About

Priyadarshini Balasubramanian, MD, is an Assistant Professor of Medicine (Endocrinology) at Yale School of Medicine. She received her MD degree at Yale New Haven Hospital, Bridgeport campus, and completed her endocrinology fellowship at Yale New Haven Hospital in New Haven, CT. Her clinical practice focuses on pituitary, adrenal, and thyroid diseases, as well as diabetes. Dr. Balasubramanian has been actively involved in research, with publications on various topics including hypoglycemia management, cardiovascular risk factors in patients with type 2 diabetes, the role of sodium-glucose co-transporter-2 inhibitors, and hypercalcemia. She is a member of several professional organizations, including the Endocrine Society, American Diabetes Association, American Thyroid Association, and the American Association of Clinical Endocrinologists. Her contributions to the field include research on multidisciplinary strategies to treat severe hypoglycemia, cardiovascular outcomes in diabetes, and novel roles for SGLT2 inhibitors in nephrolithiasis risk reduction.

Research topics

• Medicine
• Internal medicine
• Endocrinology
• Cardiology
• Urology
• Gastroenterology

Selected publications

• SUN-013 Ectopic Intrasellar Salivary Gland Tissue Mimicking Neoplasia

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: C. Rizk: None. G. Sydney: None. P. Gopal: None. S. Omay: None. P. Balasubramanian: None. Background: Ectopic salivary tissue within the sella is rare and mostly asymptomatic. Preoperative diagnosis is often challenging as they mimic pituitary neoplasms and the diagnosis is typically made after resection or biopsy. We present a case of ectopic intrasellar salivary gland tissue confirmed on histopathology in a patient who was presumed to have a meningioma on her initial imaging performed for the evaluation of headache. Case Presentation: A 61-year-old female presented with 4 month history of severe bifrontal headache and bilateral upper extremity weakness. Brain MRI was performed revealing a 2.8 x 2.6 x 1.9 cm mass along the left petroclival region extending into the sella, and into the left cavernous sinus with deviation of the pituitary stalk. The MR imaging characteristics were consistent with meningioma. Endocrine biochemical evaluation was unremarkable. Given the discordance between the patient’s clinical presentation and imaging characteristics and the short duration of her symptoms, endoscopic endonasal biopsy of the sellar lesion was performed for a definitive diagnosis. Histopathology was consistent with benign seromucinous salivary gland tissue with chronic inflammatory infiltrate. To rule out metastatic disease, DOTATATE PET scan was done which showed tracer uptake within the sella and the left cavernous sinus but no other abnormality. The patient was managed conservatively with improvement in her symptoms, and the lesion has remained stable on serial MRI imaging over the last one year. Conclusion: Ectopic salivary gland tissue in the sellar region is a rare finding and is typically asymptomatic. When symptoms do occur, they are often attributed to leakage of glandular secretions leading to localized inflammation. In uncommon instances, larger lesions may cause endocrine disturbances, including hyperprolactinemia or growth hormone deficiency. Definitive diagnosis generally relies on histopathological evaluation, and the overall prognosis is excellent. Presentation: Sunday, July 13, 2025

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• MON-117 GnRH Agonist Therapy Induced Pituitary Apoplexy

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: G.I. Sydney: None. P. balasubramanian: None. Background: Pituitary apoplexy is a rare yet serious condition characterized by acute hemorrhage or infarction of the pituitary gland. Gonadotropin-releasing hormone (GnRH) agonists have been implicated as potential triggers for pituitary apoplexy, particularly in patients with known pituitary adenomas. Here, we report a case of a patient with no prior diagnosis of pituitary adenoma, who developed pituitary apoplexy in the context of GnRH agonist therapy for in vitro fertilization (IVF). Case Presentation: A 31-year-old female with a history of infertility and recurrent miscarriages presented with acute onset intractable headache, nausea and dizziness a few days after her initial round of IVF utilizing a micro-Lupron flare protocol for egg retrieval. Physical examination revealed intact visual field and a normal cranial nerve exam, with no focal neurological deficits. MRI pituitary demonstrated a 1.2 x 0.9 x 1 cm pituitary mass with a non-enhancing hemorrhagic focus with extension into the suprasellar cistern without significant mass effect on the optic chiasm. Biochemical evaluation was unremarkable with the exception of a mildly elevated prolactin of 51.3 ng/mlL (reference range : 3.0-30.0 ng/mlL), likely due to stalk effect. Given the patient’s clinical stability and lack of neurological deficits, a conservative management approach was pursued during the hospitalization, deferring surgical intervention to the outpatient setting. A decision for surgical intervention was based on her immediate plans for pregnancy and concern for mass effect on the optic chiasm due to physiological enlargement of the pituitary gland in pregnancy. Conclusion: Pituitary apoplexy, although rare, has been reported in association with GnRH agonist therapy, typically in patients with pre-existing gonadotropin-secreting or nonfunctioning pituitary adenomas. The latency between treatment and symptoms onset is variable. The proposed pathophysiologic mechanism involves pituitary stimulation by GnRH agonists, potentially leading to the underlying adenoma’s growth and subsequent tissue infraction or hemorrhage. This case underscores the risk of pituitary apoplexy in the setting of IVF-related GnRH agonist therapy and highlights the importance of early recognition and prompt management of this rare yet serious complication. Presentation: Monday, July 14, 2025

