Endocrinology, Diabetes, and Metabolism Commons^™

A Rare Sight: Isolated Third Nerve Palsy As The Sole Presentation Of A Non-Functional Pituitary Adenoma, Jorge A. Aboytes, Jose J. Loayza, Ivan Mogollon, Ismael Cantu

Research Colloquium

Introduction: Hypopituitarism results from insufficient pituitary hormone production, often due to adenomas—accounting for ~15% of intracranial tumors. Non-functional adenomas, typically affecting older adults, may present with visual field deficits, headaches, or cranial nerve palsies when extending into the cavernous sinus. Isolated oculomotor (third nerve) palsy is a rare initial manifestation.

Case: A 46-year-old man with uncontrolled type 2 diabetes presented with acute right-sided headache, diplopia, ptosis, and right leg weakness. He had right ptosis, a fixed dilated pupil, facial droop, and right leg weakness. Given concern for stroke, he received thrombolytic therapy with partial leg improvement, but persistent diplopia and …

Diabetes-Related Foot Complications And Socioeconomic Influences Among Hispanic Males In South Texas: A Scoping Review, Mariana J. Rodriguez, Demian Rodriguez, Amanda L. Killeen

School of Podiatric Medicine - Student Research

Introduction: Diabetes mellitus is the 7^th leading cause of death in the United States and is 6^th in the state of Texas. Counties from South Texas are primarily affected with higher rates of diabetes than both the state and national average. Diabetes mellitus is a complex and progressive disease which can affect multiple systems of the body, leading to serious complications if untreated, especially in the lower extremities. Uncontrolled diabetes is often associated with diabetic foot ulcers (DFU), foot infections, and lower extremity amputations (LEA). South Texas is a region predominantly populated by Hispanic Americans who are disproportionally …

Geriatric Brittle Type 1 Diabetes Mellitus: Case Study And Management Strategies, Saba Irfan, Amanda Cantu

Research Colloquium

“Brittle diabetes” describes a form of diabetes marked by severe, unpredictable fluctuations in blood glucose, often leading to frequent episodes of hypoglycemia and hyperglycemia. Though not formally recognized by major diabetes organizations, the term is clinically useful, especially for vulnerable populations such as older adults with Type 1 Diabetes Mellitus (T1DM). Age-related factors—cognitive impairment, mobility limitations, dexterity issues, sensory decline, inconsistent eating habits, and frailty—make glycemic control particularly challenging and require a personalized, multidisciplinary management approach.

We report the case of a 66-year-old Hispanic female with long-standing T1DM, seizure disorder, and osteoporosis. Despite adherence to a prescribed insulin regimen, her …

The Sodium Chronicles: Unraveling The Enigma Of Hypothyroidism-Induced Hyponatremia, Raquel Z. Lara, Tejaswini Swamy, Jennifer Rojas Huen, Ricardo Serna

Research Colloquium

Background: Hyponatremia is an electrolyte disturbance with various etiologies, but hypothyroidism is rarely the primary cause. Literature suggests that hypothyroidism-related hyponatremia occurs primarily in severe cases, with some studies suggesting that hypothyroidism should not be considered a sole contributor if TSH levels are below 50 mIU/L. Patients with hyponatremia have a high risk of prolonged hospital stays and readmission, underscoring the clinical importance of identifying uncommon causes such as severe hypothyroidism. This case highlights this rare association, contributing to the existing limited literature.

Case Presentation: A 74-year-old woman with Type 2 Diabetes, complicated nephrotic syndrome and nephropathy, congestive heart failure, …

Comparison Of Cytology And Histology Diagnosis Methods In Metastatic Anaplastic Thyroid Cancer, Phyllis Yang, John Nicholas Cauba, Shizue Mito

Research Colloquium

Background: Anaplastic thyroid cancer (ATC) is a rare and extremely aggressive form of thyroid cancer that presents as a rapidly enlarging neck mass with compressive symptoms. Its malignancy and mortality rates approach nearly 90% and is a feared transformation of papillary thyroid cancer (PTC). A contributor to its increased mortality is its predilection for metastasis, which by nature, is less documented in medical literature. The study of ATC’s diagnostic algorithm, which classically utilizes cytological and histological confirmation, is crucial in enhancing early recognition and atypical presentations.

