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2011
Updates for physicians on practices, advances and research from Cleveland Clinic’s Endocrinology & Metabolism Institute
Endocrine Notes
The Cleveland Clinic Foundation Endocrinology & Metabolism Institute Endocrine Notes 9500 Euclid Avenue / AC311 Cleveland, OH 44195
In This Issue:
F o r Yo u r PaT I E N T s
Medical Concierge Complimentary assistance for out-of-state patients
and families: 800.223.2273, ext. 55580, or email
medicalconcierge@ccf.org.
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patients and families: 001.216.444.8184 or visit
clevelandclinic.org /ic.
MyChart®Cleveland Clinic MyChart® is a secure, online personal health-
care 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 appoint-
ments and request new ones. A new feature, Schedule My
Appointment, allows patients to view their primary physician’s
open schedule and make appointments online in real time.
Patients may register for MyChart® through their physician’s
office or by going online to ccf.org/mychart.
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mobile ICU vehicles, helicopters and fixed-wing aircraft serve
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port 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.
Physician Directory
View all Cleveland Clinic staff
online at clevelandclinic.org/staff.
Outcomes Data View the latest clinical Outcomes
books from Cleveland Clinic’s Endo-
crinology & Metabolism Institute at
clevelandclinic.org/quality/outcomes.
Referring Physician Center
For help with service-related issues,
information about our clinical special-
ists and services, details about CME
opportunities and more, email
refdr@ccf.org, or call 216.448.0900
or 888.637.0568.
CME Opportunities: Live & Online
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 publica-tions and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org.
C l E v E l a N d C l I N I C r E s o u r C E G u I d E
Track Your Patient’s Care onlineDrConnect is a secure online service providing our phy-
sician 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.
request Medical records216.445.2547 or 800.223.2273, ext. 52547
EMI referralsEndocrinology & Metabolism Institute 216.444.6568 or 800.223.2273, ext. 46568
Bariatric Surgery 216.445.2224 or 800.223.2273, ext. 52224
2 New Entity: Primary Hyperparathyroidism with Normal PTH
4 a rare Case of acromegaly diagnosed during Pregnancy
6 robotic approach Preferred for adrenalectomy
8 sTaMPEdE substudy asks Whether Gastric Bypass reverses Beta Cell dysfunction
9 sTaMPEdE 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
11-ENd-008
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.
77763_CCFBCH_Cover_ACG.indd 1 11/15/11 7:36 AM
hio
Endocrine Notes
Chairman, Endocrinology & Metabolism Institute
James B. Young, MD
Managing Editor
Cora M. Liderbach
Art Director
Mike Viars
Marketing
Bill Sattin, PhD
Mary Anne Connor
Endocrine Notes updates physicians on clinical prac-
tices, advances and research from Cleveland Clinic’s
Endocrinology & Metabolism Institute. It is written for
physicians and should be relied upon for medical education
purposes only. It does not provide a complete overview of
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
Contact usGeneral 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 locationsMain 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 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
Cleveland Clinic Willoughby
Hills Family Health Center
2570 SOM Center Road
Willoughby Hills, Ohio 44094
440.943.2500
Cleveland Clinic Wooster
Family Health Center
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Wooster, Ohio 44691
330.287.4500
Lakewood Hospital
Professional Building
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Lakewood, Ohio 44107
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Professional Building
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Medina, Ohio 44256
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Medical Building
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Warrensville Heights, Ohio 44122
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Cleveland Clinic Florida
2950 Cleveland Clinic Blvd.
Weston, Fla. 33331
877.463.2010
Leila Khan, MDSpecialty Interest(s): General endocrinology, diabetes, calcium/bone disordersLocation(s): Main campus; Willoughby Hills Family Health CenterOffice: 216.445.1598 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500
M. Cecilia Lansang, MD, MPHSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campusOffice: 216.445.5246 | Fax: 216.445.1656Appointments: 216.444.6568
Melissa Li-Ng, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Solon Family Health CenterOffice: 216.444.1949 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Solon, 440.519.6800
Vinni Makin, MDSpecialty Interest(s): General endocrinology, diabetes, hirsutism, acne, thyroid disordersLocation(s): Main campus; Solon Family Health CenterOffice: Main campus, 216.444.0539; Solon, 440.519.6800 | Fax: Main campus, 216.445.1656; Solon, 440.519.6908Appointments: Main campus, 216.444.6568; Solon, 440.519.6800
Adi Mehta, MDSpecialty Interest(s): Diabetes mellitus, thyroid disorders, gynecologic endocrinology, endocrine complications of pregnancy, menopause, lipid disorders, general and adolescent endocrinologyLocation(s): Main campus; Beachwood Family Health Center (Reproductive Endocrinology only)Office: 216.445.5312 | Fax: 216.445.7261Appointments: Main campus, 216.444.6568; Beachwood, 216.839.3000
Guy Mulligan, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Twinsburg Family Health and Surgery Center; South Pointe/Charles Miner Medical BuildingOffice: 330.888.4000 | Fax: 330.963.4561Appointments: Main Campus, 216.444.6568; Twinsburg, 330.888.4000; South Pointe, 216.295.1010
Christian Nasr, MDCo-director, Thyroid CenterSpecialty Interest(s): Thyroid nodules, thyroid cancers, flushing syndromesMain campus; Lorain Family Health and Surgery Center (Thyroid cancer only)Office: 216.445.1788 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Lorain, 440.204.7400
Leann Olansky, MDSpecialty Interest(s): Diabetes and diabetes complica-tions, gestational diabetes, general endocrinologyLocation(s): Main campus; Stephanie Tubbs Jones Health CenterOffice: 216.444.2642 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Stephanie Tubbs Jones Health Center, 216.767.4242
Richard Shewbridge, MDSpecialty Interest(s): Endocrinology, diabetes, thyroid disorders, hyperlipidemia, osteoporosisLocation(s): MedinaOffice: 330.725.3713 | Fax: 330.725.2141Appointments: 330.725.3713
Mario Skugor, MDCo-director, Thyroid CenterAssociate Director, Endocrinology Fellowship ProgramSpecialty Interest(s): Osteoporosis and calcium metabolism, obesity and diabetes, multiple endocrine neoplasia syndromes, thyroid disorders, thyroid cancerLocation(s): Main campusOffice: 216.445.0739 | Fax: 216.445.1656Appointments: 216.444.6568
David Shewmon, MDSpecialty Interest(s): General endocrinology, diabetes, high cholesterol, osteomalacia, osteoporosis, pituitary tumors, thyroid conditions, thyroid cancerLocation(s): Wooster Family Health CenterOffice: 330.287.4690 | Fax: 330.287.4876Appointments: 330.287.4690
Mariam Stevens, MDSpecialty Interest(s): Diabetes, gestational diabetes, goiter, Graves’ disease, Hashimoto’s disease, hirsutism, hyperthyroidism, hypoglycemia, hypothyroidism, polycystic ovary syndrome, thyroid disease, thyroid noduleLocation(s): Independence Family Health CenterOffice: 216.986.4000 | Fax: 216.986.4995Appointments: 216.986.4000
Robert Zimmerman, MDDirector, Cleveland Clinic Diabetes CenterVice Chairman, Department of Endocrinology, Diabetes and MetabolismProgram Director, Endocrinology Training ProgramSpecialty Interest(s): Diabetes, thyroid disorders, growth hormone in adultsLocation(s): Main campusOffice: 216.444.9428 | Fax: 216.445.1656Appointments: 216.444.6568
Department of Endocrine Surgery
Eren Berber, MDDirector, Robotic Endocrine SurgerySpecialty 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 surgeryLocation(s): Main campusOffice: 216.445.0555 | Fax: 216.636.0662Appointments: 216.444.6568
Kresimira (Mira) Milas, MDDirector, Thyroid CenterSpecialty Interest(s): Endocrine surgery (thyroid and parathyroid), thyroid cancer, multiple endocrine neoplasia syndromes, hereditary thyroid disordersLocation(s): Main campusOffice: 216.444.4985 | Fax: 216.636.0662Appointments: 216.444.6568
Jamie Mitchell, MDSpecialty Interest(s): Endocrine surgery (thyroid, parathyroid and adrenal), laparoscopic solid organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumorsLocation(s): Main campus; Independence Family Health Center; Solon Family Health CenterOffice: 216.445.9713 | Fax: 216.636.0662Appointments: Main campus, 216.444.6568; Independence, 216.986.4000; Solon, 440.519.6800
Joyce J. Shin, MDSpecialty 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 tumorsLocation(s): Main campus; Willoughby Hills Family Health CenterOffice: 216.636.9365 | Fax: 216.636.0662Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500
Allan Siperstein, MD Department ChairSpecialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, laparoscopic thermal ablation of liver tumors, pancreatic endocrine tumorsLocation(s): Main campusOffice: 216.444.5664 | Fax: 216.636.0662Appointments: 216.444.6568
Bariatric and Metabolic Institute
Stacy Brethauer, MDSpecialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, hernia repair, endoscopy, surgery for GERD, hiatal hernia, solid-organ endoluminal surgery, single-incision laparoscopic surgeryLocation(s): Main campusOffice: 216.444.9244 | Fax: 216.445.1586Appointments: 216.445.2224
Derrick Cetin, DOSpecialty Interest(s): Bariatric medicine, medical weight management, nutrition sciences, obesity management, preoperative evaluation, diabetes careLocation(s): Main CampusOffice: 216.445.4255 | Fax: 216.636.1588Appointments: 216.445.2224
Bipan Chand, MDSpecialty 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 surgeryLocation(s): Main campusOffice: 216.444.6668 | Fax: 216.445.1586Appointments: 216.445.2224
Karen Cooper, DOSpecialty Interest(s): Bariatric medicine, family medicine, kinesiology and nutrition sciences, exercise instructionLocation(s): Main campusOffice: 216.445.1114 | Fax: 216.445.1586Appointments: 216.445.2224
Matthew Kroh, MDSpecialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgeryLocation(s): Main campus Office: 216.445.9966 | Fax: 216.444.2153Appointments: 216.445.2224
Tomasz Rogula, MD, PhDSpecialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgeryLocation(s): Main campus; Strongsville Family Health and Surgery CenterOffice: 216.445.0255 | Fax: 216.445.1586Appointments: Main campus: 216.445.2224; Strongsville: 440.878.2500
Philip Schauer, MDDepartment ChairSpecialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, colon surgery, weight management, hernia surgery, biliary surgery, surgery for GERDLocation(s): Main campusOffice: 216.444.4794 | Fax: 216.445.1586Appointments: 216.445.2224
Endocrinology & Metabolism Institute | staff Directory
Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations.