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• SUN-770 Severe Hypocalcemia in Diffuse Metastatic Prostate Cancer: Impact of Osteoblastic Lesions and Denosumab Therapy

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: G.I. Sydney: None. P. Balasubramanian: None. Background: Hypocalcemia in patients with metastatic prostate cancer is often multifactorial, with osteoblastic metastases playing a central role. Antiresorptive agents such as Denosumab are commonly used in the management of these cancers to decrease the incidence of skeletal related events and bone pain. However, these agents increase the risk of hypocalcemia which can be serious and life threatening if not promptly identified and treated. Clinical Case: We present a 71-year-old male with advanced prostate cancer and extensive osteoblastic metastases, admitted with bilateral subdural hematomas after a fall. He was treated with monthly Denosumab injections due to extensive skeletal metastases and received the last Denosumab dose one month prior to admission. Labs at time of admission revealed calcium of 6.2 mg/dL (reference range: 8.8 - 10.2 mg/dL), albumin 2.4 g/dL (reference range 3.6 - 4.9 g/dL; corrected calcium 7.5 mg/dL) iPTH 213 (reference range 15-65 pg/dL), magnesium 1.7 mg/dL (reference range 1.7 - 2.4 mg/dL), and creatinine 0.41 mg/dL (reference range 0.40 - 1.30 mg/dL). He endorsed fatigue and generalized weakness which he attributed to his cancer treatment but no other symptoms of hypocalcemia. Physical exam was significant for cachexia and Chvostek sign was negative. Vitamin D and 1, 25 vitamin D subsequently resulted as 52 ng/mL (reference range 20 - 50 ng/mL ) and 357 pg/dL (reference range 25-66 pg/dL). The hypocalcemia was attributed to a combination of osteoblastic metastases, recent Denosumab therapy, poor oral intake, and critical illness. He was managed aggressively, initially with a calcium gluconate drip and subsequently optimized on calcium citrate (1250 mg four times daily) and calcitriol (1 mcg BID) with concurrent magnesium repletion. His calcium and magnesium normalized within a few days and he was discharged with follow up. Conclusion: This case highlights the multifaceted etiology of hypocalcemia in metastatic prostate cancer, particularly in the presence of osteoblastic bone lesions and the use of antiresorptive therapy. Osteoblastic bone lesions promote calcium deposition and new bone formation resulting is decreased serum calcium levels. Parathyroid glands typically increase PTH secretion but are often ineffective at normalizing calcium levels despite severe secondary hyperparathyroidism. Antiresorptive agents increase the risk of hypocalcemia in these patients. Prompt identification and treatment with high doses of calcium, calcitriol and magnesium with close monitoring can prevent life threatening complications. Comprehensive evaluation of contributing factors and tailored therapeutic strategies are crucial to improving outcomes in this population. Presentation: Sunday, July 13, 2025

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• MON-333 Tall Cell Variant Papillary Thyroid Cancer in Graves’ Disease in the Absence of Discrete Thyroid Nodules