Methods: This systematic review catalogs the diagnosis, clinical properties, and metastasis sites of anaplastic …

Il-17a Immune Signature Across Stratified Stages Of Type 2 Diabetes​, Brittney C. White, Antonio Hernandes Chaves-Neto, Peter Elvin, Javier La Fontaine, Eric L. Brown, Walid Fakhouri, Craig Hanis, Claudia Biguetti

School of Podiatric Medicine - Student Research

Purpose: This study investigated whether IL-17A, a pro-inflammatory cytokine associated with Th17 cell activity, reflects distinct stages of type 2 diabetes progression.

Methods: Forty-two obese individuals (average age: 60.4 ± 10.3 years; 55% male; BMI: 31.3 ± 4.9) from Starr County, Texas, were matched for gender and BMI and stratified into five metabolic groups based on fasting blood glucose, 2-hour oral glucose tolerance test, and HbA1c levels. Groups included diabetes-free, isolated impaired glucose tolerance, combined glucose impairment, diabetes without complications, and diabetes with lower extremity complications. IL-17A protein levels were quantified from buffy coat samples using ELISA. After excluding …

Specialty Grand Challenge: Existing Issues And Emerging Frontiers In Renal Endocrinology, A. T. M. Emdadul Haque, Mohammed S. Razzaque

School of Medicine Publications

We are currently in an exciting time to advance the field of renal endocrinology. There has never been a more favorable time to study the molecular and cellular mechanisms underlying renal hormone functions in physiology, pharmacology, and pathophysiology. The availability of advanced research tools provides unique opportunities to dissect the complex regulatory roles of renal hormones. The kidneys are vital organs in the human body; each one is composed of approximately one million functional nephrons. Understanding the precise roles and regulation of kidney-derived hormones and hormones that exert endocrine effects on the kidneys will help in preventing or delaying various …

Manganese-Induced Precocious Puberty Alters Mammary Epithelial Cell Proliferation In Female Rats, Alina M. Hamilton, Vinod K. Srivastava, Jill K. Hiney, William L. Dees, Robert K. Dearth

School of Integrative Biological & Chemical Sciences Faculty Publications

Precocious puberty (PP) is an established breast cancer risk factor. In the normal mammary gland, hormone receptor-positive (HR+) cells rarely proliferate. In breast cancer, proliferating epithelial cells are often HR+. It is not known if PP can modify this population of proliferating HR+ cells. Previously, we established a manganese-induced precocious puberty (MnPP) model to study the effects of PP on mammary gland development in female rats. Here, we characterized the distribution of HR+ proliferating mammary epithelial cells in prepubertal and adult rodents, in association with precocious puberty. Female rats were exposed daily to 10 mg/kg manganese chloride or saline (control) …

Successful Limb Salvage In A Severe Diabetic Foot Infection: A Case Study Of Aggressive Surgical Intervention And Grafting Technique, Stephanie N. Campbell, Amanda Killeen, Michael Sobolevsky

Research Symposium

Background: Severe necrotizing diabetic foot infections are known to have high morbidity, high amputation risk, and high complication rates. Efforts at preserving the limb require significant surgical efforts and lengthy wound care. This process is more complicated in patients with significant housing instability.

Case Presentation: A 53-year-old male with uncontrolled diabetes (A1c 7.9%), housing insecurity, food insecurity presented with severe necrotizing diabetic foot infection with ascending cellulitis, infectious hemorrhagic bullae, multi-compartment abscesses of the foot and anterior leg. It is known that patients with diabetes are at increased risk of both amputation and surgical interventions than patients without diabetes. This …

An Endocrine Enigma: The Implications Of Pembrolizumab Therapy, Miguel A. Lopez, Mario Trujillo Acosta, Jose Romero Villarreal Calderon, Laura Garcia

Research Symposium

Disorders of the endocrine system are a potential complication of cancer treatment despite newer immunotherapy agents holding promise to improve patient outcomes. Breast cancer in particular requires pharmacologic intervention based on the receptor positivity. For example, a triple negative workup often requires neoadjuvant therapy with the newer immunotherapy agent pembrolizumab. Clinicians should be aware of the potential adverse effects of this drug, most notably adrenal insufficiency. This case follows a 52 year old hispanic female patient with a history of triple negative left sided breast cancer on immunotherapy with pembrolizumab, who presented to the emergency department after a syncopal episode …

Prevalence Of Liver Cirrhosis And Its Association With Obesity Among Mexican Americans: An Evidence Synthesis, Alexa Perlick, Abaigeal Thompson, Colton Wayne, Angel Rendon, Jose E. Campo Maldonado

Research Colloquium

Introduction: Chronic liver disease is the 6^th and 7^th leading cause of death in Hispanic men and Hispanics, respectively.¹ In contrast to other causes of liver disease, the prevalence of nonalcoholic liver disease has been growing as is diabetes and obesity.²

Objective: There is a paucity of data regarding the prevalence of cirrhosis for Mexican Americans in South Texas. The aim of this evidence synthesis is to investigate the prevalence of cirrhosis in Hispanic populations and its relationship with obesity.

