Endocrine System Diseases Commons^™

Surviving Ph 7.0: Rapid Interprofessional Collaboration In Severe Metformin-Associated Lactic Acidosis With Refractory Shock, Karl J. Schlicht Md, Amaani Faizal, Vincent Macolino, Julian Coz

Rowan-Virtua Research Day

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication with mortality rates of 30-50%. Although metformin is the most widely prescribed antidiabetic medication, severe MALA requiring emergent hemodialysis remains uncommon, with an estimated incidence of 2-9 cases per 100,000 patient-years. Risk factors include acute kidney injury, dehydration, and tissue hypoxia. Early hemodialysis initiation is independently associated with improved survival. This case highlights how rapid interprofessional collaboration from the emergency department to the intensive care unit enabled in a patient presenting with profound acidemia and survival multiorgan dysfunction

Sodium-Glucose Cotransporter-2 Inhibitor Use In Patients With Cirrhosis And Type 2 Diabetes: Impact On Hepatic Decompensation And Hospitalization, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: SGLT2 inhibitors improve cardiovascular and renal outcomes in type 2 diabetes mellitus (T2DM), but their safety in cirrhosis remains uncertain given risks of volume depletion, infection, and decompensation. We evaluated the association between SGLT2 inhibitor use and hepatic decompensation and healthcare utilization in cirrhotic patients with T2DM.

Methods: A retrospective cohort study was performed using the TriNetX multicenter electronic health record network. Adults with cirrhosis and T2DM between 2018–2024 were classified as SGLT2 inhibitor-treated versus untreated. Propensity score matching (1:1) yielded 23,234 patients per group. Primary outcomes included new ascites, hepatic encephalopathy (HE), ED visits/inpatient admissions, and all-cause mortality. …

Title: Impact Of Hypertriglyceridemia ≥500 Mg/Dl On Acute Pancreatitis Outcomes: A Propensity Score–Matched Cohort Study, Jashanveer S. Johal, Bianca Patel, Mahmoud Al-Bataineh, Archana Salek, Om Patel, Jason Hyman, Yecheskel Schneider, Abdallah Hussein

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Background: Hypertriglyceridemia is a recognized cause of acute pancreatitis, but the prognostic impact of markedly elevated triglycerides (TG) on clinical outcomes remains unclear. We evaluated whether TG ≥500 mg/dL at presentation predicts worse pancreatitis outcomes.

Methods: Using the TriNetX multicenter electronic health record network, adults hospitalized with acute pancreatitis and a TG measurement within 48 hours of admission between 2018–2024 were identified. Patients with TG ≥500 mg/dL were compared with those with TG < 500 mg/dL after 1:1 propensity score matching on demographics and comorbidities (n=7,014 per group). Primary outcomes included ICU stay, pancreatic complications, need for procedure, and all-cause mortality. Secondary outcomes included acute renal failure, cardiovascular events, repeat pancreatitis, infection, and liver failure. Odds ratios (OR) with 95% confidence intervals were estimated.

Results: Compared with TG < 500 mg/dL, patients with TG ≥500 mg/dL had higher risks of ICU admission (25.3% vs. 17.2%; OR 1.63), pancreatic complications (5.3% vs. 4.5%; OR 1.19), and mortality (4.6% vs. 3.3%; OR 1.39). Need for procedural intervention was lower in the high-TG group (1.2% vs. 3.6%; OR 0.34). Secondary outcomes including acute renal failure (15.5% vs. 10.7%; OR 1.54), repeat pancreatitis (58.6% vs. 51.9%; OR 1.31), and infection (13.7% vs. 12.0%; OR 1.17) were all significantly elevated. Cardiovascular events and liver failure did not differ significantly.