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: L. Bernacet-Rivera: None. S. Thomas: None. S. Richer: None. P. Balasubramanian: None. Background: Patients with Graves’ disease (GD) and thyroid nodules have a higher risk of cancer compared to euthyroid patients mostly accounted for by well differentiated tumors. Recent studies have shown an increased risk of aggressive variants of papillary thyroid cancer (PTC) such as tall cell variant (TCV) in patients with GD. We present a case of multifocal TCV PTC in a patient without discrete thyroid nodules on preoperative imaging. Clinical case: A 46-year-old woman with Graves’ disease diagnosed 20 years ago, managed with methimazole presented with symptoms of neck discomfort and dysphagia. Physical examination was remarkable for diffusely enlarged thyroid gland with no palpable nodules. Thyroid bruit was present on auscultation. CT neck showed enlarged heterogenous thyroid gland causing moderate tracheal compression at the thoracic inlet. She underwent total thyroidectomy due to the large goiter and compressive symptoms. Intraoperatively, a small amount of thyroid issue was left behind to preserve recurrent laryngeal nerves. Final pathology showed multifocal PTC, TCV in a background of diffuse hyperplasia and lymphocytic thyroiditis with no lymphovascular invasion or extrathyroidal extension. Of note, thyroid ultrasound (US) prior to surgery showed diffusely enlarged and hyperemic gland without discrete nodules. Post operative thyroglobulin(TG) at 6 weeks was elevated at 10 ng/mL (expected levels in an athyrotic patient are <0.1 ng/mL) with negative TG antibody. She underwent radioactive iodine remnant ablation with 31.5 mCi of I 131 and post therapy scan demonstrated thyroid origin tissue without iodine avid distant metastasis. On follow up at 1 year, TG decreased to 0.4 ng/mL and US neck showed no suspicious lymphadenopathy. Conclusion: The incidence of PTC in higher in GD patients than in euthyroid individuals. The risk is higher in patients with multiple and large nodules. Our patient lacked discrete nodules on thyroid US and was noted to have aggressive TCV cancer after surgical resection. While the mechanism of this association is not known, autoimmunity and inflammation are thought to play a role in pathogenesis of thyroid cancer in GD. Further studies are warranted to determine the pathogenesis, prevalence and prognosis although the true prevalence may be difficult to determine as most GD patients do not undergo surgery. Presentation: Monday, July 14, 2025

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• 7168 Papillary thyroid carcinoma co-existing with intrathyroidal metastasis from lung neuroendocrine tumor

  Journal of the Endocrine Society · 2024-10-01

  articleOpen access1st authorCorresponding

  Abstract Disclosure: P. Balasubramanian: None. A. Ladenheim: None. S. Gilani: None. C. Gibson: None. P. Kunz: None. Introduction: Papillary thyroid carcinoma is the most common differentiated thyroid carcinoma. Thyroid metastasis from neuroendocrine tumors (NETs) is extremely rare with an estimated prevalence of <1%. We report a rare case of 59 year old female with co-existence of papillary thyroid carcinoma and intrathyroidal metastasis from a lung NET. Case: A 59-year-old female with a metastatic, well-differentiated lung NET (Ki-67 15%, unable to distinguish between typical and atypical) was noted to have a suspicious hypermetabolic left thyroid nodule on both FDG PET CT and Ga68 DOTATATE PET CT during the initial work-up . Thyroid ultrasound showed a suspicious 1.9 cm TR5 left upper pole nodule and biopsy was consistent with papillary thyroid cancer. Final pathology following total thyroidectomy and central neck dissection demonstrated 1.6 cm left papillary thyroid carcinoma with no lympho-vascular invasion or extrathyroidal extension co-existing with an intrathyroidal metastasis from the lung NET. Calcitonin stain was negative in the NET. Post op, thyroglobulin level was 0.18 with negative thyroglobulin antibodies. Given her low risk thyroid cancer, RAI was deferred. She was started on everolimus for management of metastatic lung NET and has stable disease 12 months after initiation of treatment. Conclusion: With increased use of advanced imaging for diagnosis, staging and treatment response evaluation, incidental thyroid nodules have become a common finding. However, there is a paucity of guidelines from professional organizations regarding the management of these nodules. Malignancy rates of FDG and Ga68 DOTATATE avid nodules can be as high as 35% and 20% respectively. While a significant proportion of these will be papillary thyroid cancers, it is important to consider the possibility of metastasis in patients with diagnosed primary malignancy. Thyroid metastasis from NETs occurs rarely but in these cases, it is crucial to differentiate it from medullary thyroid carcinoma using immunohistochemistry for calcitonin. Accurate diagnosis is critical as medical and surgical treatment can vary significantly in primary versus secondary malignancies of the thyroid. Presentation: 6/2/2024