77763_CCFBCH_Cover_ACG.indd 2 11/8/11 12:14 PM
Endocrine Notes | 1 | 2011 800.223.2273, ext. 46568 | 1 | clevelandclinic.org/endonotes
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, MDChairman, 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
77763_CCFBCH_Text_ACG.indd 1 11/15/11 7:16 AM
Endocrine Notes | 2 | 2011
We conducted a review of 843 patients who had undergone
initial bilateral parathyroid exploration at Cleveland Clinic
between January 2005 and December 2010. Of the study
population, 46 patients (5.5 percent) were found to have
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.
A review of medical histories found that PHP had been
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
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.
The study also noted three subgroups of NHPHP:
consisted of 7 patients with preoperative iPTH
values < 40 pg/mL, the lowest measuring 5 pg/mL.
consisted of 19 patients, all having
consisted of 20 patients who occasionally
demonstrated iPTH values > 60 pg/mL, even though most
In Cleveland Clinic’s Department of Endocrine Surgery, we
have described another entity of PHP, which we have desig-
nated normohormonal primary hyperparathyroidism (NHPHP).
Patients with this entity have high calcium levels but normal-
to-low PTH levels – as low as 5 pg/mL. Knowledge of this
subgroup may help the diagnosis of PHP to be made earlier.
We feel it is appropriate to accept this atypical biochemistry
-
tation. These patients have clearly enlarged parathyroids,
classical patient. This is a real subtype of the disease.
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.
Primary HyperparathyroidismWith Normal PTH Levels: A Modern Parathyroid Disease Entity
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800.223.2273, ext. 46568 | 3 | clevelandclinic.org/endonotes
Other than the preoperative iPTH values, there were no
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.
A few distinct subgroup differences are interesting to
highlight. For example, patients in subgroups I and II were
more commonly diagnosed by the endocrine surgeon after
being referred for thyroid disease, as compared with patients
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.
Given such differences among the subgroups, we initially
wondered whether we were simply diagnosing PHP at an
earlier phase of disease evolution. However, when we found
similar degrees of hypercalcemia, morphology of parathyroid
disease and abnormal gland volume among all subgroups,
we became convinced that NHPHP is a real entity – a
distinct phenotype of PHP.
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.
At Cleveland Clinic, the usual practice is to proceed to
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
PTHrp measurement, SPEP, selective venous sampling or CT
scanning to evaluate for malignancy. The additional testing
did not elucidate other etiologies of hypercalcemia, and all
patients had PHP.
Having performed this study and having this data to refer-
ence, we are comfortable recommending an imaging workup
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
levels but iPTH levels < 60 pg/mL and even < 40 pg/mL,
the diagnosis of primary hyperparathyroidism should be
considered, particularly if no other etiology of hypercalcemia
and surgery is curative.
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.
For more information, please contact Dr. Milas at
216.444.4985 or at milasm@ccf.org.
By Mira Milas, MD, and Lucy B. Wallace, MD
77763_CCFBCH_Text_ACG.indd 3 11/8/11 12:12 PM
Endocrine Notes | 4 | 2011
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.
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
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.
A Rare Case of AcromegalyDiagnosed During Pregnancy
77763_CCFBCH_Text_ACG.indd 4 11/8/11 12:12 PM
800.223.2273, ext. 46568 | 5 | clevelandclinic.org/endonotes
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.
Scheduling surgery after delivery
Pituitary MRI at four weeks postpartum showed that the
patient’s adenoma was stable. She underwent transsphe-
noidal resection of the adenoma, which immunostained
positively for GH, but surgery failed to achieve a biochem-
ical 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.
Treatment considerations during pregnancy
As was true for this patient, the majority of pregnancies in
patients with acromegaly are uneventful, and newborns
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.
Dopamine agonists and somatostatin analogs appear to be
safe during pregnancy, but because safety data are sparse,
their usage is generally reserved for symptomatic patients.
The use of the GH receptor antagonist pegvisomant seems
promising during pregnancy when somatostatin analogs
and surgery fail to control tumor growth. However, experi-
ence with pegvisomant is extremely limited, so its use will
require further study.
Surgery can be safely postponed until after delivery for
most patients except when it is needed in an emergency
for acute visual loss or pituitary apoplexy.
About the authors
Dr. Cheng worked on this case as a fellow in the Department of
Endocrinology, Diabetes and Metabolism with Laurence Kennedy, MD,
Chair, and endocrinologists Amir Hamrahian, MD, Charles Faiman, MD,
and Betul Hatipoglu, MD; and with obstetrician Fadi Khoury, MD.
For further information, contact Dr. Hamrahian at
216.445.8538 or hamraha@ccf.org, or Dr. Kennedy at
216.445.8645 or kennedl4@ccf.org.
Imaging
MRI of the pituitary without contrast revealed a macroadenoma measuring1.0 x 1.5 x 1.0 cm with noimpingement of the optic chiasmMRI of the pituitary without contrast revealed a macroadenoma that measured 1.0 x 1.5 x 1.0 cm with no impinge-ment of the optic chiasm.
IMAGING
By Vicky Cheng, MD, and Laurence Kennedy, MD
Based on poster presentation at American Association of Clinical Endocrinologists (AACE)
20th Annual Meeting and Clinical Congress, San Diego, Calif., April 13-17, 2011.
77763_CCFBCH_Text_ACG.indd 5 11/14/11 11:50 AM
Endocrine Notes | 6 | 2011
After several years’ experience in performing
robotic adrenalectomies, Cleveland Clinic endo-
crine surgeons have found that robotic surgery
provides significant advantages over conven-
tional laparoscopy. To date, they have performed
more than 71 robotic adrenalectomies with no
complications and no mortality.
“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
endocrine surgeon Eren Berber, MD, below, who
spearheads the technology and is training other-
Endocrinology & Metabolism Institute surgeons.
“Moreover, when we compared the robotic series
with past laparoscopies, it became clear that
the duration of the surgery was similar, if not
shorter, despite removing larger tumors.
“We also noticed a trend toward a shorter hospi-
tal 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 cumber-
some, 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 demand-
ing, 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
Now the Preferred Approach to Adrenalectomy
Robotic Surgery
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robotic adrenalectomy is about 30 minutes faster than
posterior laparoscopic adrenalectomy,” notes Dr. Berber.
Large volume of adrenal procedures
Cleveland Clinic’s volume of adrenal operations is one of
the largest in the world, notes Dr. Berber, who believes that
a comprehensive adrenal surgery program should offer
a variety of surgical options.