Conclusions: TG ≥500 mg/dL in acute pancreatitis was associated with greater ICU utilization, complications, and mortality, but lower procedural intervention rates. Admission triglyceride …

Beyond Glycemic Control: A Comparative Analysis Of Dapagliflozin Vs Empagliflozin, Wesley Augustus Kim, Heaven Chu, Kayla Ancheta, Nicole Shellenbarger, Sophia Ginet, Akash Patel

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SGLT2 inhibitors have emerged as a drug class with cardiorenal benefits beyond glycemic control in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). This review compares two widely used SGLT2 inhibitors dapagliflozin and empagliflozin across efficacy, safety, and cost-effectiveness outcomes in patients with comorbid CKD and T2DM. A systematic literature search of PubMed, Scopus, and Embase yielded 10 final articles after screening. Both agents demonstrated comparable cardiorenal benefits, with dapagliflozin showing advantages in weight, blood pressure, and glycemic markers, while empagliflozin proved more cost-effective for CKD-specific disease management. Neither drug demonstrated significant safety concerns over placebo …

Myxedema Coma: Recognizing A Silent But Potentially Fatal Emergency, Aashna Chaudhry, Robin Lahr, James Espinosa, James Espinosa, Alan Lucerna

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Myxedema coma is an endocrinologic emergency that requires prompt recognition and treatment. It is described as severe hypothyroidism characterized by life-threatening slowing of metabolic processes, often occurring in the setting of precipitating factors such as trauma, infection, medications, or cold exposure. This case report presents a clinical case in which early suspicion of myxedema coma in an elderly female patient led to prompt treatment and life-saving measures.

Impact Of Chronic Kidney Disease On Outcomes Following Endoscopic Retrograde Cholangiopancreatography (Ercp): A Propensity-Matched Cohort Study Using The Trinetx Database, Jashanveer S. Johal, Mahmoud Al-Bataineh, Archana Salek, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

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Background: Chronic kidney disease (CKD) is known to influence clinical outcomes across a range of procedures, but its impact on endoscopic retrograde cholangiopancreatography (ERCP) outcomes remains poorly characterized. We evaluated the association between CKD and post-ERCP survival and procedural complications.

Methods: A retrospective cohort study was conducted using the TriNetX database. Adults with CKD stages 1–5 undergoing ERCP between 2010–2024 were identified and compared to patients without CKD undergoing the same procedure. Propensity score matching (1:1) was performed to balance known demographic and clinical confounders. Primary outcomes included 30-day all-cause mortality, procedural complications, all-cause infections, and gastrointestinal bleeding. Adjusted hazard …

Igg4-Related Autoimmune Pancreatitis In Patients With Prior Occupational Exposure: A Case Report And Review Of Risks Concerning Blue-Collared Workers, Zachary A. Coren, Justin Le, Jason Tran, Nicholas Moscardelli, Krish Patel, Joshua Coren

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Autoimmune pancreatitis (AIP), a manifestation of IgG4-related disease (IgG4-RD), is a rare, often misdiagnosed condition that can closely mimic pancreatic cancer, particularly in its clinical and radiographic presentation. We report the case of a 76-year-old retired plumber who presented with painless jaundice and was initially suspected to have pancreatic cancer based on imaging findings. Subsequent endoscopic evaluation, biopsy, and markedly elevated serum IgG4 levels led to a diagnosis of type 1 AIP. Treatment with corticosteroids resulted in rapid clinical improvement and reduction in IgG4 levels, confirming the diagnosis.

This case highlights the diagnostic challenges of AIP, especially among blue-collar workers …

Case Report: Non-Ketotic Hyperglycemia Hemichorea-Hemiballismus In The Emergency Department, Veroneka Mikhail, James Espinosa, Alan Lucerna

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Non-ketotic hyperglycemia hemichorea-hemiballismus (NH-HC), also known as diabetic striatopathy, is a rare condition characterized by glucose levels greater than 200 mg/dL and continuous, involuntary, and irregular large amplitude jerky movements localized predominantly to one side of the body called hemichorea-hemiballismus. While the differential diagnosis of irregular movements is vast, including seizures disorder, stroke, tumors, Tourette’s syndrome and rheumatic fever, clinicians should also consider diabetic striatopathy as a differential as it has very good prognosis and is easily treatable if diagnosed early. Here we discuss the case of a 72 year-old male with history of non-insulin dependent type 2 diabetes (T2DM), …

