so its use will Treatment considerations during pregnancy require further study. As was true for this patient, the majority of pregnancies in Surgery can be safely postponed until after delivery for patients with acromegaly are uneventful, and newborns most patients except when it is needed in an emergency for acute visual loss or pituitary apoplexy. IMAGING Imaging About the authors Dr. Cheng worked on this case as a fellow in the Department of MRI of the pituitary without contrast revealed a macroadenoma measuring Endocrinology, Diabetes and Metabolism with Laurence Kennedy, MD, MRI of the pituitary 1.0 x 1.5 x 1.0 cm with no Chair, and endocrinologists Amir Hamrahian, MD, Charles Faiman, MD, without contrast impingement of the optic chiasm and Betul Hatipoglu, MD; and with obstetrician Fadi Khoury, MD. revealed a macroadenoma that measured 1.0 x 1.5 x 1.0 cm with no impingement of the optic chiasm. For further information, contact Dr. Hamrahian at 216.445.8538 or [email protected], or Dr. Kennedy at 216.445.8645 or [email protected]. Based on poster presentation at American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress, San Diego, Calif., April 13-17, 2011. 800.223.2273, ext. 46568 |5| clevelandclinic.org/endonotes Robotic Surgery Now the Preferred Approach to Adrenalectomy After several years’ experience in performing endocrine surgeon Eren Berber, MD, below, who robotic adrenalectomies, Cleveland Clinic endo- spearheads the technology and is training other- crine surgeons have found that robotic surgery Endocrinology & Metabolism Institute surgeons. provides significant advantages over conven- “Moreover, when we compared the robotic series tional laparoscopy. To date, they have performed with past laparoscopies, it became clear that more than 71 robotic adrenalectomies with no the duration of the surgery was similar, if not complications and no mortality. shorter, despite removing larger tumors. “Increased dexterity from articulating instruments and 3-D vision makes dissection faster and easier. As a result, we are able to remove larger tumors minimally invasively that would have otherwise required an open operation,” says Cleveland Clinic “We also noticed a trend toward a shorter hospital stay. Overall, both immediate postoperative pain and length of stay were slightly less with the robotic approach.” Robot ideal for posterior approach Additionally, robotic technology has enabled the surgeons to refine the posterior approach, which Dr. Berber and his colleagues were first in the world to describe. “Rigid laparoscopic instruments made the procedure cumbersome, but the articulated instrumentation provided by the robot makes the operation more ergonomic,” he explains. “With the robot, we have fewer instrument collisions and can reach difficult angles more easily. “Although the posterior approach is technically more demanding, we prefer it over the lateral transabdominal approach. Because we do not enter the intra-abdominal cavity, patients have less postoperative pain and may recover faster.” The surgeons especially favor the posterior approach in certain patients with bilateral tumors or significant abdominal scarring. However, they prefer the lateral transabdominal approach for patients with thicker back tissue or with tumors larger than 6 cm. The robotic approach also compares favorably to the laparoscopic approach in posterior procedures. “Posterior Endocrine Notes |6| 2011 The posterior robotic approach avoids the intra-abdominal cavity, reduces immediate postoperative pain and shortens length of stay. robotic adrenalectomy is about 30 minutes faster than These procedures are performed through axillary incisions posterior laparoscopic adrenalectomy,” notes Dr. Berber. to eliminate visible scarring on the neck. Large volume of adrenal procedures Tracking adrenal tumor patients’ outcomes Cleveland Clinic’s volume of adrenal operations is one of Data from all adrenal tumor patients is entered into an the largest in the world, notes Dr. Berber, who believes that IRB-approved registry that is used to evaluate outcomes a comprehensive adrenal surgery program should offer and compare surgical options. The registry, started in 2000, a variety of surgical options. now contains information on 300 cases. Open adrenalectomy is available for tumors that have Dr. Berber directs a weekly multidisciplinary adrenal diseases invaded surrounding structures. Dr. Berber and colleagues clinic with Cleveland Clinic endocrinologists and radiologists. also offer radiofrequency ablation, a technique they pioneered in the treatment of adrenal tumors. Patients with unresectable tumors and patients too sick for surgery are ideal candidates for radiofrequency ablation. Other robotic procedures offered Cleveland Clinic endocrine surgeons offer a comprehensive spectrum of surgical procedures, including robotic alternaDissection during a robotic adrenalectomy. tives. For example, besides robotic adrenalectomy, Cleveland Clinic endocrine surgeons have amassed one of the largest experiences with robotic thyroidectomy and robotic parathyroidectomy in the United States. 800.223.2273, ext. 46568 To refer patients for evaluation or for further information, please contact Dr. Berber at 216.445.0555 or at [email protected]. |7| clevelandclinic.org/endonotes STAMPEDE Substudy Examines Factors Underlying Diabetes Remission or Non-Remission Bariatric surgery is now widely accepted for the treatment of severe obesity, with approximately 200,000 procedures performed in the United States yearly. With more than 50 percent of type 2 GLDEHWHVPHOOLWXV'0SDWLHQWVFODVVLÀHGDVREHVH DQGSHUFHQWFODVVLÀHGDVPRUELGO\REHVHEDULDWULF surgery has tremendous therapeutic potential. “Weight loss is a key component in the resolution of type 2 DM, “Data from this study, in conjunction with clinical trial data, and bariatric surgery can be highly effective in inducing ZLOODOORZXVWRGHÀQHPHWDEROLFDGDSWDWLRQVZLWKUHVSHFWWR weight loss,” says Cleveland Clinic endocrinologist Sangeeta changes in intestinal hormones and fat-generated hormones Kashyap, MD. “However, DM does not always resolve with following various bariatric procedures.” bariatric surgery, even with optimal weight loss.” This will help to further understanding of the potential bariat- A Cleveland Clinic study, Surgical Therapy and Medications ric surgery holds for the treatment of DM in moderate obesity. 3RWHQWLDOO\(UDGLFDWH'LDEHWHV(IÀFLHQWO\STAMPEDE), is The study may also be useful in establishing appropriate FRPSDULQJWKHHIÀFDF\DQGVDIHW\RI5RX[HQ<JDVWULF expectations, because patients with DM expect their disease bypass surgery, sleeve gastrectomy and advanced medical to resolve following bariatric surgery. WKHUDS\LQUHVWRULQJQRUPDOEORRGJOXFRVHOHYHOV+E$F percent) among diabetic patients who are moderately obese =HURLQJLQRQLQFUHWLQELRORJ\ (BMI 27-43 Kg/m2). Philip Schauer, MD, Director of the After surgery, not all patients are likely to achieve com- Bariatric and Metabolic Institute (pictured above), is plete remission. Dr. Kashyap believes this may be due to principal investigator. poor baseline residual B-cell function and a lack of incretin /RRNLQJIRUXQGHUO\LQJIDFWRUV STAMPEDELVUHDIÀUPLQJWKHYDOXHRIEDULDWULFSURFHGXUHV in helping many patients achieve glycemic control, yet a number of patients have been unable to achieve or maintain stimulation induced by either procedure. It is currently unclear whether weight loss alone or incretin-related effects on B-cell function is the dominant mechanism related to long-term DM remission. DM remission despite dramatic weight loss. This prompted Dr. “Given their potential to enhance insulin secretion, promote Kashyap to launch a substudy of STAMPEDE, funded by the B-cell growth and induce weight loss, understanding the dif- American Diabetes Association, to examine the clinical and ferential response of incretin hormones to the various bariatric metabolic factors determining DM non-remission after either procedures in patients who achieve DM remission versus Roux-en-Y gastric bypass or sleeve gastrectomy. non-remission is critical,” she says. “As endocrinologists, we need to understand which patients The ability of bariatric surgery to reverse DM may depend on ZLOOEHQHÀWPRVWIURPEDULDWULFVXUJHU\LQRUGHUWRRSWLPL]H disease duration and severity. Patients with recent-onset DM patient selection and determine the point at which surgery and mild hyperglycemia who do not require insulin are likely should be recommended,” says Dr. Kashyap. to have the greatest baseline B-cell