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Article: New-onset primary adrenal insufficiency in pregnancy associated with a unilateral adrenal infarction: a case report.

Menon, Lakshmi / Edem, Dinesh / Maradana, Jhansi / Sharma, Pranjali / Tamhane, Shrikant

Endocrinology, diabetes & metabolism case reports

2023 Volume 2023, Issue 4

Abstract: Summary: New-onset primary adrenal insufficiency is rare in pregnancy. The symptoms of adrenal insufficiency such as nausea, vomiting and dizziness may be attributed to the pregnancy itself, which can lead to a delay in the diagnosis. The presence of ... ...

Abstract	Summary: New-onset primary adrenal insufficiency is rare in pregnancy. The symptoms of adrenal insufficiency such as nausea, vomiting and dizziness may be attributed to the pregnancy itself, which can lead to a delay in the diagnosis. The presence of hypotension, hypoglycemia or hyperkalemia should raise the suspicion for adrenal insufficiency. We report the case of a 25-year-old woman who presented with tachycardia, left flank pain and vomiting at 36 weeks' gestation. She was found to have primary adrenal insufficiency and started on hydrocortisone and fludrocortisone with resolution of the vomiting and tachycardia. MRI of the abdomen revealed an acute nonhemorrhagic infarct of the left adrenal gland. The contralateral adrenal gland was normal. Autoimmune and infectious etiologies of primary adrenal insufficiency were ruled out and the adrenal insufficiency was attributed to the unilateral adrenal infarction. Adrenal insufficiency persisted after delivery and then resolved at approximately 16 months post partum. This case highlights the need to test women with unilateral adrenal infarction in pregnancy for the presence of primary adrenal insufficiency. Learning points: Adrenal insufficiency should be considered when a pregnant woman develops nausea, vomiting and dizziness in association with hypotension or hypoglycemia. Hypovolemic hyponatremia related to vomiting can occur in pregnancy, but the failure to correct hyponatremia despite adequate IV hydration should raise the suspicion for adrenal insufficiency. Adrenal infarction should be in the differential diagnosis for unilateral flank pain in pregnancy. Other common etiologies for flank pain in pregnancy include nephrolithiasis, pyelonephritis and acute cholecystitis. Unilateral adrenal infarction in pregnancy can lead to the development of primary adrenal insufficiency. Following delivery, these patients need to be monitored for the resolution of the adrenal insufficiency.
Language	English
Publishing date	2023-11-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2785530-2
ISSN	2052-0573
ISSN	2052-0573
DOI	10.1530/EDM-23-0093
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Ectopic Adrenocorticotropic Hormone-Producing Metastatic Gastrinoma: A Case Report.

Tamhane, Shrikant / Menon, Lakshmi P / Edem, Dinesh / Sharma, Pranjali / Maradana, Jhansi

Cureus

2023 Volume 15, Issue 9, Page(s) e45329

Abstract: Pancreatic neuroendocrine tumors secreting gastrin and adrenocorticotropic hormone (ACTH) are rare. The presentation of the cases can be varied, making the diagnosis challenging and often delayed. Here, we present a patient who presented with severe ... ...

Abstract	Pancreatic neuroendocrine tumors secreting gastrin and adrenocorticotropic hormone (ACTH) are rare. The presentation of the cases can be varied, making the diagnosis challenging and often delayed. Here, we present a patient who presented with severe hypokalemia and was found to have ectopic Cushing's syndrome. An abdominal CT scan showed a pancreatic lesion with metastatic liver disease. A biopsy of the liver lesion confirmed a metastatic neuroendocrine tumor. The final diagnosis was ectopic ACTH-producing metastatic gastrinoma. Twenty-four-hour urinary cortisol was significantly elevated at 9,790 mcg/24 hours. The excess hormonal secretion was successfully treated with ketoconazole and somatostatin analogs. She was further started on chemotherapy with capecitabine plus temozolomide, which has become the preferred chemotherapy treatment after the results of the recently completed trial. She also received Y90 therapy for metastatic liver disease. The prognosis of metastatic pancreatic neuroendocrine tumors is poor. Multidisciplinary combined therapies can help control disease and improve prognosis. We present an 18-month-long patient follow-up and a literature review of ectopic ACTH-producing metastatic gastrinomas.
Language	English
Publishing date	2023-09-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.45329
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Article: Retraction Note: Thyroid nodules update in diagnosis and management.

Tamhane, Shrikant / Gharib, Hossein

Clinical diabetes and endocrinology

2016 Volume 2, Page(s) 10

Abstract: This retracts the article DOI: 10.1186/s40842-015-0011-7.]. ...