Open adrenalectomy is available for tumors that have
invaded surrounding structures. Dr. Berber and colleagues
also offer radiofrequency ablation, a technique they pio-
neered 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 alterna-
tives. For example, besides robotic adrenalectomy, Cleveland
Clinic endocrine surgeons have amassed one of the largest
experiences with robotic thyroidectomy and robotic parathy-
roidectomy in the United States.
These procedures are performed through axillary incisions
to eliminate visible scarring on the neck.
Tracking adrenal tumor patients’ outcomes
Data from all adrenal tumor patients is entered into an
IRB-approved registry that is used to evaluate outcomes
and compare surgical options. The registry, started in 2000,
now contains information on 300 cases.
Dr. Berber directs a weekly multidisciplinary adrenal diseases
clinic with Cleveland Clinic endocrinologists and radiologists.
To refer patients for evaluation or for further information,
please contact Dr. Berber at 216.445.0555 or at
berbere@ccf.org.
The posterior robotic approach avoids the intra-abdominal cavity, reduces immediate postoperative pain and shortens length of stay.
Dissection during a robotic adrenalectomy.
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Endocrine Notes | 8 | 2011
“Weight loss is a key component in the resolution of type 2 DM,
and bariatric surgery can be highly effective in inducing
weight loss,” says Cleveland Clinic endocrinologist Sangeeta
Kashyap, MD. “However, DM does not always resolve with
bariatric surgery, even with optimal weight loss.”
A Cleveland Clinic study, Surgical Therapy and Medications
STAMPEDE), is
bypass surgery, sleeve gastrectomy and advanced medical
percent) among diabetic patients who are moderately obese
(BMI 27-43 Kg/m2). Philip Schauer, MD, Director of the
Bariatric and Metabolic Institute (pictured above), is
principal investigator.
STAMPEDE
in helping many patients achieve glycemic control, yet a
number of patients have been unable to achieve or maintain
DM remission despite dramatic weight loss. This prompted Dr.
Kashyap to launch a substudy of STAMPEDE, funded by the
American Diabetes Association, to examine the clinical and
metabolic factors determining DM non-remission after either
Roux-en-Y gastric bypass or sleeve gastrectomy.
“As endocrinologists, we need to understand which patients
patient selection and determine the point at which surgery
should be recommended,” says Dr. Kashyap.
“Data from this study, in conjunction with clinical trial data,
changes in intestinal hormones and fat-generated hormones
following various bariatric procedures.”
This will help to further understanding of the potential bariat-
ric surgery holds for the treatment of DM in moderate obesity.
The study may also be useful in establishing appropriate
expectations, because patients with DM expect their disease
to resolve following bariatric surgery.
After surgery, not all patients are likely to achieve com-
plete remission. Dr. Kashyap believes this may be due to
poor baseline residual B-cell function and a lack of incretin
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.
“Given their potential to enhance insulin secretion, promote
B-cell growth and induce weight loss, understanding the dif-
ferential response of incretin hormones to the various bariatric
procedures in patients who achieve DM remission versus
non-remission is critical,” she says.
The ability of bariatric surgery to reverse DM may depend on
disease duration and severity. Patients with recent-onset DM
and mild hyperglycemia who do not require insulin are likely
to have the greatest baseline B-cell function. Those with poor
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
surgery has tremendous therapeutic potential.
STAMPEDE Substudy Examines Factors Underlying Diabetes Remission or Non-Remission
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residual B-cell function at baseline may not experience the
improvements in insulin sensitivity and thus achieve only
partial remission or nonremission.
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.
Lipotoxicity plays a central role in inducing B-cell dysfunction
and insulin resistance, which lead to the development of DM.
Therefore, “the impact of bariatric surgery on the weight-
related and non-weight-related effects of lipotoxicity must be
determined in patients achieving longer-term, complete DM
remission versus non-remission,” she says. “Since weight
regain is associated with an increase in fat mass, we expect
to see a direct impact of weight regain on impairing insulin
sensitivity and glucose tolerance.”
One-year outcomes for the study will be available in 2012,
and two-year outcomes will be available in 2013.
For more information, please contact Dr. Kashyap (above) at
216.445.2679 or at kashyas@ccf.org.
STAMPEDE IINow Enrolling
Cleveland Clinic is currently enrolling patients for the
STAMPEDE II (Surgical Therapy and Medications Potentially
Eradicate Diabetes Efficiently) study. The randomized,
controlled trial will examine short- and long-term outcomes of
advanced medical therapy versus advanced medical therapy
combined with Roux-en-Y gastric bypass.
The effect of each approach on disease progression,
complications and organ damage will be evaluated. Sixty
men and women with type 2 diabetes are sought for the
study. Candidates must be between 20 and 60 years of age
and have a body mass index between 27 and 43 kg/m2.
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.
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Endocrine Notes | 10 | 2011
“The value of bariatric procedures in helping morbidly
obese patients achieve glycemic control has been con-
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.
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).
Bariatric Surgery Now Standard Treatment for Morbidly Obese Diabetic Patients
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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
“Depending on their preoperative weight, patients can expect
to lose 40 to 70 percent of their excess body weight in the
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.
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
For more information about gastric plication, contact
Dr. Schauer at 216.444.4794 or at schauep@ccf.org.
Gastric Plication Holds Promisefor 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.
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Endocrine Notes | 12 | 2011
With current availability of GHRH limited to research use only, there is no satisfactory
(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.
Study Compares Glucagon Stimulation Test to Insulin Tolerance Test in Evaluating Adult
“Our hypothesis is that the GST can accurately and safely diagnose GHD in patients with hypothalamic-
pituitary 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 contra-
indications to its use. This is particularly important for clinical endocrinologists who are not comfortable
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 ACTH-
dependent. 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.
The study is recruiting 30 patients with adult-onset hypothalamic-pituitary disorders: 15 with one
controls matched for age, sex and body mass index are also being recruited. The ITT and two GSTs
levels will be measured at baseline and every 30 minutes, up to 240 minutes.
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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 hamraha@ccf.org.
“Our hypothesis is that the GST can accurately and safely
-
thalamic-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.”
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Endocrine Notes | 14 | 2011
Journals
Below are peer-reviewed journal articles and
book chapters published within the past year by
Endocrinology & Metabolism Institute staff.
Solomon TPJ, Haus JM, Kelly KR, Cook MD, Filion J, Rocco
M, Kashyap SR, Watanabe RM, Barkoukis H, Kirwan JP. A
low-glycemic index diet combined with exercise reduces insulin
resistance, postprandial hyperinsulinemia, and glucose-depen-
dent insulinotropic polypeptide responses in obese, prediabetic
humans. Am J Clin Nutr. 2010 Dec;92(6):1359-1368.
Flechner SM, Berber E, Askar M, Stephany B, Agarwal A, Milas
M. Allotransplantation of cryopreserved parathyroid tissue
for severe hypocalcemia in a renal transplant recipient. Am J
Transplant. 2010 Sep;10(9):2061-2065.
Shewmon DA, Craig JM. Creatine supplementation prevents
statin-induced muscle toxicity. Ann Intern Med. 2010
Nov 16;153(10):690-692.
Jarrar AM, Milas M, Mitchell J, LaGuardia L, O’Malley M,
Berber E, Siperstein A, Burke C, Church JM. Screening for thy-
roid cancer in patients with familial adenomatous polyposis.
Ann Surg. 2011 Mar;253(3):515-521.
Milas M, Shin J, Gupta M, Novosel T, Nasr C, Brainard J,
Mitchell J, Berber E, Siperstein A. Circulating thyrotropin
receptor mRNA as a novel marker of thyroid cancer: clinical
applications learned from 1758 samples. Ann Surg. 2010
Oct;252(4):643-651.
Abdelmalak B, Abdelmalak JB, Knittel J, Christiansen E, Mascha
E, Zimmerman R, Argalious M, Foss J. The prevalence of undiag-
nosed diabetes in non-cardiac surgery patients, an observational
study. Can J Anaesth. 2010 Dec;57(12):1058-1064.
Abdelmalak B, Zimmerman R, Foss J. Reply [Diagnosing preop-
erative hyperglycemia in non-diabetic patients: a challenge and
an opportunity]. Can J Anaesth.2011;58(6):583.
Albashir S, Olansky L, Sasidhar M. Progressive muscle
weakness: More there than meets the eye. Cleve Clin J Med.
2011 Jun;78(6):385-391.
Hamaty M. Insulin treatment for type 2 diabetes:
When to start, which to use. Cleve Clin J Med. 2011
May;78(5):332-342.
Kashyap SR. In reply [Bariatric surgery, vitamin C, and
kidney stones]. Cleve Clin J Med. 2010 Dec;77(12):844.