function. Those with poor Endocrine Notes |8| 2011 STAMPEDE II Now Enrolling residual B-cell function at baseline may not experience the IXOOEHQHÀWRILQFUHWLQVWLPXODWLRQDQGZHLJKWORVVUHODWHG improvements in insulin sensitivity and thus achieve only partial remission or nonremission. :HLJKWUHJDLQDOVRFRQVLGHUHG A second issue to evaluate is the effect of weight regain on DM. Although most patients experience substantial weight loss in the 12 months following bariatric surgery, weight regain beginning in year two does occur in some patients. Dr. Kashyap hopes to determine how weight regain leads to non-response by establishing the weight-related effects on lipotoxicity-mediated insulin resistance 12 and 24 months following bariatric surgery. Cleveland Clinic is currently enrolling patients for the Lipotoxicity plays a central role in inducing B-cell dysfunction STAMPEDE II (Surgical Therapy and Medications Potentially and insulin resistance, which lead to the development of DM. Eradicate Diabetes Efficiently) study. The randomized, Therefore, “the impact of bariatric surgery on the weight- controlled trial will examine short- and long-term outcomes of related and non-weight-related effects of lipotoxicity must be advanced medical therapy versus advanced medical therapy determined in patients achieving longer-term, complete DM combined with Roux-en-Y gastric bypass. remission versus non-remission,” she says. “Since weight The effect of each approach on disease progression, regain is associated with an increase in fat mass, we expect to see a direct impact of weight regain on impairing insulin complications and organ damage will be evaluated. Sixty sensitivity and glucose tolerance.” men and women with type 2 diabetes are sought for the One-year outcomes for the study will be available in 2012, and have a body mass index between 27 and 43 kg/m2. study. Candidates must be between 20 and 60 years of age and two-year outcomes will be available in 2013. Co-investigators for STAMPEDE II are Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute; Sangeeta Kashyap, MD, of the Department of Endocrinology, Diabetes and Metabolism; and John Kirwan, PhD, of the departments of Gastroenterology and Hepatology, and Pathobiology. For more information about STAMPEDE II, call 800.223.2273, ext. 53983, or visit clinicaltrials.gov. For more information, please contact Dr. Kashyap (above) at 216.445.2679 or at [email protected]. 800.223.2273, ext. 46568 |9| clevelandclinic.org/endonotes Bariatric Surgery Now Standard Treatment for Morbidly Obese Diabetic Patients In March 2011, the International Diabetes Federation (IDF) issued a position statement upgrading bariatric surgery from an option to a priority for morbidly obese patients (BMI > 35 kg/m2) with type 2 diabetes mellitus (DM). “The value of bariatric procedures in helping morbidly obese patients achieve glycemic control has been conÀUPHG,WLVWLPHIRUPHWDEROLFVXUJHU\WREHDQDFFHSWHG option, because diabetes in severely obese patients is often refractory to conventional therapy with insulin and oral agents, due to severe insulin resistance,” explains Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute and a member of the IDF expert panel that authored the position statement. The IDF statement also says that patients with a BMI of 30–35 kg/m2 should be considered for surgery when hemoglobin A1c is > 7.5 percent despite optimal therapy, and particularly if weight is increasing or in the presence of other weight-responsive co-morbidities that are not achieving targets using conventional therapies, including hypertension, dyslipidemia and obstructive sleep apnea. The IDF writing group reviewed the data related to other conventional, standard bariatric operations and novel interventional procedures and considered gastric banding (above left), sleeve gastrectomy (above middle), gastric bypass (Roux-en-Y, above right), biliopancreatic diversion and duodenal switch in its clinical recommendations. Endocrine Notes | 10 | 2011 Gastric Plication Holds Promise for Extreme Weight Loss Gastric plication, called laparoscopic greater curvature plication (LGCP) when performed laparoscopically, is a promising investigational bariatric procedure that may be useful in achieving weight loss and metabolic goals with very low morbidity. Neither the stomach nor intestines are removed, enabling the plication to be reversed or converted to another procedure at a later time, if desired. The entire procedure can be completed in less than one hour. Most patients leave the hospital after a few hours in recovery and can return to work within seven to 10 days. Problems are rare, and major complications occur in fewer than 1 percent of cases. LGCP is considered investigational as a primary procedure for weight loss and is being offered to patients at Cleveland &OLQLFDVSDUWRIDFOLQLFDOWULDOWKDWZLOOEHWWHUGHÀQHVKRUW DQGORQJWHUPEHQHÀWV Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute, and colleagues have helped pioneer the procedure and have published initial results showing VLJQLÀFDQWZHLJKWORVV “Depending on their preoperative weight, patients can expect to lose 40 to 70 percent of their excess body weight in the ÀUVW\HDUDIWHUVXUJHU\$OWKRXJKORQJWHUPVWXGLHVDUHQRW\HW DYDLODEOHWKLVZHLJKWORVVUHVXOWVLQVLJQLÀFDQWLPSURYHPHQWLQ diabetes as well as hypertension, obstructive sleep apnea and hypercholesterolemia in the postoperative period,” he says. In LGCP, the surgeon makes several incisions (< 1 cm) in the abdomen as portals for the video camera and instrumentation. One or more folds are made in the stomach, reducing volume to approximately 75 percent to enhance satiety and reduce appetite. No stapling or cutting is involved; the folds are sutured in place. 800.223.2273, ext. 46568 6WDF\%UHWKDXHU0'LVRQHRI&OHYHODQG&OLQLF·VEDULDWULFVXUJHRQV For more information about gastric plication, contact Dr. Schauer at 216.444.4794 or at [email protected]. | 11 | clevelandclinic.org/endonotes Study Compares Glucagon Stimulation Test to Insulin Tolerance Test in Evaluating Adult *URZWK+RUPRQH'HÀFLHQF\ With current availability of GHRH limited to research use only, there is no satisfactory DOWHUQDWLYHWRWKHLQVXOLQWROHUDQFHWHVW,77IRUHYDOXDWLRQRIJURZWKKRUPRQHGHÀFLHQF\ (GHD) in adults. The glucagon stimulation test (GST) has been recommended as an alternative. Cleveland Clinic is one of four institutions participating in a study comparing the GST to the ITT for this purpose. “Our hypothesis is that the GST can accurately and safely diagnose GHD in patients with hypothalamicpituitary disorders. It is readily available, relatively inexpensive and well-tolerated,” says Cleveland Clinic endocrinologist Amir Hamrahian, MD. “Unlike the ITT, it is not labor-intensive, and there are few contraindications to its use. This is particularly important for clinical endocrinologists who are not comfortable ZLWKWKH,77RUGRQRWKDYHWKHQHFHVVDU\VWDIIRUORJLVWLFDOVXSSRUWWRFRQGXFW,77VLQWKHLURIÀFHµ 7KUHHVWXG\DUPV ,QRUGHUWRGHWHUPLQHWKHFXWRIISRLQWZLWKWKHKLJKHVWVHQVLWLYLW\DQGVSHFLÀFLW\WRGLIIHUHQWLDWH between GHD and normal growth hormone levels, the study has been designed with one ITT and two glucagon arms. One glucagon arm evaluates the standard GST; the other evaluates glucagon dosage based on weight. The GST may also be used to evaluate the integrity of the hypothalamic-pituitary-adrenal axis by provoking ACTH and cortisol secretion. “Cortisol release in response to glucagon seems to be ACTHdependent. Similar to the ITT, the GST examines the entire HPA axis. Whether the test can accurately evaluate the integrity of the hypothalamic-pituitary-adrenal axis and use the same cutoff values for cortisol as the ITT and ACTH stimulation tests is unknown,” says Dr. Hamrahian. It is normal to give 1 or 1.5 mg glucagon if the patient’s weight is greater than 90 kg. In this study, participants are given 0.03 mg/kg, up to a maximum of 3 mg, to determine whether increasing the dose improves the ability of the test to use the same cutoff values as the ITT and ACTH stimulation tests. “This would assure us that the GST will provide results closer to the current gold standard,” he explains. 