Abstract	[This retracts the article DOI: 10.1186/s40842-015-0011-7.].
Language	English
Publishing date	2016-04-14
Publishing country	England
Document type	Retraction of Publication
ZDB-ID	2834859-X
ISSN	2055-8260
ISSN	2055-8260
DOI	10.1186/s40842-016-0025-9
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Article: Thyroid nodule update on diagnosis and management.

Tamhane, Shrikant / Gharib, Hossein

Clinical diabetes and endocrinology

2016 Volume 2, Page(s) 17

Abstract: Thyroid nodules are common. The clinical importance of thyroid nodules is related to excluding malignancy (4.0 to 6.5% of all thyroid nodules), evaluate their functional status and assess for the presence of pressure symptoms. Incidental thyroid nodules ... ...

Abstract	Thyroid nodules are common. The clinical importance of thyroid nodules is related to excluding malignancy (4.0 to 6.5% of all thyroid nodules), evaluate their functional status and assess for the presence of pressure symptoms. Incidental thyroid nodules are being diagnosed with increasing frequency in the recent years with the use of newer and highly sensitive imaging techniques. The high prevalence of thyroid nodules necessitates that the clinicians use evidence-based approaches for their assessment and management. New molecular tests have been developed to help with evaluation of malignancy in thyroid nodules. This review addresses advances in thyroid nodule evaluation, and their management considering the current guidelines and supporting evidence.
Language	English
Publishing date	2016-10-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2834859-X
ISSN	2055-8260
ISSN	2055-8260
DOI	10.1186/s40842-016-0035-7
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Article ; Online: ACP Journal Club. Review: Intensive blood pressure control reduces retinopathy in diabetes.

Smith, Steven A / Tamhane, Shrikant

Annals of internal medicine

2015 Volume 162, Issue 12, Page(s) JC7

MeSH term(s)	Blood Pressure ; Blood Pressure Determination ; Diabetes Mellitus ; Humans ; Retinal Diseases
Language	English
Publishing date	2015-06-16
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/ACPJC-2015-162-12-007
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Article: RETRACTED ARTICLE: Thyroid nodules update in diagnosis and management.

Tamhane, Shrikant / Gharib, Hossein

publication RETRACTED

Clinical diabetes and endocrinology

2015 Volume 1, Page(s) 11

Abstract: Thyroid nodules are very common. With widespread use of sensitive imaging in clinical practice, incidental thyroid nodules are being discovered with increasing frequency. Their clinical importance is primarily related to the need to exclude malignancy (4. ...

Abstract	Thyroid nodules are very common. With widespread use of sensitive imaging in clinical practice, incidental thyroid nodules are being discovered with increasing frequency. Their clinical importance is primarily related to the need to exclude malignancy (4.0 to 6.5 percent of all thyroid nodules), assess for their functional status and any pressure symptoms caused by them. New Molecular tests are marketed for the assessment of thyroid nodules for the presence of cancer. The high prevalence of thyroid nodules requires evidence-based rational strategies for their differential diagnosis, risk stratification, treatment, and follow-up. This review addresses advances and controversies in thyroid nodule evaluation, including the new molecular tests, and their management considering the current guidelines and supporting evidence.
Language	English
Publishing date	2015-09-18
Publishing country	England
Document type	Journal Article ; Retracted Publication
ZDB-ID	2834859-X
ISSN	2055-8260
ISSN	2055-8260
DOI	10.1186/s40842-015-0011-7
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Article ; Online: Shared Decision-Making in Diabetes Care.

Tamhane, Shrikant / Rodriguez-Gutierrez, Rene / Hargraves, Ian / Montori, Victor M

Current diabetes reports

2015 Volume 15, Issue 12, Page(s) 112

Abstract: Shared decision-making (SDM) is a collaborative process by which patients and clinicians work together in a deliberative dialogue. The purpose of this dialogue is to identify reasonable management options that best fit and addresses the unique situation ... ...