Methods: PubMed was used to perform a thorough literature search on September10, 2020. The terms “liver …

Severe Hyponatremia Associated With Partial Empty Sella Syndrome, Lily Chen, Shyama Appareddy, Laura Garcia

Research Colloquium

Hyponatremia, serum sodium concentration < 135 mmol/L, is further classified by patient volume status. Symptoms are dependent on the acuity of sodium loss. Acute onset hyponatremia can present with confusion, disorientation, headache, agitation, vomiting, and lethargy. Patients with hyponatremia warrant a thorough workup and can be a leading manifestation of hypopituitarism in the geriatric population. A 77 year old patient, history of pituitary adenoma, presented with generalized symptoms of fatigue, gait instability, poor appetite and confusion associated with severe hyponatremia and hypoglycemia. The patient has a history of pituitary adenoma treated with cabergoline, hypothyroidism treated with levothyroxine and gonadal insufficiency treated with testosterone, with no reported history of diuretic use. On admission, the patient had a sodium level of 116 mmol/L. While the patient reported improvement in symptoms, patient’s confusion was noted to persist despite appropriate correction of sodium and glucose. Patient had an AM cortisol of 4 mcg/dL. Cosyntropin test was conducted and noted to be negative. MRI Brain with Gadolinium revealed empty sella turcica with a small amount of enhancing pituitary tissue, which may indicate a response to previous cabergoline therapy. Despite negative cosyntropin results, the patient was suspected to have relative adrenal insufficiency due to multiple acute stressors including illness, hospitalization, disruption of routine and abrupt smoking cessation. Patient was given a trial of hydrocortisone with improvements noted in his mental status, strength and appetite. Thus, careful consideration should be given towards adrenal insufficiency secondary to hypopituitarism as an etiology for severe hyponatremia.

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …

Vitamin D Deficiency Among Children And Adolescents Living In Sunny South Texas, Yoscelina E. Martinez-Lopez, Margarita Faz, Beatriz Tapia, Juan C. Lopez-Alvarenga, Francisco J. Cervantes

Research Symposium

Background: Exposure to sunlight is essential to produce Vitamin D (ViD). Recent studies suggest obesity is associated with low ViD concentration. Living in South Texas with 220 sunny days a year should be enough to maintain adequate ViD levels. We aimed to analyze ViD levels and obesity in children and adolescents.

Methods: We included 1239 pediatric (1.5 to 18.8 years old) participants (primary care clinic from Laredo) with registered CDC percentiles of BMI (pBMI) and serum concentrations of ViD (Atellica™). Data are described as median (p25, p75), Loess correlation between pBMI and ViD, ANCOVA to adjust by age, sex, and …

A Case Of Osteogenesis Imperfecta In A Patient Diagnosed In Adulthood, Khalid Sheikh, M. Lastovica, N. S. Appareddy, R. Wagner, E. Luna

Research Symposium

Background: Osteogenesis imperfecta (OI) is an extremely rare inherited connective tissue disorder, with an incidence of 1 in 20,000 births in the United States. Our aim is to assist other providers in diagnosing and managing patients with OI and concurrent medical morbidities.

Case Presentation: A 21 year old male with a BMI of 34 and a lifetime history of over 10 fractures presented to the Emergency department after a complex seizure at home. The seizure was witnessed by his mother and lasted less than one minute. He had another seizure two weeks prior to presentation. In the ED, the patient …

Circulating Microrna Responses To Acute Whole-Body Vibration And Resistance Exercise In Postmenopausal Women, Samuel R. Buchanan, Ryan M. Miller, Michelle Nguyen, Christopher D. Black, J. Mikhail Kellawan, Michael G. Bemben, Debra A. Bemben

Health & Human Performance Faculty Publications

Evaluating alterations in circulating microRNA (c-miRNA) expression may provide deeper insight into the role of exercise in the attenuation of the negative effects of aging on musculoskeletal health. Currently, there are sparse data on c-miRNA responses to acute exercise in postmenopausal women. The purpose of this study was to characterize the effects of acute bouts of resistance exercise and whole-body vibration on expression of selected c-miRNAs in postmenopausal women aged 65-76 years (n=10). We also examined relationships between c-miRNAs and muscle strength and bone characteristics. This randomized crossover design study compared c-miRNA responses to a bout of resistance exercise (RE) …

