About

Preethika Ekanayake is an Assistant Clinical Professor in the Department of Medicine at UC San Diego. She completed her undergraduate education with a BS in Neuroscience from the University of California, Los Angeles, and earned her MD from the University of California, Davis. Her postgraduate training includes an Internal Medicine Residency at UC San Diego and a fellowship in Endocrinology, Diabetes, and Metabolism at UC San Diego. She has received recognition such as the Alpha Omega Alpha (AOA) Junior Inductee in 2011 and the AMA Physicians of Tomorrow Scholarship in the same year. Her research work involves various aspects of endocrinology and metabolism, with publications on topics such as osteoporosis treatment in organ transplant recipients, orbital inflammation after zoledronate infusion, endocrinopathies induced by abiraterone, and the management of type 2 diabetes with insulin pump therapy. She has contributed to the understanding of the effects of SGLT-2 inhibitors, ketogenesis, and the evolving treatment paradigms for diabetes, emphasizing cardiorenal protection. Her work also includes studies on electronic glucose management systems and steroid metabolic enzymes. Her research is characterized by a focus on clinical applications in endocrinology and metabolism, contributing to the advancement of treatment strategies and understanding of metabolic diseases.

Research topics

• Internal medicine
• Medicine
• Computer Science
• Chemistry
• Endocrinology
• Cardiology
• Radiology
• Nursing
• Intensive care medicine
• Urology
• Organic chemistry
• Database

Selected publications

• Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach

  Therapeutic Advances in Endocrinology and Metabolism · 2025-06-14 · 2 citations

  reviewOpen accessSenior author

  Bone and mineral disorders are highly prevalent in solid organ transplant recipients. These patients are at high risk for osteoporosis and fragility fractures due to several pre- and post-transplant factors, including end-stage organ disease leading to chronic malnutrition and osteomalacia, as well as chronic immunosuppressive therapy that has direct adverse effects on bone remodeling. Low pre-transplant bone mineral density is associated with an increased risk for fragility fracture post-transplant. Furthermore, there is a precipitous loss of bone density within 6-12 months post-transplant due to a myriad of causal factors. In this review, we will elaborate on the treatment options and challenges in management of osteoporosis in solid organ recipients using vitamin D, calcium, bisphosphonates, denosumab, and osteoanabolic agents. The greatest body of evidence discusses the use of bisphosphonates, with most patients benefiting from early treatment.

  PublisherDOI

• SUN-004 Paraganglioma-Induced Catecholamine Crisis Presenting with Cardiomyopathy