Case Report And Brief Review: Hypoglycemic Hemiplegia As A Stroke Mimic, Joel Collins Ii, James A. Espinosa, James Lee, Alan Lucerna

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Here we present the case of a 47-year-old male with a history of diabetes mellitus (DM), who was brought to the emergency department with right sided hemiparesis and slurred speech. His blood sugar was 37 mg/dL. An intravenous line was established quickly, and the patient was administered intravenous dextrose. Within five minutes, his symptoms had significantly improved and by 10 minutes had resolved completely. A CT head and CT angiogram of the head and neck were within normal limits. Basic laboratory tests were within normal limits. The initial neurology service consult noted that his diagnosis was hypoglycemic hemiplegia. The patient …

Effectiveness Of Exercise After Meals In Reducing Blood Sugar In People Who Are Overweight, Obese, Or Have Type 2 Diabetes: A Systematic Review And Meta-Analysis, Brian Fardman, Jie Kang, Nicholas Ratamess, Avery Faigenbaum, Jill Bush

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Studies investigating the acute effect of postprandial exercise (PPE) on glucose responses exhibit significant heterogeneity in terms of participant demographic, exercise protocol, and exercise timing post-meal. As such, this study aimed to further analyze the existing literature on the impact of PPE on glycemic control in overweight individuals and individuals with obesity and type 2 diabetes (T2DM). A literature search was conducted through databases such as PubMed, CINAHL, and Google Scholar. Thirty-one original research studies that met the inclusion criteria were selected. A random-effect meta-analysis was performed to compare postprandial glucose area under the curve (AUC) and 24 h mean …

Effect Of Time-Restricted Feeding On Anthropometric, Metabolic, And Fitness Parameters: A Systematic Review, Brian Fardman, Jie Kang, Nicholas Ratamess, Avery Faigenbaum, Jill Bush, Noah Beller, Ariselle Vargas, Tyler Andriopoulos

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Time restricted feeding (TRF) as a form of intermittent fasting (IF) has gained popularity because its ability to reduce body mass (BM) without an emphasis on caloric restriction. However, how this dietary protocol may affect health, fitness, and performance in a relatively healthy cohort remains less clear. The purpose of this article was to systematically review the current literature concerning the effect of TRF on anthropometric, metabolic, and fitness parameters in normal-weight adults and overweight and obese individuals. A systematic search of English literature was conducted through databases including PubMed, CINAHL, and Google Scholar. The search was facilitated by using …

A Systematic Review On Cinacalcet’S Effect In Reducing Pth Serum Levels In Peritoneal Dialysis Patients, Akhil Gumidyala, Youssef Daoud, Mark Hanna, Han Jie Liu, Rikita Doshi

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Background: Patients with Chronic Kidney Disease (CKD) have low calcium levels. Low blood calcium triggers the parathyroid gland to constantly secrete parathyroid hormone (PTH) in an attempt to raise blood calcium levels back to normal. One way PTH tries to do this is by removing calcium from bone. Chronically high PTH levels leads to increased bone resorption and increases the risk for bone fractures and mortality risk. This phenomenon is called secondary hyperparathyroidism (SHPT). Calcimimetics, like cinacalcet (sensipar), act similarly to calcium by binding allosterically to Calcium-Sensing Receptors (CaSR) on the parathyroid gland, thereby reducing PTH levels. The effect of …

Analysis Of Blood Pressure, Blood Glucose, And Cholesterol Screening Results Collected During Street Outreach Events In Atlantic County, New Jersey, As Part Of A Mobile Community Health Worker Program To Identify Residents At High Risk For Severe Covid-19, Kenneth W. Stagliano, Richard T. Jermyn, Alexander E. Abbott, Donato F. Tassoni, Amy Palen, Frank Carozza, Nicole M. Miller

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Background: This study seeks to evaluate the status of random blood pressure, cholesterol, and blood glucose screening results in Atlantic County, NJ. This study also aims to identify the rates of hyperlipidemia, hyperglycemia, and hypertension within the target population, and potential differences between surveyed age demographics.