Olansky L. Q: Do incretin drugs for type 2 diabetes increase
the risk of acute pancreatitis? Cleve Clin J Med. 2010
Aug;77(8):503-505.
Pantalone KM, Nasr C. Approach to a low TSH level: Patience is
a virtue. Cleve Clin J Med. 2010 Nov;77(11):803-811.
Bhatwadekar AD, Guerin EP, Jarajapu YPR, Caballero S,
Sheridan C, Kent D, Kennedy L, Lansang MC, Ruscetti FW,
Pepine CJ, Higgins PJ, Bartelmez SH, Grant MB. Transient
inhibition of transforming growth factor-beta 1 in human diabetic
CD34+ cells enhances vascular reparative functions. Diabetes.
2010 Aug;59(8):2010-2019.
Pop-Busui R, Evans GW, Gerstein HC, Fonseca V, Fleg JL,
Hoogwerf BJ, Genuth S, Grimm RH, Corson MA, Prineas R.
Effects of cardiac autonomic dysfunction on mortality risk in the
Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
Diabetes Care. 2010 Jul;33(7):1578-1584.
Solomon TPJ, Haus JM, Kelly KR, Rocco M, Kashyap SR,
Kirwan JP. Improved pancreatic beta-cell function in type 2
diabetic patients after lifestyle-induced weight loss is related to
glucose-dependent insulinotropic polypeptide. Diabetes Care.
2010 Jul;33(7):1561-1566.
Publications
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800.223.2273, ext. 46568 | 15 | clevelandclinic.org/endonotes
Reasner C, Olansky L, Seck TL, Williams-Herman DE, Chen M,
Terranella L, Johnson-Levonas AO, Kaufman KD, Goldstein BJ.
sitagliptin and metformin compared with metformin monotherapy
in patients with type 2 diabetes mellitus. Diabetes Obes Metab.
2011 Jul;13(7):644-652.
Rhoads GG, Dain MP, Zhang Q, Kennedy L. Two-year
glycaemic control and healthcare expenditures following
initiation of insulin glargine versus neutral protamine Hagedorn
insulin in type 2 diabetes. Diabetes Obes Metab. 2011
Aug;13(8):711-717.
Cheng V, Doshi KB, Falcone T, Faiman C. Hyperandrogenism in
a postmenopausal woman: diagnostic and therapeutic challenges.
Endocr Pract. 2011 Mar;17(2):e21-e25.
Mulligan GB, Eray E, Faiman C, Gupta M, Pineyro MM, Makdissi
A, Suh JH, Masaryk TJ, Prayson R, Weil RJ, Hamrahian AH.
Reduction of false-negative results in inferior petrosal sinus sam-
pling with simultaneous prolactin and corticotropin measurement.
Endocr Pract. 2011 Jan-Feb;17(1):33-40.
Nyalakonda K, Sharma T, Ismail-Beigi F. Preservation of
Beta-cell function in type 2 diabetes. Endocr Pract. 2010
Nov-Dec;16(6):1038-1055.
Pantalone KM, Faiman C, Olansky L. Insulin glargine use during
pregnancy. Endocr Pract. 2011 May;17(3):448-455.
Hatipoglu BA, Kennedy L. Postradiation therapy hypopituitarism.
Expert Rev Endocrinol Metab. 2011 Mar;6(2):187-194.
Tariq N, Chand B. Presurgical evaluation and postoperative care
for the bariatric patient. Gastrointest Endosc Clin N Am. 2011
Apr;21(2):229-240.
Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S,
Fung J. Robotic versus laparoscopic resection of liver tumours.
HPB (Oxford). 2010 Oct;12(8):583-586.
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.
Attaluri V, Lebeis C, Brethauer S, Rosenblatt S. Advanced lapa-
dialysis catheters. J Am Coll Surg. 2010 Dec;211(6):699-704.
Tritos NA, Greenspan SL, King D, Hamrahian A, Cook DM,
Jonsson PJ, Wajnrajch MP, Koltowska-Haggstrom M, Biller BMK.
lower IGF-I are associated with lower bone mineral density in
-
sis. J Clin Endocrinol Metab. 2011 May;96(5):1516-1523.
Zerikly RK, Amiri L, Faiman C, Gupta M, Singh RJ, Nutter B,
Kennedy L, Hatipoglu B, Weil RJ, Hamrahian AH. Diagnostic
characteristics of late-night salivary cortisol using liquid chroma-
tography-tandem mass spectrometry. J Clin Endocrinol Metab.
2010 Oct;95(10):4555-4559.
Berber E, Siperstein A. Re: Robot-assisted posterior retroperito-
neoscopic adrenalectomy (From: Ludwig AT, Wagner KR, Lowry
PS, et al. J Endourol 2010;24:1307-1314). J Endourol. 2011
Mar;25(3):541-542.
Tamimi TI, Elgouhari HM, Alkhouri N, Yerian LM, Berk MP,
Lopez R, Schauer PR, Zein NN, Feldstein AE. An apoptosis
panel for nonalcoholic steatohepatitis diagnosis. J Hepatol. 2011
Jun;54(6):1224-1229.
El-Hayek KM, Chand B. Biologic prosthetic materials for hernia
repairs. J Long Term Eff Med Implants. 2010;20(2):159-169.
Kashyap SR, Roman LJ, Mandarino L, DeFronzo R, Bajaj M.
Hypoadiponectinemia is closely associated with impaired nitric
oxide synthase activity in skeletal muscle of type 2 diabetic
subjects. Metab Syndr Relat Disord. 2010 Oct;8(5):459-463.
Milas Z, Shin J, Milas M. New guidelines for the management
of thyroid nodules and differentiated thyroid cancer. Minerva
Endocrinol. 2011 Mar;36(1):53-70.
continued on next page
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Endocrine Notes | 16 | 2011
Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B,
Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith
JD, Allayee H, Tang WHW, DiDonato JA, Lusis AJ, Hazen SL.
-
cular disease. Nature. 2011 Apr 7;472(7341):57-63.
Marko NF, Hamrahian AH, Weil RJ. Immediate postoperative
cortisol levels accurately predict postoperative hypothalamic-
pituitary-adrenal axis function after transsphenoidal surgery for
pituitary tumors. Pituitary. 2010 Sep;13(3):249-255.
Akyildiz HY, Morris-Stiff G, Aucejo F, Fung J, Berber E. Techniques
of radiofrequency-assisted precoagulation in laparoscopic liver
resection. Surg Endosc. 2011 Apr;25(4):1143-1147.
Alasfar F, Chand B. Intraoperative endoscopy for laparoscopic
Roux-en-Y gastric bypass: leak test and beyond. Surg Laparosc
Endosc Percutan Tech. 2010 Dec;20(6):424-427.
Harvey A, Bohacek L, Neumann D, Mihaljevic T, Berber E.
Robotic thoracoscopic mediastinal parathyroidectomy for persis-
tent 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.
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.
Brethauer SA, Chand B, Schauer PR, Thompson CC. Transoral
gastric volume reduction for weight management: technique
and feasibility in 18 patients. Surg Obes Relat Dis. 2010
Nov-Dec;6(6):689-694.
Brethauer SA, Harris JL, Kroh M, Schauer PR. Laparoscopic
gastric plication for treatment of severe obesity. Surg Obes
Relat Dis. 2011 Jan-Feb;7(1):15-22.
Gatmaitan P, Huang H, Talarico J, Moustarah F, Kashyap S,
Kirwan JP, Schauer PR, Brethauer SA. Pancreatic islet isolation
after gastric bypass in a rat model: technique and initial results
for a promising research tool. Surg Obes Relat Dis. 2010
Sep-Oct;6(5):532-537.
Ransom D, Ashton K, Windover A, Heinberg L. Internal consis-
tency and validity assessment of SCL-90-R for bariatric surgery
candidates. Surg Obes Relat Dis. 2010 Nov-Dec;6(6):622-627.
Windover AK, Merrell J, Ashton K, Heinberg LJ. Prevalence and
psychosocial correlates of self-reported past suicide attempts
among bariatric surgery candidates. Surg Obes Relat Dis. 2010
Nov-Dec;6(6):702-706.
Akyildiz HY, Mitchell J, Milas M, Siperstein A, Berber E.
Laparoscopic radiofrequency thermal ablation of neuroendo-
crine hepatic metastases: Long-term follow-up. Surgery. 2010
Dec;148(6):1288-1293.