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: A. Dhulipalli: None. J.K. Sicklick: None. P.S. Ekanayake: None. Background: Catecholamine-secreting tumors like paragangliomas (PGL) are rare neuroendocrine neoplasms that can result in catastrophic cardiometabolic complications if left untreated. Clinical Case: A 61-year-old male with a history of 50-pack year smoking, hypertension, type 2 diabetes and biopsy proven 5.4x3x3.3-cm aortocaval catecholamine-secreting PGL, who previously declined surgical resection, presented to the ER 18 months later. He was found to be in hypertensive emergency and diabetic ketoacidosis (DKA). Lab tests showed blood glucose of 564 mg/dL (ref 70-99), beta-hydroxybutyrate of 17.3 mg/dL (ref <2.8), anion gap of 28 mmol/L (ref 7-15), pH 7.2 (ref 7.33-7.40), troponin of 1403 ng/L (ref <22) and NT-proBNP of 6268 pg/mL (ref <899). Echocardiogram showed an ejection fraction (EF) of 23% without wall motion abnormalities. He had evidence of demand ischemia and congestive heart failure with X-ray evidence of Kerley B lines. Hormonal workup revealed elevated serum epinephrine at 35,390 pg/mL (ref 10-200), norepinephrine at 40,808 pg/mL (ref 80-520), chromogranin A at 862 ng/mL (ref <103), serum metanephrines at 49.5 nmol/L (ref <0.49) and normetanephrines at 39.9 nmol/L (ref <0.8). CT scan showed his PGL had enlarged in the interim to 5.4x4.4x8.1 cm with central necrosis. He was started on insulin drip for DKA and nicardipine drip for hypertensive crisis. He was later switched to alpha blockade (doxazosin, titrated to 8 mg twice a day) followed by beta blockade. After 5 days of doxazosin, EF improved to 56% with resolution of volume overload. Due to high cardiac risk, cardiac catheterization was performed, revealing 90% stenosis of the left anterior descending artery, leading to placement of 2 stents. He was started on Plavix. Six weeks later, he underwent tumor resection. Plavix was held and he was placed on intravenous antiplatelet (P2Y12) inhibitor, cangrelor, until the first surgical incision. Due tumor involvement of the anterior wall of the inferior vena cava, vascular resection with primary inferior vena cava (IVC) repair was required. The estimated blood loss was 2000 mL and his post-operative course was notable for one hypertensive episode. The patient was discharged in good health 7 days postoperatively. Conclusion: Excess catecholamines increase cardiac workload by raising heart rate and blood pressure, which contributes to myocardial ischemia and impaired cardiac function. Alpha before beta-blockade is crucial to prevent unopposed alpha-adrenergic activity. However, surgical resection is the definitive treatment. This case highlights the profound effects of long-standing catecholamine excess on cardiometabolic health and the success of post-operative outcomes when a complex paraganglioma surgery is performed at a tertiary care center with a multidisciplinary team. Presentation: Sunday, July 13, 2025

  PublisherOA PDFDOI

• Bone Health ECHO Case Report: Orbital Inflammation after Zoledronate Infusion

  Journal of Clinical Densitometry · 2024-08-10 · 2 citations

  articleSenior author
  PublisherDOI

• Author response for "Identifying Those Patients with Type 2 Diabetes Who Might Benefit from Insulin Pump Therapy: Literature Review, Clinical Opportunities, Potential Benefits & Challenges"

  2023-03-10

  peer-review1st authorCorresponding
  PublisherDOI

• Identifying patients with type 2 diabetes who might benefit from insulin pump therapy: Literature review, clinical opportunities, potential benefits and challenges

  Diabetes Obesity and Metabolism · 2023-03-23 · 9 citations

  reviewOpen access1st authorCorresponding

  The global prevalence and increasing incidence rates of type 2 diabetes (T2D) have rippling effects on healthcare costs and diminishing quality of life. Despite advances in technology, continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, is rarely being recommended by healthcare professionals and is underutilized in T2D management. This review analyses the available literature on CSII use in T2D patients. In addition, it discusses which groups of patients may benefit from CSII, identifies potential challenges associated with CSII use, and suggests future directions for research to expand the applicability of this technology to the broader T2D population.

  PublisherOA PDFDOI

• Abiraterone-Induced Endocrinopathies

  JCEM Case Reports · 2023-02-17 · 8 citations

  articleOpen accessSenior authorCorresponding

  Abiraterone, a CYP17A1 inhibitor, is used along with prednisone in patients with castration-resistant and castration-sensitive prostate cancer, yielding improved overall and disease-free survival. However, little is documented in the endocrinology literature about the incidences of the endocrine side effects of abiraterone. In this case series, we discuss the diagnosis and management of 3 prostate cancer patients who experienced mineralocorticoid excess and secondary adrenal insufficiency related to abiraterone and prednisone use.

  PublisherOA PDFDOI

• Thyroid Gland Ultrasonography: Hashimoto’s, Graves’, Thyroiditis, Toxic Multinodular Goiter

  Contemporary Endocrinology · 2023-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

• Increase in hematocrit with SGLT-2 inhibitors - Hemoconcentration from diuresis or increased erythropoiesis after amelioration of hypoxia?