Methods: Medical students participating in the COVID-19 CHW Service Corps collected blood pressure, cholesterol, and blood glucose screenings at multiple screening events in Atlantic County, NJ during a two-year period. This data was analyzed retrospectively using ANOVA, non-parametric Kruskal Walis Test, and Tukey's pairwise comparisons.

Results: Senior adults had significantly higher SBP than …

A Case Report Of Primary Central Nervous System Lymphoma Presenting With Diabetes Insipidus, Lan Ngo, Adam Kandil

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Diabetes insipidus (DI) is characterized by decreased secretion or action of antidiuretic hormone (ADH), resulting in polyuria, polydipsia, and potential electrolyte disturbances. Severe hypernatremia secondary to uncontrolled DI can manifest with neurologic symptoms including seizure-like activity. This case report discusses a case of central DI arising from damage to the pituitary gland as the first presentation of a brain tumor, in the context of a 56-year-old patient who presented with seizure-like activity and sensory changes.

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

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According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

Diabetes Health Education For South Jersey Communities, Heaven Chu, Sarah Tamous, Ashhabal Kavvi, Amin Khan

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Diabetes is a chronic health condition that hinders the body’s metabolic process using insulin to maintain glycemic homeostasis. It is prevalent worldwide, with about 10% of the global adult population affected. Socio-economic and cultural factors and determinants make diabetes and diabetes management more of a health risk for certain populations rather than others. The prevalence of diabetes in the United States is higher than the global average and the risk factors disproportionately affect disadvantaged communities.

This study was designed to investigate health disparities in diabetes among a diverse population sample. The study included researching the disparities of diabetes patients in …

Exploring Geriatric Self Management Of Type 2 Dm: A Systematic Review, Ahmed Gawash, David F. Lo, Kunal P. Shah, Jasmine Emanuel, Brandon Goodwin, Don D. Shamilov, Gaurav Kumar, Nathan Jean, Christian P. White

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This review explores diabetic self-management in geriatric individuals, focusing on positive attitudes and support from family/friends as crucial for self-care optimization. A comprehensive search in health databases was conducted, which involved screening 248 participants across eight qualitative research studies. Themes emphasizing the importance of listening to one’s body, acknowledging hidden issues, and recognizing the impact of various factors on diabetes self-care were established. A holistic approach to self management, emphasizing the significance of positive attitudes, cultural sensitivity, and individual values in healthcare practices is recommended. Embracing cultural diversity and addressing barriers can enhance self-management and quality of life for geriatric …

Evaluation Of Outcome Following Oocyte Retrieval In Women With Marked Diminished Oocyte Reserve (Dor) Where The Only Oocyte Retrieved Was In A Metaphase I State, Brooke Neumann, Jerome Check, Carrie Wilson, Donna Summers, Kathleen Hollahan

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OBJECTIVE: To determine if there is value in culturing a metaphase I oocyte to metaphase II followed by intracytoplasmic sperm injection (ICSI), fertilization, then embryo transfer (ET) in women with marked DOR. MATERIALS AND METHODS: A follicle stimulating hormone (FSH) receptor up-regulation technique was used in women whose day 3 serum FSH levels were >12 mIU/mL and/or the serum anti-mullerian (AMH) level was <1ng/mL to mature antral follicle(s) to the dominant follicle stage (average diameter >18) and serum estradiol (E2) >200pg/mL when 10,000 IU human chorionic gonadotropin (hCG) would be given followed by oocyte retrieval 32 hours later. The basic tenet of this follicle maturation technique is to 1) use very little …

