Showing papers by "Michael T. McDermott published in 2016"

Novel Management of Insulin Autoimmune Syndrome with Rituximab and Continuous Glucose Monitoring.

Abstract: Context: Insulin autoimmune syndrome (IAS), or Hirata's disease, is a rare hypoglycemic disorder characterized by spontaneous hypoglycemia without evidence of exogenous insulin administration, a high serum concentration of total immunoreactive insulin, and the presence of insulin autoantibodies in high titer. The majority of cases occur in the Asian population, and treatment is generally successful with watchful waiting or steroids. Case Description: We report the case of a 71-year-old Caucasian man with severe hypoglycemia due to IAS that was refractory to a prolonged course of high-dose steroids. Type 1 diabetes prevention trials using rituximab have shown selective suppression of insulin autoantibodies, which are the pathogenic antibodies in IAS, and therefore we provided this therapy. Treatment with two doses of rituximab and daily use of a continuous glucose monitor resulted in disease remission. Conclusion: We present the first case where potentially life-threatening hypoglycemia due to IAS was succ...

Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement.

Abstract: Context: Custom-compounded bioidentical hormone therapy (HT) has become widely used in current endocrine practice, which has led to unnecessary risks with treatment. Objective: This scientific statement reviews the pharmacology and physiology of popular compounded hormones and the misconceptions associated with these therapies. The hormones reviewed include: estradiol and estrogens, progesterone and progestins, testosterone, dehydroepiandrosterone, levothyroxine, and triiodothyronine. Results: Overall, there is a general lack of standardization and quality control regarding how custom-compounded bioidentical hormones are produced and administered, leading to the possibility of overdosing, underdosing, or contamination. There is also recent evidence of patient harm and death associated with treatment, as seen with fungus-contaminated glucocorticoid preparations. With estrogen, progestin, and dehydroepiandrosterone treatments, the practice of baseline hormone measurements to replace “abnormal” hormone defic...

Cardiovascular Outcomes of New Medications for Type 2 Diabetes.

Abstract: Cardiovascular (CV) disease remains the leading cause of death in people with diabetes, highlighting the importance of using treatment options that do not increase CV risk or possibly decrease CV outcomes. Since 2008, the Food and Drug Administration has required demonstration of CV safety for all new medications developed for the glycemic management of diabetes. Seven trials have been published that have established CV safety for three DPP-4 inhibitors (alogliptin, saxagliptin, and sitagliptin), three GLP-1 receptor agonists (liraglutide, lixisenatide, and semaglutide), and one sodium–glucose cotransporter-2 inhibitor (empagliflozin). Three of those studies also established superiority with liraglutide, empagliflozin, and semaglutide at reducing the composite primary endpoint of major CV events (CV death, nonfatal myocardial infarction, and nonfatal stroke). In addition, one trial found an increase in heart failure hospitalizations with saxagliptin. The findings of these trials must be compared ...

Molecular Pathogenesis of Thyroid Cancer and Oncogenes in Thyroid Cancer

Abstract: At the time of conception, the human organism is a single cell zygote. During the course of development into an adult, this cell expands into a complex mass of approximately 100 trillion cells, with an enormous variety of shapes, sizes, and functions. Normal tissue growth and development require prolific cell division, exquisitely regulated cell differentiation, and appropriately timed cell death or apoptosis. Neoplastic transformation of tissue generally occurs when abnormal regulatory mechanisms promote excessive cell division, impaired cell differentiation, and/or failure of apoptosis. In most tumor types, this aberrant control originates at the genetic level. Intensive study of these regulatory mechanisms has led to significant progress in our ability to diagnose, predict biological behavior, and understand the basic molecular pathophysiology of thyroid neoplasms. The upcoming sections explore the major advances in the study of thyroid oncogenes and tumor suppressor genes and address the clinical utility of these discoveries.

Poor prognostic indicators for patients treated with radiosurgery for brain metastases.

Abstract: 32 Background: Radiosurgery (SRS) is a standard palliative treatment for patients with limited number of brain metastases. Growing evidence supports the use of SRS for more extensive disease. As SRS is increasingly used in advanced cancer, we sought to identify predictors of survival after SRS to help better inform patients about prognosis. Methods: We reviewed patients treated with SRS for brain metastases at the University of California, San Francisco (UCSF) from Jan 2010-Dec 2013. Before SRS, all patients were screened for appropriateness of SRS at a multidisciplinary conference. Post-SRS overall survival (OS) was estimated by Kaplan-Meier method and compared by log-rank tests. Frequencies of death within 30 days of SRS were compared by chi-squared tests. Results: Demographic and imaging data was available for 326 SRS patients. At SRS consult, 90% patients were Karnofsky Performance Status (KPS) ≥ 70. Median number of brain metastases at consult was 2 (range 1-37). Median follow up was 13 months. Media...