Abstract	Shared decision-making (SDM) is a collaborative process by which patients and clinicians work together in a deliberative dialogue. The purpose of this dialogue is to identify reasonable management options that best fit and addresses the unique situation of the patient. SDM supports the patient-centered translation of research into practice. SDM also helps implement a core principle of evidence-based medicine: evidence is necessary but never sufficient to make a clinical decision, as consideration of patient values and context is also required. SDM conversations build on a partnership between the patient and the clinician, draw on the body of evidence with regard to the different treatment options, and consider options in light of the values, preferences, and context of the patient. SDM is appropriate for diabetes care because diabetes care often requires consideration of management options that differ in ways that matter to patients, such as the way in which they place significant demands on patient's life and living. In the last decade, SDM has proven feasible and useful for sharing evidence with patients and for involving patients in making decisions with their clinicians. Health care and clinical policies advocate SDM, but these policies have yet to impact diabetes care. In this paper, we describe what SDM is, its known impact on diabetes care, and needed work to implement this patient-centered approach in the care of the millions of patients with diabetes.
MeSH term(s)	Decision Making ; Diabetes Mellitus/therapy ; Evidence-Based Medicine ; Humans
Language	English
Publishing date	2015-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2065167-3
ISSN	1539-0829 ; 1534-4827
ISSN (online)	1539-0829
ISSN	1534-4827
DOI	10.1007/s11892-015-0688-0
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Article ; Online: Bilateral pheochromocytoma: Clinical characteristics, treatment and longitudinal follow-up.

Kittah, Nana Esi / Gruber, Lucinda M / Bancos, Irina / Hamidi, Oksana / Tamhane, Shrikant / Iñiguez-Ariza, Nicole / Babovic-Vuksanovic, Dusica / Thompson, Geoffrey B / Lteif, Aida / Young, William F / Erickson, Dana

Clinical endocrinology

2020 Volume 93, Issue 3, Page(s) 288–295

Abstract: Objective: Comprehensive data about patients with bilateral pheochromocytoma are limited. We aimed to describe the clinical presentation, genetic analysis, treatment and outcomes of patients with bilateral pheochromocytoma.: Design: A retrospective ... ...

Abstract	Objective: Comprehensive data about patients with bilateral pheochromocytoma are limited. We aimed to describe the clinical presentation, genetic analysis, treatment and outcomes of patients with bilateral pheochromocytoma. Design: A retrospective study at a tertiary care centre. Patients: All patients with bilateral pheochromocytoma evaluated at Mayo Clinic in Rochester, Minnesota between January 1951 and December 2015. Measurements: Tumour size, genetic testing, plasma/urine metanephrines and catecholamines. Results: A total of 94 patients (51% women) were diagnosed with bilateral pheochromocytoma at a median age at first presentation of 31 years (range, 4-70). Bilateral disease was noted in 8.0% of pheochromocytoma patient overall and 37.5% of patients 18 years of younger. Most patients presented with synchronous tumours (80%). Median time to metachronous tumours was 4.5 years (range, 1-38). Genetic disease was identified in 75 (80%) patients, including MEN 2A (42.6%), VHL (19.1%), MEN 2B (9.6%) and NF1 (8.5%). Excess catecholamines were present in 97% of patients. Patients with synchronous pheochromocytoma commonly underwent simultaneous bilateral adrenalectomy (99%), and 18 (24%) had cortical-sparing surgery. Multicentric tumours were reported in 23 of 77 (30%) patients with available data. Recurrent disease was found in 9.6% of patients, and 8.5% developed metastatic disease. Median follow-up was 8.5 years. At the study conclusion, 4 patients had died due to pheochromocytoma or adrenalectomy. Conclusions: Bilateral pheochromocytoma occurred in 7.0% of adults with pheochromocytoma and 37.5% of paediatric patients. Genetic disease was identified in 80% of patients, predominantly MEN2A. Multicentric tumours were common, but most were still cured following adrenalectomy.
MeSH term(s)	Adrenal Gland Neoplasms/genetics ; Adrenal Gland Neoplasms/surgery ; Adrenalectomy ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Pheochromocytoma/genetics ; Pheochromocytoma/surgery ; Retrospective Studies ; von Hippel-Lindau Disease
Language	English
Publishing date	2020-06-22
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14222
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Article ; Online: GH Therapy in Childhood Cancer Survivors: A Systematic Review and Meta-Analysis.

Tamhane, Shrikant / Sfeir, Jad G / Kittah, Nana Esi N / Jasim, Sina / Chemaitilly, Wassim / Cohen, Laurie E / Murad, M Hassan

The Journal of clinical endocrinology and metabolism

2018 Volume 103, Issue 8, Page(s) 2794–2801

Abstract: Background: GH deficiency (GHD) is common among childhood cancer survivors (CCSs) with history of tumors, surgery, and/or radiotherapy involving the hypothalamus-pituitary region. We aimed to evaluate the effects of GH therapy (GHT) in CCSs on adult ... ...