  PublisherDOI

• 7418 Xanthoma Disseminatum - A Rare cause of Diabetes Insipidus

  Journal of the Endocrine Society · 2024-10-01

  articleOpen access1st authorCorresponding

  Abstract Disclosure: P. Balasubramanian: None. J. Cohen: None. Z. Corbin: None. G. Panse: None. S.E. Inzucchi: None. Background: Xanthoma disseminatum is a rare non-Langerhans cell-derived benign histiocytosis of unknown etiology, characterized by mucocutaneous xanthomatosis. Systemic involvement occurs in a subset of patients, the most common manifestation being central diabetes insipidus in the setting of hypothalamic-pituitary- infundibulum infiltration, occurring in about 30-50% of the patients. We present the case of a man with biopsy proven cutaneous xanthoma disseminatum who developed central diabetes insipidus due to pituitary stalk involvement. Case Presentation: A 69-year-old male presented with a 2-year history of symmetrically distributed, erythematous to hyperpigmented macules and papules in the axillae and inguinal folds. He did not have any mucosal lesions. Skin biopsy revealed histiocytic infiltrate consistent with non-Langerhans cell histiocytosis, likely xanthoma disseminatum. He developed symptoms of polyuria and nocturia around the same time of the eruption, resulting in a large daily fluid intake of 100-120 ounces/day for several months. Laboratory evaluation revealed normal electrolytes. After an overnight water deprivation test, serum osmolality was 299mOsm/kg, serum sodium was 144mmol/L and urine osmolality was 280mOsm/kg, consistent with partial central diabetes insipidus. MRI pituitary with and without IV contrast showed thickening and hyperenhancement of the pituitary stalk. Anterior pituitary function was intact except for mild hypogonadotropic hypogonadism. He was started on DDAVP with good response and resolution of symptoms. Conclusion: Xanthoma disseminatum is characterized by extensive mucocutaneous xanthomatosis with occasional systemic involvement. The natural history of xanthoma disseminatum is usually benign, indolent, and slowly progressive with spontaneous regression described in a few cases. Hypothalamic and pituitary involvement may cause hyperprolactinemia, central diabetes insipidus, and variable degrees of hypopituitarism. Diabetes insipidus is often mild and sometimes transient. Occasionally, central diabetes insipidus can precede the skin lesions. Prognosis is generally good. Central nervous system involvement outside the hypothalamus/pituitary carries a poor prognosis. Presentation: 6/2/2024

  PublisherDOI

• Baseline Cardiovascular Risk Factor Control in Patients With Type 2 Diabetes and Coronary Disease Versus Stroke: Secondary Analysis of Cardiovascular Outcome Trials

  Stroke · 2023 · 11 citations

  1st authorCorresponding
  • Medicine
  • Internal medicine
  • Cardiology

  BACKGROUND: Patients with type 2 diabetes (T2D) and cardiovascular disease are at increased risk for recurrent ischemic events. Cardiovascular risk factor control is vital for secondary prevention, but how this compares among individuals with different T2D macrovascular complications is unknown. We aimed to determine if there might be differences in risk factor control in patients with T2D with previous stroke versus coronary artery disease (CAD). METHODS: Cross-sectional analyses were performed on 12 856 patients with T2D with prior history of stroke with or without CAD from 3 diabetes cardiovascular outcome trials: CARMELINA (The Cardiovascular and Renal Microvascular Outcome Study With Linagliptin), EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), and CAROLINA (The Cardiovascular Outcome Study of Linagliptin vs Glimepiride in Type 2 Diabetes). Risk factors at baseline assessed included dyslipidemia, hypertension, smoking, and current antiplatelet/anticoagulant therapy. Control, respectively, was defined as LDL (low-density lipoprotein)-C <100 mg/dL or statin use, systolic blood pressure <140 and diastolic blood pressure <90 mm Hg, not currently smoking, and use of an antiplatelet/anticoagulant medication. The odds ratio of 3 to 4 (or good) versus 0 to 2 (or suboptimal) risk factors controlled was analyzed by logistic regression models. RESULTS: The odds for good versus suboptimal risk factor control in patients with CAD alone was higher than in those with stroke alone across all 3 trials odds ratios (95% CI): CARMELINA, 2.05 (1.67-2.51), EMPA-REG OUTCOME, 2.50 (2.10-2.99), and CAROLINA, 1.63 (1.21-2.20). The respective odds ratios were lower (and rendered nonsignificant in CAROLINA) when cardiovascular risk factor control in patients with both CAD and stroke were compared with those with stroke alone: CARMELINA, 1.45 (1.13-1.87); EMPA-REG OUTCOME, 1.62 (1.25-2.08); and CAROLINA, 1.16 (0.74-1.83). CONCLUSIONS: In contemporary populations of patients with T2D, there was significant discordance in control of cardiovascular risk factors between patients with stroke versus CAD, with the former having less optimal control. The intermediate results in patients with both CAD and stroke suggest that these differences could be related at least in part to clinician factors. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifiers: NCT01243424, NCT01131676, NCT01897532.