Burden Of Type 2 Diabetes And Associated Cardiometabolic Traits And Their Heritability Estimates In Endogamous Ethnic Groups Of India: Findings From The Indigenius Consortium, Vettriselvi Venkatesan, Rector Arya, Juan Carlos Lopez Alvarenga, Krishna K. Sharma, Roy G. Resendez, Juliet A. Ezeilo, Marcio Almeida, Srinivas Mummidi, John Blangero, Ravindranath Duggirala

School of Medicine Publications

To assess the burden of type 2 diabetes (T2D) and its genetic profile in endogamous populations of India given the paucity of data, we aimed to determine the prevalence of T2D and estimate its heritability using family-based cohorts from three distinct Endogamous Ethnic Groups (EEGs) representing Northern (Rajasthan [Agarwals: AG]) and Southern (Tamil Nadu [Chettiars: CH] and Andhra Pradesh [Reddys: RE]) states of India. For comparison, family-based data collected previously from another North Indian Punjabi Sikh (SI) EEG was used. In addition, we examined various T2D-related cardiometabolic traits and determined their heritabilities. These studies were conducted as part of the …

Expression Of Integrin And Tgfbi In Human Retinal Pericytes, Andrew T C Tsin, Brenda Su, Laura Valdez, Edgar Serrato

School of Medicine Publications

Purpose: The aim for this study is to investigate the expression of integrin α3, β1 and TGF-β induced protein (TGFBI) and the secretion of TGFBI by primary culture of human retinal pericytes (pHRP). Evidence suggests that chronic diabetes associate with HRP apoptosis leading to the development of diabetic retinopathy.

Methods: pHRP (Cell Systems) were cultured in complete media (15mM glucose) in a humidified, 5% CO2, 37°C condition. Cells were seeded at passage 6 to 8 into a 24 well-plate with coverslips or P10 dishes. Cells (85% confluence) media were then replaced by DMEM media with euglycemic glucose (5.5mM) or hyperglycemic …

Pumping Iron - How Do Race And Gender Affect The Risk Of Anemia In A Cohort Of Predominantly Hispanic Heart Failure (Hf) Patients Seen In A Community Hospital In The Rio Grande Valley (Rgv)?, Michael Lapelusa, Andrea M. Cordero-Reyes, Francisco Avellan, Daniella Concha, Laura Garcia, James Hanley

School of Medicine Publications

Introduction Anemia in patients with heart failure (HF) is common. Data reported shows a variable prevalence ranging from 10-40%. Additionally, it has also been demonstrated that it is associated with poor outcomes. Multiple risk factors have been shown to contribute to the presence of anemia in HF patients (1). We were interested in determining the risk factors for anemia in HF patients in our population in the lower Rio Grande Valley.

Methods We performed a retrospective chart review of patients admitted with a diagnosis of HF (Heart Failure with Preserved Ejection Fraction HFpEF, Heart Failure with Reduced Ejection Fraction HFrEF …

Principal Component Regression Analysis Of Nutrition Factors And Physical Activities With Diabetes, Ke-Sheng Wang, Ying Lu, Xin Xie, Shaoqing Gong, Chun Xu, Zhanxin Sha

Health & Biomedical Sciences Faculty Publications

The associations of nutrition factors and physical activities with adult diabetes are inconsistent; while most of these factors are inter correlated. The aims of this study are to overcome the disturbance of the multicollinearity of the risk factors and examine the associations of these factors with diabetes using the principal component analysis (PCA) and regression analysis with principal component scores (PCS). Totally, 659 adults with diabetes and 2827 non-diabetic were selected from the 2012 Health Information National Trends Survey (HINTS 4, Cycle 2). PCA was utilized to deal with multicollinearity of the risk factors. Weighted univariate and multiple logistic regression …

Effects Of Conjugated Linoleic Acid And Metformin On Insulin Sensitivity In Obese Children: Randomized Clinical Trial, Nayely Garibay-Nieto, Gloria Queipo-García, Flor Alvarez, Mayra Bustos, Erendira Villanueva, Fernando Ramírez, Mireya León, Estibalitz Laresgoiti-Servitje, Juan Carlos Lopez Alvarenga, Ravi Duggirala

School of Medicine Publications

Context: Insulin resistance precedes metabolic syndrome abnormalities and may promote cardiovascular disease and type 2 diabetes in children with obesity. Results of lifestyle modification programs have been discouraging, and the use of adjuvant strategies has been necessary.