Immigration Status And Household Income As Predictors Of Childhood Obesity, Bhaumik Patel, Jeffery Powers

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Childhood obesity rates have been on a remarkably steep rise in recent years. According to recent literature, the rate in the United States alone has more than doubled compared to other regions in the world such as Australia, Canada and Europe1,2 . Especially in the African immigrant community, there has been speculation of a higher prevalence of childhood obesity in the United States3 . This warranted further investigation into demographic factors impacting childhood obesity rates and their subsequent consequences with other clinical diseases such as diabetes and heart disease. The CDC reports that in 2011-2014, among individuals ages 2 to …

Clinical Practice Workflow Implementation For The Improvement Of Diabetic Metric Compliance, Sugosh Anur, Sohil Khanna, Alison Mancuso, Alexander Kowalski

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Recent guidance suggests the management of screen-detected diabetes can be optimized using multifactorial interventions to improve overall disease burden, patient outcomes, and cost-savings. We explored preventive diabetic care and implemented interventions to increase recommended testing compliance among patients with Type II Diabetes Mellitus. This study employed a multi-faceted approach beginning with the distribution of surveys to patients in the Stratford Family Medicine Office in order to gauge their health literacy level pertaining to Diabetes management. Patient electronic medical records were evaluated to determine baseline levels for all laboratory values. Data analysis was completed using Statistical Package for the Social Sciences …

Improving Diabetic Retinopathy Screening Practices With Qi Methodology In Family Medicine Offices, Rea Isaac, Anne Jones

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Early detection and treatment of diabetic retinopathy (DR) is crucial in preventing vision loss and blindness in vulnerable diabetics. With around 7.7 million patients having DR, and the target population being 20 -75 years old, the potential for improving their quality of life is substantial (WHO, 2022). Despite the importance of timely and routine eye exams, 45% of diabetic patients do not complete an exam despite physicians recommendations (Lu, 2014). This project aims to standardize eye exams, improve process flow, and improve patient understanding of the urgency of timely and comprehensive eye exams for DR. Multiple PDSA cycles and QI …

The Effects Of Obesity And Diabetes On The Pediatric Population, Keyur Patel, Vrushank Shah, Zachary Harris, Kanad Mukherjee

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The World Health Organization has declared diabetes (DM) and Obesity to be epidemics due to their rising prevalence. Obesity plays a role in the aetiopathogenesis of type 2 diabetes, the most common type of diabetes in the world, as well as the development of its complications. Obesity and overweight play a growing role in type 1 diabetes. Weight gain is often thought of as a side effect of insulin therapy, but it also has a significant pathophysiological impact at different stages of the disease. (1) In the United States and other nations across the world, childhood obesity has become a …

Pregnancy Outcome With In Vitro Fertilization-Embryo Transfer According To Age In Women With Diminished Oocyte Reserve (Dor) Using A Follicle Stimulating Hormone Receptor Up-Regulation Technique, Brooke Neumann, Jerome Check, Carrie Wilson, Michael Sobel, Jung Choe

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Objective: About 18 years ago, one of the top IVF centers published a study and found that women with DOR did not have any live deliveries at any age in women with a day 3 serum FSH exceeding 18 mIU/mL. The failure to achieve a live delivery may have been related to the ovarian hyperstimulation regimen with possible down regulation of the FSH receptor needed to produce a key enzyme needed for successful implantation. The purpose of this 25-year retrospective review was to evaluate the efficacy of a specific type of mild stimulation referred to as the FSH receptor up-take …

Outcomes In Type Ii Diabetes Patients Through The Covid 19 Pandemic A Retrospective Chart Review, Zurwa Nishat, Tara Pellegrino, Robert Steer

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Context: The COVID-19 pandemic provided a unique opportunity for urgent expansion of telemedicine services as providers continued to supply longitudinal care to patients. Patients with type II diabetes were vulnerable to serious infection with COVID-19 as well as disruption in management of their chronic disease.