Abstract	Background: GH deficiency (GHD) is common among childhood cancer survivors (CCSs) with history of tumors, surgery, and/or radiotherapy involving the hypothalamus-pituitary region. We aimed to evaluate the effects of GH therapy (GHT) in CCSs on adult height, risk of diabetes mellitus, abnormal lipids, metabolic syndrome, quality of life, secondary tumors, and disease recurrence. Methods: We searched multiple databases for randomized and observational studies. Pairs of reviewers independently selected studies and collected data. Random effects meta-analysis was used to pool outcomes across the studies. Results: We included 29 observational studies at moderate to high risk of bias. Sixteen studies compared CCSs on GHT with those not on GHT (512 patients, GH dose: 0.3 to 0.9 IU/kg/week). GHT was significantly associated with height gain [standard deviation score, 0.61; 95% CI, 0.08 to 1.13] and was not significantly associated with the occurrence of secondary tumors [odds ratio (OR), 1.10; 95% CI, 0.72 to 1.67] or tumor recurrence (OR, 0.57; 95% CI, 0.31 to 1.02). Thirteen studies compared CCSs on GHT with normal age- or sex-matched controls or controls with idiopathic GHD or short stature. GHT was associated with either improved or unchanged risk of diabetes, lipid profiles, and metabolic syndrome. GHT was associated with improvements in quality of life. Conclusion: CCSs treated with GHT gain height compared with the untreated controls. GHT may improve lipid profiles and quality of life and does not appear to increase the risk of diabetes or the development of secondary tumors, although close monitoring for such complications remains warranted due to uncertainty in the current evidence.
MeSH term(s)	Adult ; Cancer Survivors ; Child ; Growth Disorders/diagnosis ; Growth Disorders/drug therapy ; Growth Disorders/etiology ; Hormone Replacement Therapy ; Human Growth Hormone/deficiency ; Human Growth Hormone/therapeutic use ; Humans ; Hypopituitarism/diagnosis ; Hypopituitarism/drug therapy ; Hypopituitarism/etiology
Chemical Substances	Human Growth Hormone (12629-01-5)
Language	English
Publishing date	2018-07-06
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2018-01205
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Article ; Online: Diagnosis of GH Deficiency as a Late Effect of Radiotherapy in Survivors of Childhood Cancers.

Sfeir, Jad G / Kittah, Nana Esi N / Tamhane, Shrikant U / Jasim, Sina / Chemaitilly, Wassim / Cohen, Laurie E / Murad, M Hassan

The Journal of clinical endocrinology and metabolism

2018 Volume 103, Issue 8, Page(s) 2785–2793

Abstract: Background: Limited guidance exists for selecting a laboratory method for diagnosing GH deficiency (GHD) when it occurs as a late effect of radiotherapy in childhood cancer survivors (CCSs).: Methods: We searched Medline, Embase, Cochrane Central ... ...

Abstract	Background: Limited guidance exists for selecting a laboratory method for diagnosing GH deficiency (GHD) when it occurs as a late effect of radiotherapy in childhood cancer survivors (CCSs). Methods: We searched Medline, Embase, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus for studies evaluating GHD that used IGF-1 or IGF-binding protein 3 (IGFBP-3) measurements compared with GH dynamic testing. Results: We included 15 studies [IGF-1 (8 studies) and IGFBP-3 (7 studies)] enrolling 477 patients. Comparator tests varied widely. Overall, both IGF-1 and IGFBP-3 had suboptimal diagnostic accuracy but were strongly correlated. The use of both tests simultaneously in the same cohort did not improve the diagnostic accuracy. Despite high variability in the testing protocols, dynamic tests remained the most accurate for appropriately identifying patients with GHD. The insulin tolerance test (ITT) appears to be the most accepted reference test when used alone or in combination with arginine; however, standardized testing strategies among practice groups are absent. GHRH and arginine stimulation performed almost similarly to the ITT; however, in one study GHRH with arginine stimulation had 66% sensitivity and 88% specificity compared with the ITT. Insufficient data were available to assess the accuracy of serial GH testing (nocturnal or over 24 hours). Conclusion: The diagnostic accuracy of various dynamic tests for GHD in CCSs appears to follow the same patterns as those in non-CCSs. Interpreting GHRH stimulation is a challenge given the primarily hypothalamic dysfunction in CCSs. IGF-1 and IGFBP-3 perform poorly in this population.
MeSH term(s)	Adult ; Age of Onset ; Cancer Survivors/statistics & numerical data ; Child ; Diagnostic Techniques, Endocrine/standards ; Growth Disorders/diagnosis ; Growth Disorders/epidemiology ; Growth Disorders/etiology ; Human Growth Hormone/deficiency ; Humans ; Predictive Value of Tests ; Radiation Injuries/diagnosis ; Radiation Injuries/epidemiology ; Radiotherapy/adverse effects ; Radiotherapy/statistics & numerical data ; Reproducibility of Results
Chemical Substances	Human Growth Hormone (12629-01-5)
Language	English
Publishing date	2018-06-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2018-01204
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