5HFUXLWPHQWRQJRLQJ The study is recruiting 30 patients with adult-onset hypothalamic-pituitary disorders: 15 with one SLWXLWDU\KRUPRQHGHÀFLHQF\3+'RWKHUWKDQ*+'DQGZLWKWZRRUPRUH3+'V7ZHQW\KHDOWK\ controls matched for age, sex and body mass index are also being recruited. The ITT and two GSTs ZLOOEHGRQHDWLQWHUYDOVRIÀYHWRGD\V'XULQJWKH*67EORRGJOXFRVHFRUWLVRODQGVHUXP*+ levels will be measured at baseline and every 30 minutes, up to 240 minutes. Endocrine Notes | 12 | 2011 “Our hypothesis is that the GST can accurately and safely GLDJQRVHJURZWKKRUPRQHGHÀFLHQF\LQSDWLHQWVZLWKK\SRthalamic-pituitary disorders...Whether the test can accurately evaluate the integrity of the hypothalamic-pituitary-adrenal axis and use the same cutoff values for cortisol as the ITT and ACTH stimulation tests is unknown.” Other centers participating in this study are Massachusetts General Hospital, the University of Oregon and Allegheny Hospital. All patients will receive a small stipend for travel expenses. To refer candidates to Cleveland Clinic or to obtain further information about inclusion and exclusion criteria, please contact Dr. Hamrahian at 216.445.8538 or at [email protected]. 800.223.2273, ext. 46568 | 13 | clevelandclinic.org/endonotes Publications Below are peer-reviewed journal articles and Abdelmalak B, Zimmerman R, Foss J. Reply [Diagnosing preop- book chapters published within the past year by erative hyperglycemia in non-diabetic patients: a challenge and Endocrinology & Metabolism Institute staff. an opportunity]. Can J Anaesth.2011;58(6):583. &OHYH&OLQ-0HG Journals Albashir S, Olansky L, Sasidhar M. Progressive muscle $P-&OLQ1XWU 2011 Jun;78(6):385-391. weakness: More there than meets the eye. Cleve Clin J Med. Solomon TPJ, Haus JM, Kelly KR, Cook MD, Filion J, Rocco Hamaty M. Insulin treatment for type 2 diabetes: M, Kashyap SR, Watanabe RM, Barkoukis H, Kirwan JP. A When to start, which to use. Cleve Clin J Med. 2011 low-glycemic index diet combined with exercise reduces insulin May;78(5):332-342. resistance, postprandial hyperinsulinemia, and glucose-dependent insulinotropic polypeptide responses in obese, prediabetic Kashyap SR. In reply [Bariatric surgery, vitamin C, and humans. Am J Clin Nutr. 2010 Dec;92(6):1359-1368. kidney stones]. Cleve Clin J Med. 2010 Dec;77(12):844. $P-7UDQVSODQW Olansky L. Q: Do incretin drugs for type 2 diabetes increase the risk of acute pancreatitis? Cleve Clin J Med. 2010 Flechner SM, Berber E, Askar M, Stephany B, Agarwal A, Milas Aug;77(8):503-505. M. Allotransplantation of cryopreserved parathyroid tissue for severe hypocalcemia in a renal transplant recipient. Am J Pantalone KM, Nasr C. Approach to a low TSH level: Patience is Transplant. 2010 Sep;10(9):2061-2065. a virtue. Cleve Clin J Med. 2010 Nov;77(11):803-811. $QQ,QWHUQ0HG 'LDEHWHV Shewmon DA, Craig JM. Creatine supplementation prevents Bhatwadekar AD, Guerin EP, Jarajapu YPR, Caballero S, statin-induced muscle toxicity. Ann Intern Med. 2010 Sheridan C, Kent D, Kennedy L, Lansang MC, Ruscetti FW, Nov 16;153(10):690-692. Pepine CJ, Higgins PJ, Bartelmez SH, Grant MB. Transient inhibition of transforming growth factor-beta 1 in human diabetic $QQ6XUJ CD34+ cells enhances vascular reparative functions. Diabetes. Jarrar AM, Milas M, Mitchell J, LaGuardia L, O’Malley M, 2010 Aug;59(8):2010-2019. Berber E, Siperstein A, Burke C, Church JM. Screening for thyroid cancer in patients with familial adenomatous polyposis. 'LDEHWHV&DUH Ann Surg. 2011 Mar;253(3):515-521. Pop-Busui R, Evans GW, Gerstein HC, Fonseca V, Fleg JL, Hoogwerf BJ, Genuth S, Grimm RH, Corson MA, Prineas R. Milas M, Shin J, Gupta M, Novosel T, Nasr C, Brainard J, Effects of cardiac autonomic dysfunction on mortality risk in the Mitchell J, Berber E, Siperstein A. Circulating thyrotropin Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. receptor mRNA as a novel marker of thyroid cancer: clinical Diabetes Care. 2010 Jul;33(7):1578-1584. applications learned from 1758 samples. Ann Surg. 2010 Oct;252(4):643-651. Solomon TPJ, Haus JM, Kelly KR, Rocco M, Kashyap SR, Kirwan JP. Improved pancreatic beta-cell function in type 2 &DQ-$QDHVWK diabetic patients after lifestyle-induced weight loss is related to Abdelmalak B, Abdelmalak JB, Knittel J, Christiansen E, Mascha glucose-dependent insulinotropic polypeptide. Diabetes Care. E, Zimmerman R, Argalious M, Foss J. The prevalence of undiag- 2010 Jul;33(7):1561-1566. nosed diabetes in non-cardiac surgery patients, an observational study. Can J Anaesth. 2010 Dec;57(12):1058-1064. Endocrine Notes | 14 | 2011 'LDEHWHV2EHV0HWDE -$P&ROO6XUJ Reasner C, Olansky L, Seck TL, Williams-Herman DE, Chen M, Attaluri V, Lebeis C, Brethauer S, Rosenblatt S. Advanced lapa- Terranella L, Johnson-Levonas AO, Kaufman KD, Goldstein BJ. URVFRSLFWHFKQLTXHVVLJQLÀFDQWO\LPSURYHIXQFWLRQRISHULWRQHDO 7KHHIIHFWRILQLWLDOWKHUDS\ZLWKWKHÀ[HGGRVHFRPELQDWLRQRI dialysis catheters. J Am Coll Surg. 2010 Dec;211(6):699-704. sitagliptin and metformin compared with metformin monotherapy in patients with type 2 diabetes mellitus. Diabetes Obes Metab. -&OLQ(QGRFULQRO0HWDE 2011 Jul;13(7):644-652. Tritos NA, Greenspan SL, King D, Hamrahian A, Cook DM, Jonsson PJ, Wajnrajch MP, Koltowska-Haggstrom M, Biller BMK. Rhoads GG, Dain MP, Zhang Q, Kennedy L. Two-year 8QUHSODFHGVH[VWHURLGGHÀFLHQF\FRUWLFRWURSLQGHÀFLHQF\DQG glycaemic control and healthcare expenditures following lower IGF-I are associated with lower bone mineral density in initiation of insulin glargine versus neutral protamine Hagedorn DGXOWVZLWKJURZWKKRUPRQHGHÀFLHQF\$.,06GDWDEDVHDQDO\- insulin in type 2 diabetes. Diabetes Obes Metab. 2011 sis. J Clin Endocrinol Metab. 2011 May;96(5):1516-1523. Aug;13(8):711-717. Zerikly RK, Amiri L, Faiman C, Gupta M, Singh RJ, Nutter B, (QGRFU3UDFW Kennedy L, Hatipoglu B, Weil RJ, Hamrahian AH. Diagnostic Cheng V, Doshi KB, Falcone T, Faiman C. Hyperandrogenism in characteristics of late-night salivary cortisol using liquid chroma- a postmenopausal woman: diagnostic and therapeutic challenges. tography-tandem mass spectrometry. J Clin Endocrinol Metab. Endocr Pract. 2011 Mar;17(2):e21-e25. 2010 Oct;95(10):4555-4559. Mulligan GB, Eray E, Faiman C, Gupta M, Pineyro MM, Makdissi -(QGRXURO A, Suh JH, Masaryk TJ, Prayson R, Weil RJ, Hamrahian AH. Reduction of false-negative results in inferior petrosal sinus sampling with simultaneous prolactin and corticotropin measurement. Endocr Pract. 2011 Jan-Feb;17(1):33-40. Berber E, Siperstein A. Re: Robot-assisted posterior retroperitoneoscopic adrenalectomy (From: Ludwig AT, Wagner KR, Lowry PS, et al. J Endourol 2010;24:1307-1314). J Endourol. 2011 Mar;25(3):541-542. Nyalakonda K, Sharma T, Ismail-Beigi F. Preservation of Beta-cell function in type 2 diabetes. Endocr Pract. 2010 -+HSDWRO Nov-Dec;16(6):1038-1055. Tamimi TI, Elgouhari HM, Alkhouri N, Yerian LM, Berk MP, Lopez R, Schauer PR, Zein NN, Feldstein AE. An apoptosis Pantalone KM, Faiman C, Olansky L. Insulin glargine use during panel for nonalcoholic steatohepatitis diagnosis. J Hepatol. 2011 pregnancy. Endocr Pract. 2011 May;17(3):448-455. Jun;54(6):1224-1229. ([SHUW5HY(QGRFULQRO0HWDE -/RQJ7HUP(II0HG,PSODQWV Hatipoglu BA, Kennedy L. Postradiation therapy hypopituitarism. El-Hayek KM, Chand B. Biologic prosthetic materials for hernia Expert Rev Endocrinol Metab. 2011 Mar;6(2):187-194. repairs. J Long Term Eff Med Implants. 2010;20(2):159-169. *DVWURLQWHVW(QGRVF&OLQ1$P 0HWDE6\QGU5HODW'LVRUG Tariq N, Chand B. Presurgical evaluation and postoperative care Kashyap SR, Roman LJ, Mandarino L, DeFronzo R, Bajaj M. for the bariatric patient. Gastrointest Endosc Clin N Am. 2011 Hypoadiponectinemia is closely associated with impaired nitric Apr;21(2):229-240. oxide synthase activity in skeletal muscle of type 2 diabetic subjects. Metab Syndr Relat Disord. 2010 Oct;8(5):459-463. +3%2[IRUG Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S, 0LQHUYD(QGRFULQRO Fung J. Robotic versus laparoscopic resection of liver tumours. Milas Z, Shin J, Milas M. New guidelines for the management HPB (Oxford). 2010 Oct;12(8):583-586. of thyroid nodules and differentiated thyroid cancer. Minerva Endocrinol. 2011 Mar;36(1):53-70. ,QW-(QGRFULQRO Yusupov E, Li-Ng M, Pollack S, Yeh JK, Mikhail M, Aloia JF. Vitamin D and serum cytokines in a randomized clinical trial. Int J Endocrinol. 2010;2010:305054. continued on next page 800.223.2273, ext. 46568 | 15 | clevelandclinic.org/endonotes Publications continued 1DWXUH Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, Ransom D, Ashton K, Windover A, Heinberg L. Internal consis- Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith tency and validity assessment of SCL-90-R for bariatric surgery JD, Allayee H, Tang WHW, DiDonato JA, Lusis AJ, Hazen SL. candidates. Surg Obes Relat Dis. 2010 Nov-Dec;6(6):622-627. *XWÁRUDPHWDEROLVPRISKRVSKDWLG\OFKROLQHSURPRWHVFDUGLRYDVcular disease. Nature. 