Greenlee C, Burmeister LA, Butler RS, Edinboro CH, Morrison
SM, Milas M. Current safety practices relating to I-131 admin-
istration for diseases of the thyroid: a survey of physicians and
allied practitioners. Thyroid. 2011 Feb;21(2):151-160.
Shin J, Chute D, Milas M, Mitchell J, Siperstein A, Berber E. A
rare case of chronic lymphocytic leukemia/small lymphocytic
lymphoma presenting in the thyroid gland. Thyroid. 2010
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.
Karabulut K, Berber E. Robotik endokrin cerrahi [Robotic endo-
crine surgery] [Turkish]. Ulusal Cerrahi Dergisi. 2011;27(1):1-5.
Book ChaptersAshton K, Budur K. Scared to sleep: A Hurricane Katrina survi-
vor. In: Foldvary-Schaefer N, Krishna J, Budur K, eds. A Case a
Week: Sleep Disorders From the Cleveland Clinic. Oxford; New
York, NY: Oxford University Press; 2011. Chapter 3. p. 43-48.
Ashton K, Streem D. Smoking cessation. In: Carey WD, ed.
Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/
Elsevier; 2010. p. 977-980.
continuedPublications
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Babar T, Skugor M. Diabetes mellitus treatment. In: Carey
WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA:
Saunders/Elsevier; 2010. p. 358-363.
Brethauer S, Kashyap S, Schauer P. Obesity. In: Carey WD, ed.
Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/
Elsevier; 2010. p. 391-396.
Chikunguwo SM, Brethauer SA, Schauer PR. Bariatric surgery.
In: Cameron JL, Cameron AM, eds. Surgery of the Esophagus
and Stomach. London; New York, NY: Springer; 2011. Chapter
16. p. 217-232.
Chinnappa P, Mehta A. Hirsutism. In: Carey WD, ed. Current
Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier;
2010. p. 376-379.
Diab DL, Hamrahian AH. Clinical detection and treatment of be-
nign and malignant pituitary diseases. In: Hunt JL, ed. Molecular
Pathology of Endocrine Diseases. New York, NY: Springer; 2010.
Chapter 17. p. 169-174.
Faiman C. Male hypogonadism. In: Carey WD, ed. Current
Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier;
2010. p. 397-401.
Gatmaitan P, Brethauer SA, Schauer PR. Obesity and presenta-
tions after anti-obesity surgery. In: Talley NJ, Kane SV, Wallace
MB, eds. Practical Gastroenterology and Hepatology. Small
and Large Intestine and Pancreas. Chichester, West Sussex ;
Hoboken, NJ: Wiley-Blackwell; 2010. Chapter 24. p. 169-175.
Gopan T, Hamrahian A. Adrenal disorders. In: Camacho PM, ed.
A Color Handbook of Clinical Endocrinology and Metabolism.
London: Manson Pub.; 2011. Chapter 5. p. 113-147.
Harvey AM, Siperstein AE, Berber E. Clinical detection and
treatment of adrenal disease. In: Hunt JL, ed. Molecular
Pathology of Endocrine Diseases. New York, NY: Springer; 2010.
Chapter 19. p. 197-203.
Hoogwerf BJ. Diabetes mellitus: Disease management. In: Carey
WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA:
Saunders/Elsevier; 2010. p. 350-354.
Ioachimescu AG, Hamrahian AH. Diseases of the adrenal
gland. In: Carey WD, ed. Current Clinical Medicine. 2nd ed.
Philadelphia, PA: Saunders/Elsevier; 2010. p. 336-349.
Mitchell JC. Clinical detection and treatment of pancreatic
neuroendocrine tumors. In: Hunt JL, ed. Molecular Pathology of
Endocrine Diseases. New York, NY: Springer; 2010. Chapter 22.
p. 229-235.
Mitchell JC, Milas M. Clinical detection and treatment of thyroid
diseases. In: Hunt JL, ed. Molecular Pathology of Endocrine
Diseases. New York, NY: Springer; 2010. Chapter 4. p. 27-35.
Moustarah F, Brethauer SA, Schauer PR. Laparoscopic surgery
for severe obesity. In: Cameron JL, Cameron AM, eds. Current
Surgical Therapy. 10th ed. Philadelphia, PA: Saunders/Elsevier;
2011. p. 1304-1316.
Nasr C. Flushing. In: Carey WD, ed. Current Clinical Medicine.
2nd ed. Philadelphia, PA: Saunders/Elsevier; 2010. p. 369-375.
Reddy SSK. Hypothalamic-pituitary disorders. In: Camacho PM,
ed. A Color Handbook of Clinical Endocrinology and Metabolism.
London: Manson Pub.; 2011. Chapter 4. p. 91-112.
Schirmer B, Schauer PR. The surgical management of obesity.
In: Brunicardi FC, ed. Schwartz’s Principles of Surgery. 9th ed.
New York, NY: McGraw-Hill; 2010. Chapter 27. p. 949-978.
Skugor M. Section 4: Endocrinology [Section editor]. In: Carey
WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia, PA:
Saunders/Elsevier; 2010. p. 335-420.
Skugor M. Hypocalcemia and hypercalcemia. In: Carey WD, ed.
Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/
Elsevier; 2010. p. 380-386.
Skugor M. Osteoporosis. In: Carey WD, ed. Current Clinical
Medicine. 2nd ed. Philadelphia, PA: Saunders/Elsevier; 2010.
p. 402-407.
Skugor M, Fleseriu M. Hypothyroidism and hyperthyroidism. In:
Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia,
PA: Saunders/Elsevier; 2010. p. 416-420.
Skugor M, Hamrahian AH. Pituitary disorders. In: Carey WD, ed.
Current Clinical Medicine. 2nd ed. Philadelphia, PA: Saunders/
Elsevier; 2010. p. 408-415.
Zimmerman R. Microvascular complications of diabetes. In:
Carey WD, ed. Current Clinical Medicine. 2nd ed. Philadelphia,
PA: Saunders/Elsevier; 2010. p. 355-357.
77763_CCFBCH_Text_ACG.indd 17 11/8/11 12:14 PM
Endocrine Notes | 18 | 2011
The 9th Annual Dr. Roizen’s Preventive Care and Integrative Medicine ConferenceFocus: Reversing Metabolic and Endocrine Disorders, including Metabolic Syndrome, Type 2 Diabetes and Thyroid Disorders, and Increasing Sexual Enjoyment
December 9-11, 2011
This activity has been approved for AMA PRA Category 1 Credits.™ To register, please call 216.448.0777, email cmeregistration@ccf.orgor visit www.ccfcme.org/wellness11.
Live and OnlineCME Opportunities
Online webcasts of interest to endocrinologists and approved for AMA PRA Category 1 Credits™ include:
For a full list of all Cleveland Clinic CME opportunities, please visit ; to manage your CME credits, use the Web portal, available 24/7.