Objective: To delineate the outcomes in type II diabetes patients through the COVID-19 pandemic by a retrospective chart review in which disease management was evaluated through HbA1c levels and BMI.

Methods: This retrospective chart review included adult T2DM patients receiving care from five university family medicine offices in NJ. HbA1c levels and BMI values were …

A Case Of Diabulimia In A 23-Year-Old Woman With Extensive Comorbidities, Stephen Poos, Kaitlin Mcgowan, Ashaki Martin

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Diabulimia is defined as intentionally withholding insulin injections for the purpose of weight loss in the setting of type 1 diabetes mellitus (T1D).

It is characterized as an eating disorder (ED), although it does not yet have DSM diagnosis status.

Recognition of the condition among medical professionals is limited but growing.

Case Report: Octreotide Associated Hyperkalemia, Darren Finn, Eric Maddock, James Espinosa, Andrew Caravello, Alan Lucerna, Henry Schuitema

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78-year-old female with past medical history of acromegaly status post pituitary adenoma status post resection presents to the emergency department with abdominal pain. ED workup was not significant for any acute intra-abdominal abnormalities; however, incidental finding of hyperkalemia was pertinent to the visit. Patient was treated in the ED for her condition but her potassium levels remained elevated despite repeated saline infusions. Patient was ultimately admitted to the hospital where it was discovered that she had recently been switched from octreotide injections to an oral somatostatin analogue Mycapssa. We believe that this patient’s hyperkalemia was caused by octreotide-induced insulin suppression …

Case Report: Thyrotoxic Hypokalemic Periodic Paralysis, Kelly Schuitema, Wayne Tamaska, Robin Lahr

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Thyrotoxic crisis, or thyroid storm, is an acute, life threatening event caused by hyperthyroidism with mortality up to 8-25% that can present with multi-system organ involvement. It is a rare, but well studied complication in the emergency department but can lead to further, less common complications. In this study we will discuss a case of thyrotoxic hypokalemic periodic paralysis. Thyrotoxic hypokalemic periodic paralysis (TPP) most commonly affects Asian men. The key features of the syndrome include acute onset of hypokalemia and paralysis. The hypokalemic aspect of the disorder is secondary to the shift intracellularly by thyroid hormones’ sensitization of Na+/K+-ATPase …

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan B. Patel

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Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Triad Of Acute Pancreatitis Coexisting With Diabetic Ketoacidosis And Very Severe Hypertriglyceridemia Successfully Resolved With Insulin Therapy Alone, Akash Patel, Monica Patel, Yvette Wang

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Diabetic ketoacidosis (DKA) is known to cause mild elevations in triglyceride levels.

Severe hypertriglyceridemia (HTG) is a well-known cause of acute pancreatitis; however, in unique cases, DKA has been shown to cause severe HTG leading to the development of acute pancreatitis (AP).

HTG causing AP only accounts for 1-4% of cases of AP

From the few cases in literature that have reported this triad of DKA, HTG, and AP, even fewer have shown to be successfully treated with insulin therapy alone with the severe degree of HTG that we discuss.

In our case, we have treated a triad of DKA, …

Lipid Profile And Admission/Discharge Locations As Predictors Of 60 Day Readmission In Adults 65 Or Older With Type 2 Diabetes Mellitus, Zac Dalton, Terrie Ginsberg, Matthew Mclaughlin

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Introduction: Reducing 30 and 60 day hospital readmissions is critical to our healthcare systems. Older folks with type 2 diabetes mellitus (T2DM) account for a disproportionate amount of readmissions. Through recognizing factors that correlate to readmissions, patients at risk may be identified.

Objective: To conduct a retrospective review of electronic medical records (EMR) to determine if there is an association between the lipid profile and admission and discharge locations of hospitalized older adults and whether they were rehospitalized 60-days post discharge.

Methods: EMRs were reviewed of 86 randomly selected consenting participants who were admitted to a community hospital and were …