2011 Apr 7;472(7341):57-63. psychosocial correlates of self-reported past suicide attempts among bariatric surgery candidates. Surg Obes Relat Dis. 2010 3LWXLWDU\ Nov-Dec;6(6):702-706. Marko NF, Hamrahian AH, Weil RJ. Immediate postoperative cortisol levels accurately predict postoperative hypothalamic- 6XUJHU\ pituitary-adrenal axis function after transsphenoidal surgery for Akyildiz HY, Mitchell J, Milas M, Siperstein A, Berber E. pituitary tumors. Pituitary. 2010 Sep;13(3):249-255. Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: Long-term follow-up. Surgery. 2010 6XUJ(QGRVF Dec;148(6):1288-1293. Akyildiz HY, Morris-Stiff G, Aucejo F, Fung J, Berber E. Techniques of radiofrequency-assisted precoagulation in laparoscopic liver 7K\URLG resection. Surg Endosc. 2011 Apr;25(4):1143-1147. Greenlee C, Burmeister LA, Butler RS, Edinboro CH, Morrison SM, Milas M. Current safety practices relating to I-131 admin- 6XUJ/DSDURVF(QGRVF3HUFXWDQ7HFK istration for diseases of the thyroid: a survey of physicians and Alasfar F, Chand B. Intraoperative endoscopy for laparoscopic allied practitioners. Thyroid. 2011 Feb;21(2):151-160. Roux-en-Y gastric bypass: leak test and beyond. Surg Laparosc Endosc Percutan Tech. 2010 Dec;20(6):424-427. Shin J, Chute D, Milas M, Mitchell J, Siperstein A, Berber E. A rare case of chronic lymphocytic leukemia/small lymphocytic Harvey A, Bohacek L, Neumann D, Mihaljevic T, Berber E. lymphoma presenting in the thyroid gland. Thyroid. 2010 Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature. Surg Laparosc Endosc Percutan Tech. 2011 Feb;21(1):e24-e27. Mitchell J, Siperstein A, Milas M, Berber E. Laparoscopic resection of abdominal paragangliomas. Surg Laparosc Endosc Percutan Tech. 2011 Feb;21(1):e48-e53. 6XUJ2EHV5HODW'LV Ashton K, Heinberg L, Windover A, Merrell J. Positive response to binge eating intervention enhances postoperative weight loss. Surg Obes Relat Dis. 2011 May-Jun;7(3):315-320. Windover AK, Merrell J, Ashton K, Heinberg LJ. Prevalence and Sep;20(9):1019-1023. Sisson TA, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, Edinboro CH, Rosenthal D, Thomas MJ, Wexler JA, Asamoah E, Avram AM, Milas M, Greenlee C. Radiation safety in the treatment of patients with thyroid diseases by radioiodine (131)i: practice recommendations of the American Thyroid Association. Thyroid. 2011 Apr;21(4):335-346. 8OXVDO&HUUDKL'HUJLVL Karabulut K, Berber E. Robotik endokrin cerrahi [Robotic endocrine surgery] [Turkish]. Ulusal Cerrahi Dergisi. 2011;27(1):1-5. Brethauer SA, Chand B, Schauer PR, Thompson CC. Transoral gastric volume reduction for weight management: technique Nov-Dec;6(6):689-694. Book Chapters Brethauer SA, Harris JL, Kroh M, Schauer PR. Laparoscopic Ashton K, Budur K. Scared to sleep: A Hurricane Katrina survi- and feasibility in 18 patients. Surg Obes Relat Dis. 2010 gastric plication for treatment of severe obesity. Surg Obes vor. In: Foldvary-Schaefer N, Krishna J, Budur K, eds. A Case a Relat Dis. 2011 Jan-Feb;7(1):15-22. Week: Sleep Disorders From the Cleveland Clinic. Oxford; New Gatmaitan P, Huang H, Talarico J, Moustarah F, Kashyap S, Kirwan JP, Schauer PR, Brethauer SA. Pancreatic islet isolation York, NY: Oxford University Press; 2011. Chapter 3. p. 43-48. Ashton K, Streem D. Smoking cessation. In: Carey WD, ed. after gastric bypass in a rat model: technique and initial results Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/ for a promising research tool. Surg Obes Relat Dis. 2010 Elsevier; 2010. p. 977-980. Sep-Oct;6(5):532-537. Endocrine Notes | 16 | 2011 Babar T, Skugor M. Diabetes mellitus treatment. In: Carey Mitchell JC. Clinical detection and treatment of pancreatic WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: neuroendocrine tumors. In: Hunt JL, ed. Molecular Pathology of Saunders/Elsevier; 2010. p. 358-363. Endocrine Diseases. New York, NY: Springer; 2010. Chapter 22. p. 229-235. Brethauer S, Kashyap S, Schauer P. Obesity. In: Carey WD, ed. Mitchell JC, Milas M. Clinical detection and treatment of thyroid Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/ diseases. In: Hunt JL, ed. Molecular Pathology of Endocrine Elsevier; 2010. p. 391-396. Diseases. New York, NY: Springer; 2010. Chapter 4. p. 27-35. Chikunguwo SM, Brethauer SA, Schauer PR. Bariatric surgery. Moustarah F, Brethauer SA, Schauer PR. Laparoscopic surgery In: Cameron JL, Cameron AM, eds. Surgery of the Esophagus and Stomach. London; New York, NY: Springer; 2011. Chapter for severe obesity. In: Cameron JL, Cameron AM, eds. Current 16. p. 217-232. Surgical Therapy. 10th ed. Philadelphia, PA: Saunders/Elsevier; 2011. p. 1304-1316. Chinnappa P, Mehta A. Hirsutism. In: Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier; Nasr C. Flushing. In: Carey WD, ed. Current Clinical Medicine. 2010. p. 376-379. 2nd ed. Philadelphia, PA: Saunders/Elsevier; 2010. p. 369-375. Diab DL, Hamrahian AH. Clinical detection and treatment of be- Reddy SSK. Hypothalamic-pituitary disorders. In: Camacho PM, nign and malignant pituitary diseases. In: Hunt JL, ed. Molecular ed. A Color Handbook of Clinical Endocrinology and Metabolism. Pathology of Endocrine Diseases. New York, NY: Springer; 2010. London: Manson Pub.; 2011. Chapter 4. p. 91-112. Chapter 17. p. 169-174. Schirmer B, Schauer PR. The surgical management of obesity. Faiman C. Male hypogonadism. In: Carey WD, ed. Current In: Brunicardi FC, ed. Schwartz’s Principles of Surgery. 9th ed. Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier; New York, NY: McGraw-Hill; 2010. Chapter 27. p. 949-978. 2010. p. 397-401. Skugor M. Section 4: Endocrinology [Section editor]. In: Carey Gatmaitan P, Brethauer SA, Schauer PR. Obesity and presenta- WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: tions after anti-obesity surgery. In: Talley NJ, Kane SV, Wallace Saunders/Elsevier; 2010. p. 335-420. MB, eds. Practical Gastroenterology and Hepatology. Small Skugor M. Hypocalcemia and hypercalcemia. In: Carey WD, ed. and Large Intestine and Pancreas. Chichester, West Sussex ; Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/ Hoboken, NJ: Wiley-Blackwell; 2010. Chapter 24. p. 169-175. Elsevier; 2010. p. 380-386. Gopan T, Hamrahian A. Adrenal disorders. In: Camacho PM, ed. A Color Handbook of Clinical Endocrinology and Metabolism. Skugor M. Osteoporosis. In: Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier; 2010. London: Manson Pub.; 2011. Chapter 5. p. 113-147. p. 402-407. Harvey AM, Siperstein AE, Berber E. Clinical detection and Skugor M, Fleseriu M. Hypothyroidism and hyperthyroidism. In: treatment of adrenal disease. In: Hunt JL, ed. Molecular Pathology of Endocrine Diseases. New York, NY: Springer; 2010. Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, Chapter 19. p. 197-203. PA: Saunders/Elsevier; 2010. p. 416-420. Hoogwerf BJ. Diabetes mellitus: Disease management. In: Carey Skugor M, Hamrahian AH. Pituitary disorders. In: Carey WD, ed. WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/ Saunders/Elsevier; 2010. p. 350-354. Elsevier; 2010. p. 408-415. Ioachimescu AG, Hamrahian AH. Diseases of the adrenal Zimmerman R. Microvascular complications of diabetes. In: gland. In: Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier; 2010. p. 336-349. 800.223.2273, ext. 46568 Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier; 2010. p. 355-357. | 17 | clevelandclinic.org/endonotes Live and Online CME Opportunities &OHYHODQG&OLQLF·V&HQWHUIRU&RQWLQXLQJ(GXFDWLRQRIIHUV FRQYHQLHQWFRPSOLPHQWDU\OHDUQLQJRSSRUWXQLWLHVIURP ZHEFDVWVDQGSRGFDVWVWRDKRVWRIPHGLFDOSXEOLFDWLRQV LQDGGLWLRQWROLYH&0(V\PSRVLD The 9th Annual Dr. Roizen’s Preventive Care and Integrative Medicine Conference Focus: Reversing Metabolic and Endocrine Disorders, including Metabolic Syndrome, Type 2 Diabetes and Thyroid Disorders, and Increasing Sexual Enjoyment December 9-11, 2011 0LUDJH+RWHODQG5HVRUW/DV9HJDV1HY This activity has been approved for AMA PRA Category 1 Credits.™ To register, please call 216.448.0777, email [email protected] or visit www.ccfcme.org/wellness11. 