“Can We Develop a Viable PPAR Agonist for Diabetic Patients?” and “Challenges in Developing New Therapies for Risk Reduction in Diabetes”
Diabetic Patient and Plaque Progression in Diabetic Patients: Insights from Arterial Wall Imaging”
“New and Novel Therapies for Low Bone Mass”
“Robotic Endocrine Surgery”
77763_CCFBCH_Text_ACG.indd 18 11/8/11 12:14 PM
800.223.2273, ext. 46568 | 19 | clevelandclinic.org/endonotes| | 800.223.2273, ext. 46568 | 19 | clevelandclinic.org/endonotes
TITLE PI CONTACT/NUMBER
International Metabolic Study (KIMS®)Melanie Williams216.444.5410
A Proof of Concept, Open-Label, Forced Titration, Multicenter Study to Assess the Safety/Tolerability and Melanie Williams216.444.5410
A Blinded, Placebo-Controlled, Single Ascending Dose, Phase 1 Trial for Safety, Tolerability, Pharmacokinetics and Pharmacodynamics after Subcutaneous Administration of VRS-317 in Adults
Melanie Williams216.444.5410
A Phase III, Multinational, Randomized, Double-Blind, Placebo-Controlled Parallel-Group Study Melanie Williams216.444.5410
A Randomized, Double-Masked, Placebo-Controlled, Multicenter, Phase 2 Study to Evaluate the Safety and Melanie Williams216.444.5410
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
Melanie Williams216.444.5410
The Global Hypopituitary Control and Complications Study (HypoCCS)Melanie Williams216.444.5410
The Diagnostic Accuracy of the Glucagon Stimulation Test for Evaluation of Adult Growth Hormone Melanie Williams216.444.5410
ACROSTUDY - A Multicenter, Post-Marketing Surveillance Study of Somavert Therapy in Patients with Acromegaly in the USA and Europe
Melanie Williams216.444.5410
Pelvic Floor Disorders in Bariatric Surgery PatientsSharon O’Keefe216.445.8461
A Prospective, Randomized, Controlled Trial Comparing Advanced Practice Medical Management vs. Ad-vanced Practice Medical Management Plus Bariatric Surgery in The Treatment of Type 2 Diabetes Mellitus
Chytaine Hall216.445.3983
Prospective Randomized Comparison of Bilateral vs. Focal Neck Exploration for Sporadic HyperparathyroidismLinda Heil216.444.2262
in Patients with Primary and Secondary HyperparathyroidismLinda Heil216.444.2262
T1D Exchange Type 1 Diabetes Network Denise Rose 216.444.8824
Gastric Plication for the Treatment of Obesity and Related Conditions 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
Sharon O’Keefe, 216.445.8461
Is Nipple Stimulation by a Piercing Capable of Increasing Serum Prolactin Concentrations? Melanie Williams, 216.444.5410
ACCORDION: Action to Control Cardiovascular Risk in Diabetes Trial Melanie Williams, 216.444.5410
Exenatide Study of Cardiovascular Event Lowering (EXSCEL)Melanie Williams, 216.444.5410
Current Clinical Trials
77763_CCFBCH_Text_ACG.indd 19 11/8/11 12:14 PM
Department of Endocrinology, Diabetes and Metabolism
Sanjit Bindra, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Lakewood Hospital Professional BuildingOffice: 216.529.5300 | Fax: 216.529.5301Appointments: 216.529.5300
Kevin Borst, DOSpecialty Interest(s): Endocrine disorders in pregnancy, general endocrinology, diabetesLocation(s): Lakewood Hospital Professional BuildingOffice: 216.529.5300 | Fax: 216.529.5301Appointments: 216.529.5300
Krupa Doshi, MDSpecialty Interest(s): General endocrinology, diabetes, parathyroid and calcium disorders, hirsutism, thyroid disorders, adrenal disorders, osteoporosisLocation(s): Main campusOffice: 216.445.0741 | Fax: 216.445.1656Appointments: 216.444.6568
Revital Gorodeski Baskin, MDSpecialty Interest(s): Endocrinology, thyroid disorders, thyroid cancerLocation(s): Independence Family Health CenterOffice: 216.986.4000 | Fax: 216.986.4995Appointments: 216.986.4000
Marwan Hamaty, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Strongsville Family Health and Surgery CenterOffice: 216.445.7568 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Strongsville, 440.878.2500
James Young, MDInstitute Chairman Endocrinology & Metabolism Institute216.444.2333
Laurence (Ned) Kennedy, MDChairman, Department of Endocrinology, Diabetes and Metabolism 216.445.8645
Allan Siperstein, MDChairman, Department of Endocrine Surgery216.444.5664
Philip Schauer, MDChairman, Bariatric and Metabolic Institute 216.444.4794
Amir Hamrahian, MDSpecialty Interest(s): Pituitary and adrenal disordersLocation(s): Main campusOffice: 216.445.8538 | Fax: 216.445.1656Appointments: 216.444.6568
Betul Hatipoglu, MDSpecialty Interest(s): Diabetes, thyroid disorders, pituitary disorders, adrenal disorders, alternative medicineLocation(s): Main campusOffice: 216.445.6709 | Fax: 216.445.1656Appointments: 216.444.6568
Suman Jana, MDSpecialty Interest(s): General endocrinology, diabetes, thyroid disease, thyroid cancerLocation(s): Main campus; Medina Office: 216.444.0567 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Medina, 330.725.3713
Sangeeta Kashyap, MDSpecialty Interest(s): Endocrinology, diabetes, metabolism, insulin resistance and cardiovascular risk prevention, obesity, metabolic syndrome and diseases, hyperlipidemiaLocation(s): Main campusOffice: 216.445.2679 | Fax: 216.445.1656Appointments: 216.444.6568
Laurence (Ned) Kennedy, MDDepartment ChairSpecialty Interest(s): General endocrinology, diabetes, pituitary disorders, hyperthyroidism, hypothyroidism, thyroiditisLocation(s): Main campus; Ashtabula County Medical Center; Cleveland Clinic Florida, WestonOffice: 216.445.8645 | Fax: 216.445.1656Appointments: Main Campus, 216.444.6568; Ashtabula, 440.997.6910; Florida, 954.659.6038
Endocrinology & Metabolism Institute
Staff Directory
Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations.
E N D O C R I N O L O G Y & M E T A B L O L I S M I N S T I T U T E L E A D E R S H I P
77763_CCFBCH_Text_ACG.indd 20 11/15/11 7:16 AM
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Endocrine Notes
Chairman, Endocrinology & Metabolism Institute
James B. Young, MD
Managing Editor
Cora M. Liderbach
Art Director
Mike Viars
Marketing
Bill Sattin, PhD
Mary Anne Connor
Endocrine Notes updates physicians on clinical prac-
tices, advances and research from Cleveland Clinic’s
Endocrinology & Metabolism Institute. It is written for
physicians and should be relied upon for medical education
purposes only. It does not provide a complete overview of
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
Contact usGeneral 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 locationsMain 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 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
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
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
Leila Khan, MDSpecialty Interest(s): General endocrinology, diabetes, calcium/bone disordersLocation(s): Main campus; Willoughby Hills Family Health CenterOffice: 216.445.1598 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500
M. Cecilia Lansang, MD, MPHSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campusOffice: 216.445.5246 | Fax: 216.445.1656Appointments: 216.444.6568
Melissa Li-Ng, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Solon Family Health CenterOffice: 216.444.1949 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Solon, 440.519.6800
Vinni Makin, MDSpecialty Interest(s): General endocrinology, diabetes, hirsutism, acne, thyroid disordersLocation(s): Main campus; Solon Family Health CenterOffice: Main campus, 216.444.0539; Solon, 440.519.6800 | Fax: Main campus, 216.445.1656; Solon, 440.519.6908Appointments: Main campus, 216.444.6568; Solon, 440.519.6800
Adi Mehta, MDSpecialty Interest(s): Diabetes mellitus, thyroid disorders, gynecologic endocrinology, endocrine complications of pregnancy, menopause, lipid disorders, general and adolescent endocrinologyLocation(s): Main campus; Beachwood Family Health Center (Reproductive Endocrinology only)Office: 216.445.5312 | Fax: 216.445.7261Appointments: Main campus, 216.444.6568; Beachwood, 216.839.3000
Guy Mulligan, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Twinsburg Family Health and Surgery Center; South Pointe/Charles Miner Medical BuildingOffice: 330.888.4000 | Fax: 330.963.4561Appointments: Main Campus, 216.444.6568; Twinsburg, 330.888.4000; South Pointe, 216.295.1010
Christian Nasr, MDCo-director, Thyroid CenterSpecialty Interest(s): Thyroid nodules, thyroid cancers, flushing syndromesMain campus; Lorain Family Health and Surgery Center (Thyroid cancer only)Office: 216.445.1788 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Lorain, 440.204.7400
Leann Olansky, MDSpecialty Interest(s): Diabetes and diabetes complica-tions, gestational diabetes, general endocrinologyLocation(s): Main campus; Stephanie Tubbs Jones Health CenterOffice: 216.444.2642 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Stephanie Tubbs Jones Health Center, 216.767.4242
Richard Shewbridge, MDSpecialty Interest(s): Endocrinology, diabetes, thyroid disorders, hyperlipidemia, osteoporosisLocation(s): MedinaOffice: 330.725.3713 | Fax: 330.725.2141Appointments: 330.725.3713