  Diabetes & Metabolic Syndrome Clinical Research & Reviews · 2022 · 30 citations

  1st authorCorresponding
  • Internal medicine
  • Medicine
  • Endocrinology
  PublisherDOI

• Alpelisib - Induced Hyperglycemia

  Acta Endocrinologica (Bucharest) · 2022-01-01 · 4 citations

  articleOpen access1st authorCorresponding

  Context: Phosphoinositide-3-kinase (PI3K) pathway inhibitors are increasingly used as targeted therapy in malignancies. We discuss here three cases of PI3K inhibitor induced hyperglycemia and discuss the mechanism of action of these medications and treatment of this class side effect. Objectives: Alpelisib (Piqray) is the newest PI3K inhibitor used in conjunction with Fulvestrant to treat specific types of breast cancer. Since PI3K is a critical mediator of insulin signaling, hyperglycemia is an on-target, unfortunate side effect of this treatment. We present a case series of severe hyperglycemia induced by the alpelisib in three women without a history of diabetes. Design: All three women in this study had hormone receptor (HR) positive, human epidermal growth factor receptor 2 (Her2) negative, PI3K mutated breast cancer. They were referred to our clinic by Oncology for alpelisib-induced hyperglycemia. Subjects and Methods: Review of laboratory values and glucometer values were conducted during each visit allowing treatment decisions. Two of these women are actively managed by us for their diabetes. One woman recently died due to progression of malignancy. Results: All three women presented with new onset of severe hyperglycemia after the initiation of PI3K inhibitor, alpelisib. At least one case noted maximal glucose elevation in the hours following drug ingestion. In another, cessation of Alpelisib reversed the hyperglycemia within the span of one week. Conclusion: Hyperglycemia induced by PI3K inhibitors can be recalcitrant and might necessitate interruption of chemotherapy. Optimal glucose-lowering therapy remains unclear as exogenous insulin has the theoretical potential to overcome PI3K inhibition.

  PublisherOA PDFDOI

• A novel hypothesis linking low‐grade ketonaemia to cardio‐renal benefits with sodium‐glucose cotransporter‐2 inhibitors

  Diabetes Obesity and Metabolism · 2021-10-05 · 18 citations

  review1st authorCorresponding

  The cardio-renal benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors are well established. In 2016, we postulated that these benefits are attributable, in part, to the occurrence of chronic low-grade ketonaemia and a shift in myocardial and renal fuel metabolism away from fat oxidation, which is energy inefficient, towards ketone oxidation, which is more energy efficient. This shift improves myocardial and renal function and can potentially translate into lower rates of progression to heart failure and end-stage kidney disease in patients with and without diabetes. There is now evidence that, in addition to being an efficient fuel substrate, ketones also have antiinflammatory and antioxidative benefits on the heart and the kidney. In addition, ketones have positive effects on mitochondrial biogenesis and function, and on erythropoiesis, and thereby are potentially able to further ameliorate the proinflammatory and hypoxic milieu in those with heart and kidney failure, independent of hyperglycaemia. In the present review, we propose a novel hypothesis to link the pleiotropic effects of low-grade ketonaemia to the cardio-renal benefits seen with SGLT2 inhibitors.

  PublisherDOI

Frequent coauthors

• Johanna Gerwer

  University of California, San Diego

  5 shared

• Sunder Mudaliar

  Geriatric Research Education and Clinical Center

  4 shared

• Karen C. McCowen

  4 shared

• Mohit Mittal

  Fortis Hospital

  2 shared

• Sunder Mudaliar

  VA San Diego Healthcare System

  2 shared

• Surinder Mann

  2 shared

• Mizuho S. Mimoto

  University of California San Diego Medical Center

  2 shared

• Dhavan Parikh

  University of California, Davis

  2 shared

Awards & honors

• Alpha Omega Alpha (AOA) Junior Inductee (2011)
• AMA Physicians of Tomorrow Scholarship (2011)