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• Sodium-glucose Co-transporter-2 inhibitors: a new era of cardioprotection and renoprotection

  Elsevier eBooks · 2023-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

• List of contributors

  Elsevier eBooks · 2023-01-01

  book-chapter
  PublisherDOI

• RF16 | PSUN155 Empagliflozin and the risk of nephrolithiasis

  Journal of the Endocrine Society · 2022-11-01

  articleOpen access1st authorCorresponding

  Abstract Aims Nephrolithiasis is a common disease, estimated to affect 10% of the US population. In addition to pain, often severe, it can lead to urinary tract infections and acute kidney injury, while contributing to health care costs from emergency room visits and follow-up interventions necessary to relieve stone burden. Type 2 diabetes (T2D) is a well-known risk factor for nephrolithiasis. Recently in an observational study of patients with T2D, use of sodium-glucose transport protein 2 (SGLT2) inhibitors as glucose lowering agents was associated with a 49% lower risk of nephrolithiasis when compared with use of glucagon like peptide 1 (GLP-1) receptor agonists. We examined, prospectively, the association between renal stone disease and the use of the SGLT2 inhibitor empagliflozin, using existing data from randomized clinical trials. Methods Pooled data from 15,081 patients with T2D treated with empagliflozin (10,177) or placebo (4,904) from 20 phase I-IV randomized, placebo-controlled trials including the large cardiovascular outcome trial, EMPA-REG OUTCOME, were included in this analysis. Incident urinary tract stone events were captured using a pre-defined collection of MedDRA terms: nephrolithiasis, renal colic, ureterolithiasis, calculus bladder, calculus urinary, calculus urethral, and nephrocalcinosis (MedDRA version 22.1). A sensitivity analysis used a narrower definition by excluding the terms renal colic and nephrocalcinosis. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated using the relative risk estimate stratified by study. Results The median exposure to study drug was 543 (placebo) and 549 (empagliflozin 10 or 25 mg) days We found that a total of 183 patients experienced an incident urolithiasis during follow-up (79 in placebo, 104 in pooled empagliflozin) yielding annual incidence rates of 1.01 versus 0.63 events per 100 patient years in placebo and empagliflozin, respectively. All but one event occurred in patients with no prior history of urinary tract stones. The IRR was 0.64 (95% CI 0.48, 0.86), in favor of empagliflozin. In the sensitivity analysis, now restricted to nephrolithiasis, ureterolithiasis, calculus bladder, calculus urinary, and calculus urethral, the results were similar (IRR, empagliflozin vs. placebo, 0.62 [95% CI 0.45, 0.85]). Conclusion As compared to placebo, use of empagliflozin was associated with an approximate 40% reduction in the risk of urolithiasis in patients with T2D. Alterations in lithogenic profile of the urine (including dilutional effects) of potential stone formers after SGLT2 inhibition may explain this finding. Based on these initial observations, mechanistic studies to elucidate the mediator(s) of this seemingly protective effect and dedicated randomized prospective clinical trials appear warranted in patients with renal stone disease. As with follow-up SGLT2 inhibitor investigations conducted in patients with heart failure and chronic kidney disease, such trials should include individuals who do not have T2D. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 1:12 p.m. - 1:17 p.m.

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Frequent coauthors

• Sachin Majumdar

  Yale University

  11 shared

• Silvio E. Inzucchi

  Yale University

  7 shared

• Bernard Zinman

  University of Toronto

  7 shared

• João Pedro Ferreira

  Universidade do Porto

  4 shared

• Katherine Araque

  3 shared

• Christoph Wanner

  University of Würzburg

  3 shared

• Anne Pernille Ofstad

  Boehringer Ingelheim (Norway)

  3 shared

• Majumdar Sachin

  Singapore General Hospital

  2 shared

Labs

• Endocrinology & MetabolismPI

Awards & honors

• American Board of Internal Medicine/Endocrinology, Diabetes…
• Pasquale Perielle award for outstanding leadership and schol…
• American Board of Internal Medicine Diplomate (2019)
• Intern of the year (2017)