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Dr. Pinnaro Earns Masters of Science in Translational Biomedicine

Dr. Catherina Pinnaro

Congratulations to Dr. Catherina Pinnaro, who has just fulfilled the requirements of the Masters in Translational Biomedicine at the University of Iowa. This was no easy accomplishment, as she worked on the degree while simultaneous initially being a Pediatric Endocrine Fellow and most recently while being a full time faculty member. Additionally, the degree required original research of publishable quality. Dr. Pinnaro will be using her newly acquired skills and knowledge to advance a research program aimed at better understanding the genetic modifiers of endocrine diseases.

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Treatment-Induced Neuropathy of Diabetes in Pediatric Aged Patients

Dr. Eirene Alexandrou

Treatment-Induced Neuropathy of Diabetes (TIND) is a insufficiently recognized complication, usually temporary, that can occur after rapid correction of severe hyperglycemia. Its occurrence in the pediatric-aged population has not been well studied. Dr. Eirene Alexandrou has just published a paper describing 7 cases of TIND among children and young adults. She published the work in the Journal of the Endocrine Society (link to paper). The cases occurred in both type 1 and type 2 diabetes, and in each case followed a rapid improvement from severe hyperglycemia. All but 1 of the cases were transient. Symptoms included pain, often burning in nature, numbness, and autonomic disturbance. Management included stabilization of glycemia and medical therapy.

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Glucose Control and COVID Hospitalization Risk in Persons with Type 1 Diabetes

  • Dr. Pinnaro
  • Dr. Tansey

Yesterday, data were published indicating that among persons with type 1 diabetes, higher average glucose levels are associated with increased risk of requiring hospitalization for COVID infection. The peer reviewed data was published in the Journal of Clinical Endocrinology and Metabolism ( doi permanent link ; pubmed link ). The data were collected via the national T1D Exchange study consortium. Drs. Pinnaro and Tansey from our division are part of this consortium and helped author the article. The data indicate that if you have type 1 diabetes, you should keep your blood sugars in range as much as possible to help prevent severe COVID. We remain happy to help you achieve this goal; our contact information can be found by clicking on the “clinical website” at the top of our links page.

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Electromagnetic Fields Can Treat Type 2 Diabetes

Graphical summary of findings showing that electromagnetic fields can treat type 2 diabetes.

Our division director has contributed to new scientific work that has been published in Cell Metabolism showing that exposure to generated electromagnetic fields lowers blood sugar in rodents with type 2 diabetes. Dr. Norris helped design and interpret the glycemic clamp studies that were used to better understand the physiological mechanisms involved in the phenomenon. (Pubmed link; DOI link).

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A Tale of Two Pancreases

A graphical summary of exocrine-endocrine interactions in the pancreas

Fascinatingly, the pancreas is really two organs mixed together. The exocrine part of the pancreas produces digestive enzymes that are secreted into the small intestine. The endocrine part of the pancreas makes insulin and glucose, which are secreted into the blood stream. The endocrine parts of the pancreas are scattered like islands within the exocrine part. Although the function of endocrine part of the pancreas has long been considered to be fairly independent of the exocrine, it is increasingly being recognized that the health of the exocrine pancreas influences the endocrine portion. Our division director, Dr. Norris, just helped author a review article on this topic. The work was just published in the journal Diabetologia, which is the leading diabetes research journal published in Europe. The article reviews how diseases of the exocrine pancreas can lead to defects in insulin production and diabetes. (Pubmed link, DOI link)

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Primary Adrenal Insufficiency Might Worsen COVID-19 Risk

Andrew Norris, MD PhDPost by
Andrew Norris, MD PhD
Director, Pediatric Endocrinology & Diabetes
University of Iowa Stead Family Children’s Hospital