2QOLQH&0( Online webcasts of interest to endocrinologists and approved for AMA PRA Category 1 Credits™ include: “Can We Develop a Viable PPAR Agonist for Diabetic Patients?” and “Challenges in Developing New Therapies for Risk Reduction in Diabetes” 5HOHDVH'DWH)HE (VWLPDWHG7LPHPLQXWHV ´,QWHQVLYH/LSLG0RGLÀFDWLRQLQWKH Diabetic Patient and Plaque Progression in Diabetic Patients: Insights from Arterial Wall Imaging” 5HOHDVH'DWH)HE (VWLPDWHG7LPHPLQXWHV “New and Novel Therapies for Low Bone Mass” 5HOHDVH'DWH-DQ (VWLPDWHG7LPHPLQXWHV “Robotic Endocrine Surgery” 5HOHDVH'DWH$SU (VWLPDWHG7LPHPLQXWHV For a full list of all Cleveland Clinic CME opportunities, please visit FFIFPHRUJ; to manage your CME credits, use the P\&0(FRP Web portal, available 24/7. Endocrine Notes | 18 | 2011 Current Clinical Trials TITLE PI CO N TA C T / N U M B E R International Metabolic Study (KIMS®) $PLU+DPUDKLDQ0' Melanie Williams 216.444.5410 A Proof of Concept, Open-Label, Forced Titration, Multicenter Study to Assess the Safety/Tolerability and (IÀFDF\RID:HHN7UHDWPHQWRI/&,LQ3DWLHQWVZLWK&XVKLQJ·V'LVHDVH $PLU+DPUDKLDQ0' Melanie Williams 216.444.5410 A Blinded, Placebo-Controlled, Single Ascending Dose, Phase 1 Trial for Safety, Tolerability, Pharmacokinetics and Pharmacodynamics after Subcutaneous Administration of VRS-317 in Adults ZLWK*URZWK+RUPRQH'HÀFLHQF\ $PLU+DPUDKLDQ0' Melanie Williams 216.444.5410 A Phase III, Multinational, Randomized, Double-Blind, Placebo-Controlled Parallel-Group Study WR,QYHVWLJDWHWKH&OLQLFDO(IÀFDF\DQG6DIHW\RI'LD3HS5LQ1HZO\'LDJQRVHG7\SH'LDEHWHV6XEMHFWV /HDQQ2ODQVN\0' Melanie Williams 216.444.5410 A Randomized, Double-Masked, Placebo-Controlled, Multicenter, Phase 2 Study to Evaluate the Safety and 5HQDO(IÀFDF\RI/<LQ3DWLHQWVZLWK'LDEHWLF.LGQH\'LVHDVH'XHWR7\SHRU7\SH'LDEHWHV /HDQQ2ODQVN\0' Melanie Williams 216.444.5410 TECOS: A Randomized, Placebo-Controlled Clinical Trial to Evaluate Cardiovascular Outcomes after Treatment with Sitagliptin in Patients with Type 2 Diabetes Mellitus and Inadequate Glycemic Control on Mono- or Dual-Combination Oral Antihyperglycemic Therapy 5REHUW=LPPHUPDQ0' Melanie Williams 216.444.5410 The Global Hypopituitary Control and Complications Study (HypoCCS) $PLU+DPUDKLDQ0' Melanie Williams 216.444.5410 The Diagnostic Accuracy of the Glucagon Stimulation Test for Evaluation of Adult Growth Hormone 'HÀFLHQF\DQG+\SRWKDODPLF3LWXLWDU\$GUHQDO$[LV $PLU+DPUDKLDQ0' Melanie Williams 216.444.5410 ACROSTUDY - A Multicenter, Post-Marketing Surveillance Study of Somavert Therapy in Patients with Acromegaly in the USA and Europe $PLU+DPUDKLDQ0' Melanie Williams 216.444.5410 Pelvic Floor Disorders in Bariatric Surgery Patients 6WDF\%UHWKDXHU0' Sharon O’Keefe 216.445.8461 A Prospective, Randomized, Controlled Trial Comparing Advanced Practice Medical Management vs. Advanced Practice Medical Management Plus Bariatric Surgery in The Treatment of Type 2 Diabetes Mellitus 3KLOLS6KDXHU0' Chytaine Hall 216.445.3983 Prospective Randomized Comparison of Bilateral vs. Focal Neck Exploration for Sporadic Hyperparathyroidism $OODQ6LSHUVWHLQ0' Linda Heil 216.444.2262 (IIHFWRI3DUDWK\URLGHFWRP\LQ5HGXFLQJ&RURQDU\$UWHU\&DOFLÀFDWLRQDQG,PSURYLQJ9DVFXODU&RPSOLDQFH in Patients with Primary and Secondary Hyperparathyroidism (UHQ%HUEHU0' Linda Heil 216.444.2262 T1D Exchange Type 1 Diabetes Network /DXUHQFH.HQQHG\0' Denise Rose 216.444.8824 Gastric Plication for the Treatment of Obesity and Related Conditions 3KLOLS6FKDXHU0' Sharon O’Keefe, 216.445.8461 Effect of a Portion-Controlled, Commercially Available Diet on Pre-Surgical Weight Loss and Metabolic Outcomes in Patients Undergoing Laparoscopic Bariatric Surgery /HVOLH+HLQEHUJ0' Sharon O’Keefe, 216.445.8461 Is Nipple Stimulation by a Piercing Capable of Increasing Serum Prolactin Concentrations? %HWXO+DWLSRJOX0' Melanie Williams, 216.444.5410 ACCORDION: Action to Control Cardiovascular Risk in Diabetes Trial /HDQQ2ODQVNL0' Melanie Williams, 216.444.5410 Exenatide Study of Cardiovascular Event Lowering (EXSCEL) 5REHUW=LPPHUPDQ0' Melanie Williams, 216.444.5410 800.223.2273, ext. 46568 | 19 | clevelandclinic.org/endonotes Endocrinology & Metabolism Institute Staff Directory ENDOCRINOLOGY & METABLOLISM INSTITUTE LEADERSHIP James Young, MD Institute Chairman Endocrinology & Metabolism Institute 216.444.2333 Allan Siperstein, MD Chairman, Department of Endocrine Surgery Laurence (Ned) Kennedy, MD Chairman, Department of Endocrinology, Diabetes and Metabolism Philip Schauer, MD Chairman, Bariatric and Metabolic Institute 216.445.8645 216.444.4794 216.444.5664 Department of Endocrinology, Diabetes and Metabolism Sanjit Bindra, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Lakewood Hospital Professional Building Office: 216.529.5300 | Fax: 216.529.5301 Appointments: 216.529.5300 Amir Hamrahian, MD Specialty Interest(s): Pituitary and adrenal disorders Location(s): Main campus Office: 216.445.8538 | Fax: 216.445.1656 Appointments: 216.444.6568 Kevin Borst, DO Specialty Interest(s): Endocrine disorders in pregnancy, general endocrinology, diabetes Location(s): Lakewood Hospital Professional Building Office: 216.529.5300 | Fax: 216.529.5301 Appointments: 216.529.5300 Betul Hatipoglu, MD Specialty Interest(s): Diabetes, thyroid disorders, pituitary disorders, adrenal disorders, alternative medicine Location(s): Main campus Office: 216.445.6709 | Fax: 216.445.1656 Appointments: 216.444.6568 Krupa Doshi, MD Specialty Interest(s): General endocrinology, diabetes, parathyroid and calcium disorders, hirsutism, thyroid disorders, adrenal disorders, osteoporosis Location(s): Main campus Office: 216.445.0741 | Fax: 216.445.1656 Appointments: 216.444.6568 Revital Gorodeski Baskin, MD Specialty Interest(s): Endocrinology, thyroid disorders, thyroid cancer Location(s): Independence Family Health Center Office: 216.986.4000 | Fax: 216.986.4995 Appointments: 216.986.4000 Marwan Hamaty, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Strongsville Family Health and Surgery Center Office: 216.445.7568 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Strongsville, 440.878.2500 Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations. Suman Jana, MD Specialty Interest(s): General endocrinology, diabetes, thyroid disease, thyroid cancer Location(s): Main campus; Medina Office: 216.444.0567 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Medina, 330.725.3713 Sangeeta Kashyap, MD Specialty Interest(s): Endocrinology, diabetes, metabolism, insulin resistance and cardiovascular risk prevention, obesity, metabolic syndrome and diseases, hyperlipidemia Location(s): Main campus Office: 216.445.2679 | Fax: 216.445.1656 Appointments: 216.444.6568 Laurence (Ned) Kennedy, MD Department Chair Specialty Interest(s): General endocrinology, diabetes, pituitary disorders, hyperthyroidism, hypothyroidism, thyroiditis Location(s): Main campus; Ashtabula County Medical Center; Cleveland Clinic Florida, Weston Office: 216.445.8645 | Fax: 216.445.1656 Appointments: Main Campus, 216.444.6568; Ashtabula, 440.997.6910; Florida, 954.659.6038 Endocrinology & Metabolism Institute | Staff Directory Contact Us General Patient Referral 24/7 hospital transfers or physician consults – 800.553.5056 Endocrinology & Metabolism Institute Appointments/Referrals 216.444.6568 or 800.223.2273, ext. 46568 Bariatric Surgery Appointments/Referrals 216.445.2224 or 800.223.2273, ext. 52224 On the Web at clevelandclinic.org/endonotes Endocrinology & Metabolic Institute Locations Main Campus 9500 Euclid Ave./F20 Cleveland, Ohio 44195 216.444.6568 Endocrinology & Metabolic Institute Diabetes Center 10685 Carnegie Ave. Cleveland, Ohio 44106 216.444.6568 Ashtabula County Medical Center 2420 Lake Ave. Cleveland, Ohio 44404 440.997.6969 Cleveland Clinic Beachwood Family Health and Surgery Center 26900 Cedar Road Beachwood, Ohio 44122 216.839.3000 Cleveland Clinic Independence Family Health Center 5001 Rockside Road Crown Center II Independence, Ohio 44131 216.986.4000 Cleveland Clinic Lorain Family Health and Surgery Center 5700 Cooper Foster Park Road Lorain, Ohio 44053 440.204.7400 Cleveland Clinic Solon Family Heath Center 29800 Bainbridge Road Solon, Ohio 44139 440.519.6800 Cleveland Clinic Willoughby Hills Family Health Center 2570 SOM Center Road Willoughby Hills, Ohio 44094 440.943.2500 Cleveland Clinic Wooster Family Health Center 1740 Cleveland Road Wooster, Ohio 44691 330.287.4500 Lakewood Hospital Professional Building 14601 Detroit Road Lakewood, Ohio 44107 216.529.5300 Medina Hospital Professional Building 4087 Medina Road, Ste. 400 Medina, Ohio 44256 330.725.3713 Cleveland Clinic Stephanie Tubbs Jones Health Center 13944 Euclid Ave. East Cleveland, Ohio 44112 216.767.4242 Cleveland Clinic Strongsville Family Health and Surgery Center 16761 SouthPark Center Strongsville, Ohio 44136 440.878.2500 Cleveland Clinic Twinsburg Family Health and Surgery Center 8701 Darrow Road Twinsburg, Ohio 44087 330.888.4000 South Pointe Charles Miner Medical Building 20600 Harvard Road Warrensville Heights, Ohio 44122 216.295.1010 Cleveland Clinic Florida 2950 Cleveland Clinic Blvd. Weston, Fla. 33331 877.463.2010 Endocrine