Objective: This study aimed to evaluate the effects of metformin and conjugated linoleic acid (CLA) on insulin sensitivity, measured via euglycemic-hyperinsulinemic clamp technique and insulin pathway expression molecules in muscle biopsies of children with obesity.

Design: A randomized, double-blinded, placebo-controlled clinical trial was conducted.

Setting: Children with obesity were randomly assigned to receive metformin, CLA, or placebo.

Results: Intervention had a …

Genetic Variants In Kcnj11, Tcf7l2 And Hnf4a Are Associated With Type 2 Diabetes, Bmi And Dyslipidemia In Families Of Northeastern Mexico: A Pilot Study, Hugo Leonid Gallardo-Blanco, Jesus Zacarias Villarreal-Perez, Ricardo Martin Cerda-Flores, Andres Figueroa

Computer Science Faculty Publications

The aim of the present study was to investigate whether genetic markers considered risk factors for metabolic syndromes, including dyslipidemia, obesity and type 2 diabetes mellitus (T2DM), can be applied to a Northeastern Mexican population. A total of 37 families were analyzed for 63 single nucleotide polymorphisms (SNPs), and the age, body mass index (BMI), glucose tolerance values and blood lipid levels, including those of cholesterol, low‑density lipoprotein (LDL), very LDL (VLDL), high‑density lipoprotein (HDL) and triglycerides were evaluated. Three genetic markers previously associated with metabolic syndromes were identified in the sample population, including KCNJ11, TCF7L2 and HNF4A. The KCNJ11 …

La Diabetes Y La Alimentación Determinantes En La Progresión De Aterosclerosis, Adriana Leticia Perales-Torres, Octelina Castillo-Ruíz, María Teresa Castañeda Licón, Sanjuana E. Alemán-Castillo, Juan Miguel Jiménez Andrade

Health & Biomedical Sciences Faculty Publications

El propósito de esta revisión es analizar la progresión bioquímica de la placa aterosclerótica y la relación que presenta con la diabetes y la alimentación. Se exponen las evidencias científicas de pacientes con diabetes, que a diferencia de pacientes no diabéticos presentan niveles más elevados de algunos ácidos grasos en la placa de ateroma (como el palmítico, linoleico y oleico), elevada incidencia de trombosis coronaria relacionada con el incremento en el tama˜no de la base necrótica y la disminución del tama˜no de la capa fibrosa de los ateromas. Entre ambos grupos de pacientes se expone la diferencia en el perfil …

Developmental Origins Of Cardiovascular Disease, Edwina H. Yeung, Candace Robledo, Nansi S. Boghossian, Cuilin Zhang, Pauline Mendola

School of Medicine Publications

Although cardiovascular disease has traditionally been viewed as a condition of aging individuals, increasing focus has turned to its developmental origins. Since birthweight has been related to cardiovascular disease risk, research into factors such as gravid conditions that affect fetal growth have grown. Associations between maternal diabetes and childhood obesity from sibling studies suggest a causal role but prospective studies of gestational diabetes remain mixed. Preeclampsia and increased offspring blood pressure has been consistently observed but evidence for other cardiovascular outcomes is lacking. While maternal obesity is associated with childhood obesity, causality remains unclear and paternal obesity should be investigated …

Is Bisphenol-A Exposure During Pregnancy Associated With Blood Glucose Levels Or Diagnosis Of Gestational Diabetes?, Candace A. Robledo, Jennifer D. Peck, Julie A. Stoner, Hélène Carabin, Linda Cowan, Holger M. Koch, Jean R. Goodman

School of Medicine Publications

Recent epidemiological studies indicate bisphenol A (BPA), an estrogenic chemical used in production of epoxy, polycarbonate, and plastic may increase risk of insulin resistance and type 2 diabetes. Exposure to BPA during pregnancy may contribute to development of gestational diabetes mellitus (GDM), a precursor to type 2 diabetes in women. This pilot study examined the association between BPA exposure, fasting blood glucose levels (FBG), and GDM diagnosis during pregnancy. Banked urine samples from 22 cases of GDM and 72 controls were analyzed for total (free BPA + conjugates) urinary BPA concentrations (μg/L). FBG levels (mg/dl) were obtained from 1-h 50-g …