An important, timely question regards determining which co-existing conditions increase the severity of COVID-19 in youth. In adults, for example, obesity, metabolic syndrome, and type 2 diabetes are endocrine conditions that increase the risk of severe COVID-19. By contrast, it appears that diabetes in the young does not increase the risk of severe COVID-19 infection, as noted in our other blog post (link). In fact, most most pediatric endocrine conditions are not thought to induce immunosuppression. However, disorders of glucocorticoid secretion bear closer scrutiny. Excess glucocorticoid secretion, otherwise known as endogenous Cushing Syndrome, induces immunosuppression and may increase risk of severe COVID-19 (link). Thankfully, endogenous forms of Cushing Syndrome are very rare in children. However, deficiencies of glucocorticoid secretion (otherwise known as adrenal insufficiency) are not as rare and affect scores of youth in our region. The American Association of Clinical Endocrinologists (AACE) has published a position piece (link) warning that persons with adrenal insufficiency appear to be at higher risk of death from a wide swath of respiratory infections, and that there is no reason to suspect that this risk does not extend to COVID-19. Indeed, multiple large cohort / population studies have shown that persons with adrenal insufficiency have increased susceptibility to a wide swath of infections (example publications: 2020 JCEM ; 2013 JCEM ; 2016 JCEM ; 2006 JCEM ; 2017 EuJEndo ). It is important to note that there are at least two limitations to this “best available” evidence. (1) It has not involved youth with adrenal insufficiency. (2) Despite these studies being very large, they are largely retrospective. On the other hand, the observation is biologically plausible, since cortisol is a powerful immune modulating hormone that can not be replaced in a perfectly physiological manner. Thus, the related recommendations of the AACE appear important: briefly that persons with adrenal insufficiency should maintain precautions to avoid COVID-19 exposure, to maintain their adrenal replacement therapies, and to give stress dose steroids as instructed. The AACE recommendations can be found here. As always, our pediatric endocrinology team remains available 24/7 to support youth with adrenal disorders.

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Announcing New Faculty: Eirene Alexandrou, MD

Dr. Alexandrou

We are pleased to announce that Dr. Eirene Alexandrou is starting as a new pediatric endocrinologist in our division. She received her Medical Degree from Indiana University School of Medicine, completed a residency in pediatrics at the Medical College of Georgia, and just completed a fellowship in pediatric endocrinology at the prestigious Cincinnati Children’s Hospital. She has published expertise in the areas of growth research (link) and Turner Syndrome. In clinic, her initial practice will include general pediatric endocrinology and diabetes, as well as outreach services in Cedar Rapids and Dubuque.

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Announcing New Faculty: Akhila Ramakrishna, MD

Dr. Ramakrishna

We are pleased to announce that Dr. Akhila Ramakrishna is starting as a new pediatric endocrinologist in our division. She received her Medical Degree from the Armed Forces Medical College, then completed a residency in pediatrics at Case Western Reserve, and just completed a fellowship in pediatric endocrinology at the prestigious Mayo Clinic. She has published expertise in the area of thyroid dysfunction (link) and has studied rodent models of obesity as a fellow as well. In clinic, her practice will include general pediatric endocrinology and diabetes, as well as gender-related endocrine care, obesity-related endocrine care especially regarding bariatric surgery in adolescents, and outreach pediatric endocrine services in Cedar Falls.

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Announcing New Faculty: Catherina Pinnaro, MD

Dr. Pinnaro

We are pleased to announce that Dr. Catherina “Cat” Pinnaro is starting as a new pediatric endocrinologist in our division. Her position will be on the tenure-track, meaning that she will be expected to be productive as a research physician. Dr. Pinnaro received her Medical Degree from New York Medical College where she successfully competed for a Doris Duke research year, which she spent at the University of Iowa. She then completed a residency in pediatrics at the University of Iowa, just completed a fellowship in pediatric endocrinology here as well, and is on track to earn a Master’s in Translational Biomedicine in late 2020. While a fellow, she has created several productive research projects, having already published on the genetics of 22q syndrome (link) and diabetes care simulation (link). Her research will focus on the etiology of diabetes in specific disease contexts, applying her genetics expertise. In clinic, her practice will include general pediatric endocrinology and diabetes.