Notes Chairman, Endocrinology & Metabolism Institute James B. Young, MD Endocrine Notes updates physicians on clinical practices, advances and research from Cleveland Clinic’s Managing Editor Cora M. Liderbach Endocrinology & Metabolism Institute. It is written for Art Director Mike Viars purposes only. It does not provide a complete overview of Marketing Bill Sattin, PhD Mary Anne Connor physicians and should be relied upon for medical education the topics covered and should not replace the independent judgment of a physician about the appropriateness or risks of a procedure for a given patient. © 2011 The Cleveland Clinic Foundation Leila Khan, MD Specialty Interest(s): General endocrinology, diabetes, calcium/bone disorders Location(s): Main campus; Willoughby Hills Family Health Center Office: 216.445.1598 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500 Leann Olansky, MD Specialty Interest(s): Diabetes and diabetes complications, gestational diabetes, general endocrinology Location(s): Main campus; Stephanie Tubbs Jones Health Center Office: 216.444.2642 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Stephanie Tubbs Jones Health Center, 216.767.4242 M. Cecilia Lansang, MD, MPH Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus Office: 216.445.5246 | Fax: 216.445.1656 Appointments: 216.444.6568 Richard Shewbridge, MD Specialty Interest(s): Endocrinology, diabetes, thyroid disorders, hyperlipidemia, osteoporosis Location(s): Medina Office: 330.725.3713 | Fax: 330.725.2141 Appointments: 330.725.3713 Melissa Li-Ng, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Solon Family Health Center Office: 216.444.1949 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Solon, 440.519.6800 Vinni Makin, MD Specialty Interest(s): General endocrinology, diabetes, hirsutism, acne, thyroid disorders Location(s): Main campus; Solon Family Health Center Office: Main campus, 216.444.0539; Solon, 440.519.6800 | Fax: Main campus, 216.445.1656; Solon, 440.519.6908 Appointments: Main campus, 216.444.6568; Solon, 440.519.6800 Adi Mehta, MD Specialty Interest(s): Diabetes mellitus, thyroid disorders, gynecologic endocrinology, endocrine complications of pregnancy, menopause, lipid disorders, general and adolescent endocrinology Location(s): Main campus; Beachwood Family Health Center (Reproductive Endocrinology only) Office: 216.445.5312 | Fax: 216.445.7261 Appointments: Main campus, 216.444.6568; Beachwood, 216.839.3000 Guy Mulligan, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Twinsburg Family Health and Surgery Center; South Pointe/Charles Miner Medical Building Office: 330.888.4000 | Fax: 330.963.4561 Appointments: Main Campus, 216.444.6568; Twinsburg, 330.888.4000; South Pointe, 216.295.1010 Mario Skugor, MD Co-director, Thyroid Center Associate Director, Endocrinology Fellowship Program Specialty Interest(s): Osteoporosis and calcium metabolism, obesity and diabetes, multiple endocrine neoplasia syndromes, thyroid disorders, thyroid cancer Location(s): Main campus Office: 216.445.0739 | Fax: 216.445.1656 Appointments: 216.444.6568 David Shewmon, MD Specialty Interest(s): General endocrinology, diabetes, high cholesterol, osteomalacia, osteoporosis, pituitary tumors, thyroid conditions, thyroid cancer Location(s): Wooster Family Health Center Office: 330.287.4690 | Fax: 330.287.4876 Appointments: 330.287.4690 Mariam Stevens, MD Specialty Interest(s): Diabetes, gestational diabetes, goiter, Graves’ disease, Hashimoto’s disease, hirsutism, hyperthyroidism, hypoglycemia, hypothyroidism, polycystic ovary syndrome, thyroid disease, thyroid nodule Location(s): Independence Family Health Center Office: 216.986.4000 | Fax: 216.986.4995 Appointments: 216.986.4000 Robert Zimmerman, MD Director, Cleveland Clinic Diabetes Center Vice Chairman, Department of Endocrinology, Diabetes and Metabolism Program Director, Endocrinology Training Program Specialty Interest(s): Diabetes, thyroid disorders, growth hormone in adults Location(s): Main campus Office: 216.444.9428 | Fax: 216.445.1656 Appointments: 216.444.6568 Department of Endocrine Surgery Bariatric and Metabolic Institute Eren Berber, MD Director, Robotic Endocrine Surgery Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), laparoscopic solid-organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumors, pancreatic neuroendocrine tumors, robotic thyroid and parathyroid surgery, laparoscopic and robotic adrenalectomy and liver surgery Location(s): Main campus Office: 216.445.0555 | Fax: 216.636.0662 Appointments: 216.444.6568 Kresimira (Mira) Milas, MD Director, Thyroid Center Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), thyroid cancer, multiple endocrine neoplasia syndromes, hereditary thyroid disorders Location(s): Main campus Office: 216.444.4985 | Fax: 216.636.0662 Appointments: 216.444.6568 Jamie Mitchell, MD Specialty Interest(s): Endocrine surgery (thyroid, parathyroid and adrenal), laparoscopic solid organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumors Location(s): Main campus; Independence Family Health Center; Solon Family Health Center Office: 216.445.9713 | Fax: 216.636.0662 Appointments: Main campus, 216.444.6568; Independence, 216.986.4000; Solon, 440.519.6800 Joyce J. Shin, MD Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, neuroendocrine tumors, thyroid/parathyroid ultrasound, intra-abdominal ultrasound, laparoscopic radiofrequency thermal ablation of liver tumors Location(s): Main campus; Willoughby Hills Family Health Center Office: 216.636.9365 | Fax: 216.636.0662 Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500 Allan Siperstein, MD Department Chair Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, laparoscopic thermal ablation of liver tumors, pancreatic endocrine tumors Location(s): Main campus Office: 216.444.5664 | Fax: 216.636.0662 Appointments: 216.444.6568 Christian Nasr, MD Co-director, Thyroid Center Specialty Interest(s): Thyroid nodules, thyroid cancers, flushing syndromes Main campus; Lorain Family Health and Surgery Center (Thyroid cancer only) Office: 216.445.1788 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Lorain, 440.204.7400 Stacy Brethauer, MD Specialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, hernia repair, endoscopy, surgery for GERD, hiatal hernia, solid-organ endoluminal surgery, single-incision laparoscopic surgery Location(s): Main campus Office: 216.444.9244 | Fax: 216.445.1586 Appointments: 216.445.2224 Derrick Cetin, DO Specialty Interest(s): Bariatric medicine, medical weight management, nutrition sciences, obesity management, preoperative evaluation, diabetes care Location(s): Main Campus Office: 216.445.4255 | Fax: 216.636.1588 Appointments: 216.445.2224 Bipan Chand, MD Specialty Interest(s): Advanced laparoscopy and endoscopy, endoscopy in the obese patient, gastric surgery focusing on reflux disease, hiatal hernia, bariatric operations and gastric cancer, biliary and spleen surgery, natural orifice transluminal endoscopic surgery (NOTES), endoluminal surgery Location(s): Main campus Office: 216.444.6668 | Fax: 216.445.1586 Appointments: 216.445.2224 Karen Cooper, DO Specialty Interest(s): Bariatric medicine, family medicine, kinesiology and nutrition sciences, exercise instruction Location(s): Main campus Office: 216.445.1114 | Fax: 216.445.1586 Appointments: 216.445.2224 Matthew Kroh, MD Specialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgery Location(s): Main campus Office: 216.445.9966 | Fax: 216.444.2153 Appointments: 216.445.2224 Tomasz Rogula, MD, PhD Specialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgery Location(s): Main campus; Strongsville Family Health and Surgery Center Office: 216.445.0255 | Fax: 216.445.1586 Appointments: Main campus: 216.445.2224; Strongsville: 440.878.2500 Philip Schauer, MD Department Chair Specialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, colon surgery, weight management, hernia surgery, biliary surgery, surgery for GERD Location(s): Main campus Office: 216.444.4794 | Fax: 216.445.1586 Appointments: 216.445.2224 Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations. Endocrinology & Metabolism Institute | Staff Directory Contact Us General Patient Referral 24/7 hospital transfers or physician consults – 800.553.5056 Endocrinology & Metabolism Institute Appointments/Referrals 216.444.6568 or 800.223.2273, ext. 46568 Bariatric Surgery Appointments/Referrals 216.445.2224 or 800.223.2273, ext. 52224 On the Web at clevelandclinic.org/endonotes Endocrinology & Metabolic Institute