Mario Skugor, MDCo-director, Thyroid CenterAssociate Director, Endocrinology Fellowship ProgramSpecialty Interest(s): Osteoporosis and calcium metabolism, obesity and diabetes, multiple endocrine neoplasia syndromes, thyroid disorders, thyroid cancerLocation(s): Main campusOffice: 216.445.0739 | Fax: 216.445.1656Appointments: 216.444.6568
David Shewmon, MDSpecialty Interest(s): General endocrinology, diabetes, high cholesterol, osteomalacia, osteoporosis, pituitary tumors, thyroid conditions, thyroid cancerLocation(s): Wooster Family Health CenterOffice: 330.287.4690 | Fax: 330.287.4876Appointments: 330.287.4690
Mariam Stevens, MDSpecialty Interest(s): Diabetes, gestational diabetes, goiter, Graves’ disease, Hashimoto’s disease, hirsutism, hyperthyroidism, hypoglycemia, hypothyroidism, polycystic ovary syndrome, thyroid disease, thyroid noduleLocation(s): Independence Family Health CenterOffice: 216.986.4000 | Fax: 216.986.4995Appointments: 216.986.4000
Robert Zimmerman, MDDirector, Cleveland Clinic Diabetes CenterVice Chairman, Department of Endocrinology, Diabetes and MetabolismProgram Director, Endocrinology Training ProgramSpecialty Interest(s): Diabetes, thyroid disorders, growth hormone in adultsLocation(s): Main campusOffice: 216.444.9428 | Fax: 216.445.1656Appointments: 216.444.6568
Department of Endocrine Surgery
Eren Berber, MDDirector, Robotic Endocrine SurgerySpecialty 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 surgeryLocation(s): Main campusOffice: 216.445.0555 | Fax: 216.636.0662Appointments: 216.444.6568
Kresimira (Mira) Milas, MDDirector, Thyroid CenterSpecialty Interest(s): Endocrine surgery (thyroid and parathyroid), thyroid cancer, multiple endocrine neoplasia syndromes, hereditary thyroid disordersLocation(s): Main campusOffice: 216.444.4985 | Fax: 216.636.0662Appointments: 216.444.6568
Jamie Mitchell, MDSpecialty Interest(s): Endocrine surgery (thyroid, parathyroid and adrenal), laparoscopic solid organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumorsLocation(s): Main campus; Independence Family Health Center; Solon Family Health CenterOffice: 216.445.9713 | Fax: 216.636.0662Appointments: Main campus, 216.444.6568; Independence, 216.986.4000; Solon, 440.519.6800
Joyce J. Shin, MDSpecialty 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 tumorsLocation(s): Main campus; Willoughby Hills Family Health CenterOffice: 216.636.9365 | Fax: 216.636.0662Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500
Allan Siperstein, MD Department ChairSpecialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, laparoscopic thermal ablation of liver tumors, pancreatic endocrine tumorsLocation(s): Main campusOffice: 216.444.5664 | Fax: 216.636.0662Appointments: 216.444.6568
Bariatric and Metabolic Institute
Stacy Brethauer, MDSpecialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, hernia repair, endoscopy, surgery for GERD, hiatal hernia, solid-organ endoluminal surgery, single-incision laparoscopic surgeryLocation(s): Main campusOffice: 216.444.9244 | Fax: 216.445.1586Appointments: 216.445.2224
Derrick Cetin, DOSpecialty Interest(s): Bariatric medicine, medical weight management, nutrition sciences, obesity management, preoperative evaluation, diabetes careLocation(s): Main CampusOffice: 216.445.4255 | Fax: 216.636.1588Appointments: 216.445.2224
Bipan Chand, MDSpecialty 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 surgeryLocation(s): Main campusOffice: 216.444.6668 | Fax: 216.445.1586Appointments: 216.445.2224
Karen Cooper, DOSpecialty Interest(s): Bariatric medicine, family medicine, kinesiology and nutrition sciences, exercise instructionLocation(s): Main campusOffice: 216.445.1114 | Fax: 216.445.1586Appointments: 216.445.2224
Matthew Kroh, MDSpecialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgeryLocation(s): Main campus Office: 216.445.9966 | Fax: 216.444.2153Appointments: 216.445.2224
Tomasz Rogula, MD, PhDSpecialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgeryLocation(s): Main campus; Strongsville Family Health and Surgery CenterOffice: 216.445.0255 | Fax: 216.445.1586Appointments: Main campus: 216.445.2224; Strongsville: 440.878.2500
Philip Schauer, MDDepartment ChairSpecialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, colon surgery, weight management, hernia surgery, biliary surgery, surgery for GERDLocation(s): Main campusOffice: 216.444.4794 | Fax: 216.445.1586Appointments: 216.445.2224
Endocrinology & Metabolism Institute | staff Directory
Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations.
77763_CCFBCH_Cover_ACG.indd 2 11/8/11 12:14 PM
hio
Endocrine Notes
Chairman, Endocrinology & Metabolism Institute
James B. Young, MD
Managing Editor
Cora M. Liderbach
Art Director
Mike Viars
Marketing
Bill Sattin, PhD
Mary Anne Connor
Endocrine Notes updates physicians on clinical prac-
tices, advances and research from Cleveland Clinic’s
Endocrinology & Metabolism Institute. It is written for
physicians and should be relied upon for medical education
purposes only. It does not provide a complete overview of
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
Contact usGeneral 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 locationsMain 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 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
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
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
Leila Khan, MDSpecialty Interest(s): General endocrinology, diabetes, calcium/bone disordersLocation(s): Main campus; Willoughby Hills Family Health CenterOffice: 216.445.1598 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500
M. Cecilia Lansang, MD, MPHSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campusOffice: 216.445.5246 | Fax: 216.445.1656Appointments: 216.444.6568
Melissa Li-Ng, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Solon Family Health CenterOffice: 216.444.1949 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Solon, 440.519.6800
Vinni Makin, MDSpecialty Interest(s): General endocrinology, diabetes, hirsutism, acne, thyroid disordersLocation(s): Main campus; Solon Family Health CenterOffice: Main campus, 216.444.0539; Solon, 440.519.6800 | Fax: Main campus, 216.445.1656; Solon, 440.519.6908Appointments: Main campus, 216.444.6568; Solon, 440.519.6800
Adi Mehta, MDSpecialty Interest(s): Diabetes mellitus, thyroid disorders, gynecologic endocrinology, endocrine complications of pregnancy, menopause, lipid disorders, general and adolescent endocrinologyLocation(s): Main campus; Beachwood Family Health Center (Reproductive Endocrinology only)Office: 216.445.5312 | Fax: 216.445.7261Appointments: Main campus, 216.444.6568; Beachwood, 216.839.3000
Guy Mulligan, MDSpecialty Interest(s): General endocrinology, diabetesLocation(s): Main campus; Twinsburg Family Health and Surgery Center; South Pointe/Charles Miner Medical BuildingOffice: 330.888.4000 | Fax: 330.963.4561Appointments: Main Campus, 216.444.6568; Twinsburg, 330.888.4000; South Pointe, 216.295.1010
Christian Nasr, MDCo-director, Thyroid CenterSpecialty Interest(s): Thyroid nodules, thyroid cancers, flushing syndromesMain campus; Lorain Family Health and Surgery Center (Thyroid cancer only)Office: 216.445.1788 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Lorain, 440.204.7400
Leann Olansky, MDSpecialty Interest(s): Diabetes and diabetes complica-tions, gestational diabetes, general endocrinologyLocation(s): Main campus; Stephanie Tubbs Jones Health CenterOffice: 216.444.2642 | Fax: 216.445.1656Appointments: Main campus, 216.444.6568; Stephanie Tubbs Jones Health Center, 216.767.4242
Richard Shewbridge, MDSpecialty Interest(s): Endocrinology, diabetes, thyroid disorders, hyperlipidemia, osteoporosisLocation(s): MedinaOffice: 330.725.3713 | Fax: 330.725.2141Appointments: 330.725.3713
Mario Skugor, MDCo-director, Thyroid CenterAssociate Director, Endocrinology Fellowship ProgramSpecialty Interest(s): Osteoporosis and calcium metabolism, obesity and diabetes, multiple endocrine neoplasia syndromes, thyroid disorders, thyroid cancerLocation(s): Main campusOffice: 216.445.0739 | Fax: 216.445.1656Appointments: 216.444.6568
David Shewmon, MDSpecialty Interest(s): General endocrinology, diabetes, high cholesterol, osteomalacia, osteoporosis, pituitary tumors, thyroid conditions, thyroid cancerLocation(s): Wooster Family Health CenterOffice: 330.287.4690 | Fax: 330.287.4876Appointments: 330.287.4690
Mariam Stevens, MDSpecialty Interest(s): Diabetes, gestational diabetes, goiter, Graves’ disease, Hashimoto’s disease, hirsutism, hyperthyroidism, hypoglycemia, hypothyroidism, polycystic ovary syndrome, thyroid disease, thyroid noduleLocation(s): Independence Family Health CenterOffice: 216.986.4000 | Fax: 216.986.4995Appointments: 216.986.4000
Robert Zimmerman, MDDirector, Cleveland Clinic Diabetes CenterVice Chairman, Department of Endocrinology, Diabetes and MetabolismProgram Director, Endocrinology Training ProgramSpecialty Interest(s): Diabetes, thyroid disorders, growth hormone in adultsLocation(s): Main campusOffice: 216.444.9428 | Fax: 216.445.1656Appointments: 216.444.6568