Locations Main Campus 9500 Euclid Ave./F20 Cleveland, Ohio 44195 216.444.6568 Endocrinology & Metabolic Institute Diabetes Center 10685 Carnegie Ave. Cleveland, Ohio 44106 216.444.6568 Ashtabula County Medical Center 2420 Lake Ave. Cleveland, Ohio 44404 440.997.6969 Cleveland Clinic Beachwood Family Health and Surgery Center 26900 Cedar Road Beachwood, Ohio 44122 216.839.3000 Cleveland Clinic Independence Family Health Center 5001 Rockside Road Crown Center II Independence, Ohio 44131 216.986.4000 Cleveland Clinic Lorain Family Health and Surgery Center 5700 Cooper Foster Park Road Lorain, Ohio 44053 440.204.7400 Cleveland Clinic Solon Family Heath Center 29800 Bainbridge Road Solon, Ohio 44139 440.519.6800 Cleveland Clinic Willoughby Hills Family Health Center 2570 SOM Center Road Willoughby Hills, Ohio 44094 440.943.2500 Cleveland Clinic Wooster Family Health Center 1740 Cleveland Road Wooster, Ohio 44691 330.287.4500 Lakewood Hospital Professional Building 14601 Detroit Road Lakewood, Ohio 44107 216.529.5300 Medina Hospital Professional Building 4087 Medina Road, Ste. 400 Medina, Ohio 44256 330.725.3713 Cleveland Clinic Stephanie Tubbs Jones Health Center 13944 Euclid Ave. East Cleveland, Ohio 44112 216.767.4242 Cleveland Clinic Strongsville Family Health and Surgery Center 16761 SouthPark Center Strongsville, Ohio 44136 440.878.2500 Cleveland Clinic Twinsburg Family Health and Surgery Center 8701 Darrow Road Twinsburg, Ohio 44087 330.888.4000 South Pointe Charles Miner Medical Building 20600 Harvard Road Warrensville Heights, Ohio 44122 216.295.1010 Cleveland Clinic Florida 2950 Cleveland Clinic Blvd. Weston, Fla. 33331 877.463.2010 Endocrine Notes Chairman, Endocrinology & Metabolism Institute James B. Young, MD Endocrine Notes updates physicians on clinical practices, advances and research from Cleveland Clinic’s Managing Editor Cora M. Liderbach Endocrinology & Metabolism Institute. It is written for Art Director Mike Viars purposes only. It does not provide a complete overview of Marketing Bill Sattin, PhD Mary Anne Connor physicians and should be relied upon for medical education the topics covered and should not replace the independent judgment of a physician about the appropriateness or risks of a procedure for a given patient. © 2011 The Cleveland Clinic Foundation Leila Khan, MD Specialty Interest(s): General endocrinology, diabetes, calcium/bone disorders Location(s): Main campus; Willoughby Hills Family Health Center Office: 216.445.1598 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500 Leann Olansky, MD Specialty Interest(s): Diabetes and diabetes complications, gestational diabetes, general endocrinology Location(s): Main campus; Stephanie Tubbs Jones Health Center Office: 216.444.2642 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Stephanie Tubbs Jones Health Center, 216.767.4242 M. Cecilia Lansang, MD, MPH Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus Office: 216.445.5246 | Fax: 216.445.1656 Appointments: 216.444.6568 Richard Shewbridge, MD Specialty Interest(s): Endocrinology, diabetes, thyroid disorders, hyperlipidemia, osteoporosis Location(s): Medina Office: 330.725.3713 | Fax: 330.725.2141 Appointments: 330.725.3713 Melissa Li-Ng, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Solon Family Health Center Office: 216.444.1949 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Solon, 440.519.6800 Vinni Makin, MD Specialty Interest(s): General endocrinology, diabetes, hirsutism, acne, thyroid disorders Location(s): Main campus; Solon Family Health Center Office: Main campus, 216.444.0539; Solon, 440.519.6800 | Fax: Main campus, 216.445.1656; Solon, 440.519.6908 Appointments: Main campus, 216.444.6568; Solon, 440.519.6800 Adi Mehta, MD Specialty Interest(s): Diabetes mellitus, thyroid disorders, gynecologic endocrinology, endocrine complications of pregnancy, menopause, lipid disorders, general and adolescent endocrinology Location(s): Main campus; Beachwood Family Health Center (Reproductive Endocrinology only) Office: 216.445.5312 | Fax: 216.445.7261 Appointments: Main campus, 216.444.6568; Beachwood, 216.839.3000 Guy Mulligan, MD Specialty Interest(s): General endocrinology, diabetes Location(s): Main campus; Twinsburg Family Health and Surgery Center; South Pointe/Charles Miner Medical Building Office: 330.888.4000 | Fax: 330.963.4561 Appointments: Main Campus, 216.444.6568; Twinsburg, 330.888.4000; South Pointe, 216.295.1010 Mario Skugor, MD Co-director, Thyroid Center Associate Director, Endocrinology Fellowship Program Specialty Interest(s): Osteoporosis and calcium metabolism, obesity and diabetes, multiple endocrine neoplasia syndromes, thyroid disorders, thyroid cancer Location(s): Main campus Office: 216.445.0739 | Fax: 216.445.1656 Appointments: 216.444.6568 David Shewmon, MD Specialty Interest(s): General endocrinology, diabetes, high cholesterol, osteomalacia, osteoporosis, pituitary tumors, thyroid conditions, thyroid cancer Location(s): Wooster Family Health Center Office: 330.287.4690 | Fax: 330.287.4876 Appointments: 330.287.4690 Mariam Stevens, MD Specialty Interest(s): Diabetes, gestational diabetes, goiter, Graves’ disease, Hashimoto’s disease, hirsutism, hyperthyroidism, hypoglycemia, hypothyroidism, polycystic ovary syndrome, thyroid disease, thyroid nodule Location(s): Independence Family Health Center Office: 216.986.4000 | Fax: 216.986.4995 Appointments: 216.986.4000 Robert Zimmerman, MD Director, Cleveland Clinic Diabetes Center Vice Chairman, Department of Endocrinology, Diabetes and Metabolism Program Director, Endocrinology Training Program Specialty Interest(s): Diabetes, thyroid disorders, growth hormone in adults Location(s): Main campus Office: 216.444.9428 | Fax: 216.445.1656 Appointments: 216.444.6568 Department of Endocrine Surgery Bariatric and Metabolic Institute Eren Berber, MD Director, Robotic Endocrine Surgery Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), laparoscopic solid-organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumors, pancreatic neuroendocrine tumors, robotic thyroid and parathyroid surgery, laparoscopic and robotic adrenalectomy and liver surgery Location(s): Main campus Office: 216.445.0555 | Fax: 216.636.0662 Appointments: 216.444.6568 Kresimira (Mira) Milas, MD Director, Thyroid Center Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), thyroid cancer, multiple endocrine neoplasia syndromes, hereditary thyroid disorders Location(s): Main campus Office: 216.444.4985 | Fax: 216.636.0662 Appointments: 216.444.6568 Jamie Mitchell, MD Specialty Interest(s): Endocrine surgery (thyroid, parathyroid and adrenal), laparoscopic solid organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumors Location(s): Main campus; Independence Family Health Center; Solon Family Health Center Office: 216.445.9713 | Fax: 216.636.0662 Appointments: Main campus, 216.444.6568; Independence, 216.986.4000; Solon, 440.519.6800 Joyce J. Shin, MD Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, neuroendocrine tumors, thyroid/parathyroid ultrasound, intra-abdominal ultrasound, laparoscopic radiofrequency thermal ablation of liver tumors Location(s): Main campus; Willoughby Hills Family Health Center Office: 216.636.9365 | Fax: 216.636.0662 Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500 Allan Siperstein, MD Department Chair Specialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, laparoscopic thermal ablation of liver tumors, pancreatic endocrine tumors Location(s): Main campus Office: 216.444.5664 | Fax: 216.636.0662 Appointments: 216.444.6568 Christian Nasr, MD Co-director, Thyroid Center Specialty Interest(s): Thyroid nodules, thyroid cancers, flushing syndromes Main campus; Lorain Family Health and Surgery Center (Thyroid cancer only) Office: 216.445.1788 | Fax: 216.445.1656 Appointments: Main campus, 216.444.6568; Lorain, 440.204.7400 Stacy Brethauer, MD Specialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, hernia repair, endoscopy, surgery for GERD, hiatal hernia, solid-organ endoluminal surgery, single-incision laparoscopic surgery Location(s): Main campus Office: 216.444.9244 | Fax: 216.445.1586 Appointments: 216.445.2224 Derrick Cetin, DO Specialty Interest(s): Bariatric medicine, medical weight management, nutrition sciences, obesity management, preoperative evaluation, diabetes care Location(s): Main Campus Office: 216.445.4255 | Fax: 216.636.1588 Appointments: 216.445.2224 Bipan Chand, MD Specialty Interest(s): Advanced laparoscopy and endoscopy, endoscopy in the obese patient, gastric