Department of Endocrine Surgery
Eren Berber, MDDirector, Robotic Endocrine SurgerySpecialty 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 surgeryLocation(s): Main campusOffice: 216.445.0555 | Fax: 216.636.0662Appointments: 216.444.6568
Kresimira (Mira) Milas, MDDirector, Thyroid CenterSpecialty Interest(s): Endocrine surgery (thyroid and parathyroid), thyroid cancer, multiple endocrine neoplasia syndromes, hereditary thyroid disordersLocation(s): Main campusOffice: 216.444.4985 | Fax: 216.636.0662Appointments: 216.444.6568
Jamie Mitchell, MDSpecialty Interest(s): Endocrine surgery (thyroid, parathyroid and adrenal), laparoscopic solid organ surgery, advanced laparoscopic surgery, laparoscopic radiofrequency ablation of liver tumorsLocation(s): Main campus; Independence Family Health Center; Solon Family Health CenterOffice: 216.445.9713 | Fax: 216.636.0662Appointments: Main campus, 216.444.6568; Independence, 216.986.4000; Solon, 440.519.6800
Joyce J. Shin, MDSpecialty 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 tumorsLocation(s): Main campus; Willoughby Hills Family Health CenterOffice: 216.636.9365 | Fax: 216.636.0662Appointments: Main campus, 216.444.6568; Willoughby Hills, 440.943.2500
Allan Siperstein, MD Department ChairSpecialty Interest(s): Endocrine surgery (thyroid and parathyroid), advanced laparoscopic surgery, laparoscopic adrenalectomy, laparoscopic thermal ablation of liver tumors, pancreatic endocrine tumorsLocation(s): Main campusOffice: 216.444.5664 | Fax: 216.636.0662Appointments: 216.444.6568
Bariatric and Metabolic Institute
Stacy Brethauer, MDSpecialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, hernia repair, endoscopy, surgery for GERD, hiatal hernia, solid-organ endoluminal surgery, single-incision laparoscopic surgeryLocation(s): Main campusOffice: 216.444.9244 | Fax: 216.445.1586Appointments: 216.445.2224
Derrick Cetin, DOSpecialty Interest(s): Bariatric medicine, medical weight management, nutrition sciences, obesity management, preoperative evaluation, diabetes careLocation(s): Main CampusOffice: 216.445.4255 | Fax: 216.636.1588Appointments: 216.445.2224
Bipan Chand, MDSpecialty 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 surgeryLocation(s): Main campusOffice: 216.444.6668 | Fax: 216.445.1586Appointments: 216.445.2224
Karen Cooper, DOSpecialty Interest(s): Bariatric medicine, family medicine, kinesiology and nutrition sciences, exercise instructionLocation(s): Main campusOffice: 216.445.1114 | Fax: 216.445.1586Appointments: 216.445.2224
Matthew Kroh, MDSpecialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgeryLocation(s): Main campus Office: 216.445.9966 | Fax: 216.444.2153Appointments: 216.445.2224
Tomasz Rogula, MD, PhDSpecialty Interest(s): Advanced laparoscopic surgery, bariatric surgery, gastrointestinal surgery, endoscopy, single-incision laparoscopic surgeryLocation(s): Main campus; Strongsville Family Health and Surgery CenterOffice: 216.445.0255 | Fax: 216.445.1586Appointments: Main campus: 216.445.2224; Strongsville: 440.878.2500
Philip Schauer, MDDepartment ChairSpecialty Interest(s): Bariatric surgery, laparoscopic surgery, gastrointestinal surgery, colon surgery, weight management, hernia surgery, biliary surgery, surgery for GERDLocation(s): Main campusOffice: 216.444.4794 | Fax: 216.445.1586Appointments: 216.445.2224
Endocrinology & Metabolism Institute | staff Directory
Visit clevelandclinic.org/EndoStaff for the most current staff listings and locations.
77763_CCFBCH_Cover_ACG.indd 2 11/8/11 12:14 PM
2011
Updates for physicians on practices, advances and research from Cleveland Clinic’s Endocrinology & Metabolism Institute
Endocrine Notes
The Cleveland Clinic Foundation Endocrinology & Metabolism Institute Endocrine Notes 9500 Euclid Avenue / AC311 Cleveland, OH 44195
In This Issue:
F o r Yo u r PaT I E N T s
Medical Concierge Complimentary assistance for out-of-state patients
and families: 800.223.2273, ext. 55580, or email
medicalconcierge@ccf.org.
Global Patient servicesComplimentary assistance for national and international
patients and families: 001.216.444.8184 or visit
clevelandclinic.org /ic.
MyChart®Cleveland Clinic MyChart® is a secure, online personal health-
care 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 appoint-
ments and request new ones. A new feature, Schedule My
Appointment, allows patients to view their primary physician’s
open schedule and make appointments online in real time.
Patients may register for MyChart® through their physician’s
office or by going online to ccf.org/mychart.
Critical Care Transport WorldwideCleveland 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. Trans-
port 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.
Physician Directory
View all Cleveland Clinic staff
online at clevelandclinic.org/staff.
Outcomes Data View the latest clinical Outcomes
books from Cleveland Clinic’s Endo-
crinology & Metabolism Institute at
clevelandclinic.org/quality/outcomes.
Referring Physician Center
For help with service-related issues,
information about our clinical special-
ists and services, details about CME
opportunities and more, email
refdr@ccf.org, or call 216.448.0900
or 888.637.0568.
CME Opportunities: Live & Online
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 publica-tions and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org.
C l E v E l a N d C l I N I C r E s o u r C E G u I d E
Track Your Patient’s Care onlineDrConnect is a secure online service providing our phy-
sician 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.
request Medical records216.445.2547 or 800.223.2273, ext. 52547
EMI referralsEndocrinology & Metabolism Institute 216.444.6568 or 800.223.2273, ext. 46568
Bariatric Surgery 216.445.2224 or 800.223.2273, ext. 52224
2 New Entity: Primary Hyperparathyroidism with Normal PTH
4 a rare Case of acromegaly diagnosed during Pregnancy
6 robotic approach Preferred for adrenalectomy
8 sTaMPEdE substudy asks Whether Gastric Bypass reverses Beta Cell dysfunction
9 sTaMPEdE 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
11-ENd-008
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.
77763_CCFBCH_Cover_ACG.indd 1 11/15/11 7:36 AM
2011
Updates for physicians on practices, advances and research from Cleveland Clinic’s Endocrinology & Metabolism Institute
Endocrine Notes
The Cleveland Clinic Foundation Endocrinology & Metabolism Institute Endocrine Notes 9500 Euclid Avenue / AC311 Cleveland, OH 44195
In This Issue:
F o r Yo u r PaT I E N T s
Medical Concierge Complimentary assistance for out-of-state patients
and families: 800.223.2273, ext. 55580, or email
medicalconcierge@ccf.org.
Global Patient servicesComplimentary assistance for national and international
patients and families: 001.216.444.8184 or visit
clevelandclinic.org /ic.
MyChart®Cleveland Clinic MyChart® is a secure, online personal health-
care 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 appoint-
ments and request new ones. A new feature, Schedule My
Appointment, allows patients to view their primary physician’s
open schedule and make appointments online in real time.
Patients may register for MyChart® through their physician’s
office or by going online to ccf.org/mychart.
Critical Care Transport WorldwideCleveland 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. Trans-
port 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.
Physician Directory
View all Cleveland Clinic staff
online at clevelandclinic.org/staff.
Outcomes Data View the latest clinical Outcomes
books from Cleveland Clinic’s Endo-
crinology & Metabolism Institute at
clevelandclinic.org/quality/outcomes.
Referring Physician Center
For help with service-related issues,
information about our clinical special-
ists and services, details about CME
opportunities and more, email
refdr@ccf.org, or call 216.448.0900
or 888.637.0568.
CME Opportunities: Live & Online
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 publica-tions and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org.
C l E v E l a N d C l I N I C r E s o u r C E G u I d E
Track Your Patient’s Care onlineDrConnect is a secure online service providing our phy-
sician 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.
request Medical records216.445.2547 or 800.223.2273, ext. 52547
EMI referralsEndocrinology & Metabolism Institute 216.444.6568 or 800.223.2273, ext. 46568
Bariatric Surgery 216.445.2224 or 800.223.2273, ext. 52224
2 New Entity: Primary Hyperparathyroidism with Normal PTH
4 a rare Case of acromegaly diagnosed during Pregnancy
6 robotic approach Preferred for adrenalectomy
8 sTaMPEdE substudy asks Whether Gastric Bypass reverses Beta Cell dysfunction
9 sTaMPEdE 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
11-ENd-008
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.
77763_CCFBCH_Cover_ACG.indd 1 11/22/11 5:27 PM
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