surgery focusing on reflux disease, hiatal hernia, bariatric operations and gastric cancer, biliary and spleen surgery, natural orifice transluminal endoscopic surgery (NOTES), endoluminal surgery Location(s): Main campus Office: 216.444.6668 | Fax: 216.445.1586 Appointments: 216.445.2224 Karen Cooper, DO Specialty Interest(s): Bariatric medicine, family medicine, kinesiology and nutrition sciences, exercise instruction Location(s): Main campus Office: 216.445.1114 | Fax: 216.445.1586 Appointments: 216.445.2224 Matthew Kroh, MD Specialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgery Location(s): Main campus Office: 216.445.9966 | Fax: 216.444.2153 Appointments: 216.445.2224 Tomasz Rogula, MD, PhD Specialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgery Location(s): Main campus; Strongsville Family Health and Surgery Center Office: 216.445.0255 | Fax: 216.445.1586 Appointments: Main campus: 216.445.2224; Strongsville: 440.878.2500 Philip Schauer, MD Department Chair Specialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, colon surgery, weight management, hernia surgery, biliary surgery, surgery for GERD Location(s): Main campus Office: 216.444.4794 | Fax: 216.445.1586 Appointments: 216.445.2224 Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations. C l e v e l a n d C l inic R E SOUR C E G u i d e Physician Directory Referring Physician Center CME Opportunities: Live & Online View all Cleveland Clinic staff For help with service-related issues, online at clevelandclinic.org/staff. information about our clinical special- Outcomes Data ists and services, details about CME Cleveland Clinic’s Center for Continuing Education’s website offers convenient, complimentary learning opportunities, from patient simulations, webcasts and podcasts to a host of medical publications and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org. View the latest clinical Outcomes books from Cleveland Clinic’s Endocrinology & Metabolism Institute at opportunities and more, email [email protected], or call 216.448.0900 or 888.637.0568. clevelandclinic.org/quality/outcomes. EMI Referrals Endocrinology & Metabolism Institute 216.444.6568 or 800.223.2273, ext. 46568 Bariatric Surgery 216.445.2224 or 800.223.2273, ext. 52224 F o r Y o u r P a tient s DrConnect is a secure online service providing our physician colleagues with real-time information about the treatment their patients receive at Cleveland Clinic. To receive your next patient report electronically, establish a DrConnect account at clevelandclinic.org/drconnect. Complimentary assistance for out-of-state patients and families: 800.223.2273, ext. 55580, or email [email protected]. Complimentary assistance for national and international patients and families: 001.216.444.8184 or visit MyChart ® Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that connects patients to portions of their medical record at any time of day or night. Patients may view test results, renew prescriptions, review past appointments and request new ones. A new feature, Schedule My 216.445.2547 or 800.223.2273, ext. 52547 open schedule and make appointments online in real time. Appointment, allows patients to view their primary physician’s Patients may register for MyChart® through their physician’s office or by going online to ccf.org/mychart. Cleveland Clinic’s critical care transport teams and fleet of mobile ICU vehicles, helicopters and fixed-wing aircraft serve critically ill and highly complex patients across the globe. Transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.379.CODE (2633). For all other critical care transfers, call 216.448.7000 or 866.547.1467 or visit clevelandclinic.org/criticalcaretransport. Cleveland Clinic’s Diabetes & Endocrinology Program is ranked 5th in the nation in U.S.News & World Report’s annual America’s Best Hospitals survey. Updates for physicians on practices, advances and research from Cleveland Clinic’s Endocrinology & Metabolism Institute clevelandclinic.org /ic. Request Medical Records Critical Care Transport Worldwide Endocrine Notes Medical Concierge Global Patient Services Track Your Patient’s Care Online The Cleveland Clinic Foundation Endocrinology & Metabolism Institute Endocrine Notes 9500 Euclid Avenue / AC311 Cleveland, OH 44195 11-END-008 In This Issue: 2New Entity: Primary Hyperparathyroidism with Normal PTH 4A Rare Case of Acromegaly Diagnosed During Pregnancy 6Robotic Approach Preferred for Adrenalectomy 8 STAMPEDE Substudy Asks Whether Gastric Bypass Reverses Beta Cell Dysfunction 9STAMPEDE II Study Now Enrolling Patients 10Bariatric Surgery Now Standard Treatment for Morbidly Obese Diabetic Patients 11Gastric Plication Holds Promise for Extreme Weight Loss 12Adult Growth Hormone Deficiency: Study Compares Glucagon Stimulation Test to Insulin Tolerance Test 14Publications 18 Live and Online CME 19Current Clinical Trials 20Staff Directory 2011 C l e v e l a n d C l inic R E SOUR C E G u i d e Physician Directory Referring Physician Center CME Opportunities: Live & Online View all Cleveland Clinic staff For help with service-related issues, online at clevelandclinic.org/staff. information about our clinical special- Outcomes Data ists and services, details about CME Cleveland Clinic’s Center for Continuing Education’s website offers convenient, complimentary learning opportunities, from patient simulations, webcasts and podcasts to a host of medical publications and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org. View the latest clinical Outcomes books from Cleveland Clinic’s Endocrinology & Metabolism Institute at opportunities and more, email [email protected], or call 216.448.0900 or 888.637.0568. clevelandclinic.org/quality/outcomes. EMI Referrals Endocrinology & Metabolism Institute 216.444.6568 or 800.223.2273, ext. 46568 Bariatric Surgery 216.445.2224 or 800.223.2273, ext. 52224 F o r Y o u r P a tient s DrConnect is a secure online service providing our physician colleagues with real-time information about the treatment their patients receive at Cleveland Clinic. To receive your next patient report electronically, establish a DrConnect account at clevelandclinic.org/drconnect. Complimentary assistance for out-of-state patients and families: 800.223.2273, ext. 55580, or email [email protected]. Complimentary assistance for national and international patients and families: 001.216.444.8184 or visit MyChart ® Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that connects patients to portions of their medical record at any time of day or night. Patients may view test results, renew prescriptions, review past appointments and request new ones. A new feature, Schedule My 216.445.2547 or 800.223.2273, ext. 52547 open schedule and make appointments online in real time. Appointment, allows patients to view their primary physician’s Patients may register for MyChart® through their physician’s office or by going online to ccf.org/mychart. Cleveland Clinic’s critical care transport teams and fleet of mobile ICU vehicles, helicopters and fixed-wing aircraft serve critically ill and highly complex patients across the globe. Transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.379.CODE (2633). For all other critical care transfers, call 216.448.7000 or 866.547.1467 or visit clevelandclinic.org/criticalcaretransport. Cleveland Clinic’s Diabetes & Endocrinology Program is ranked 5th in the nation in U.S.News & World Report’s annual America’s Best Hospitals survey. Updates for physicians on practices, advances and research from Cleveland Clinic’s Endocrinology & Metabolism Institute clevelandclinic.org /ic. Request Medical Records Critical Care Transport Worldwide Endocrine Notes Medical Concierge Global Patient Services Track Your Patient’s Care Online The Cleveland Clinic Foundation Endocrinology & Metabolism Institute Endocrine Notes 9500 Euclid Avenue / AC311 Cleveland, OH 44195 11-END-008 In This Issue: 2New Entity: Primary Hyperparathyroidism with Normal PTH 4A Rare Case of Acromegaly Diagnosed During Pregnancy 6Robotic Approach Preferred for Adrenalectomy 8 STAMPEDE Substudy Asks Whether Gastric Bypass Reverses Beta Cell Dysfunction 9STAMPEDE II Study Now Enrolling Patients 10 Bariatric Surgery Now Standard Treatment for Morbidly Obese Diabetic Patients 11 Gastric Plication Holds Promise for Extreme Weight Loss 12 Adult Growth Hormone Deficiency: Study Compares Glucagon Stimulation Test to Insulin Tolerance Test 14 Publications 18 Live and Online CME 19 Current Clinical Trials 20 Staff Directory 2011
