About

Dr. Devaprabu Abraham completed his graduate and postgraduate training in India and England respectively. He joined the University of Utah internal medicine residency program in 1993 and pursued endocrine fellowship training at the Mayo Clinic in Rochester, Minnesota. Following his fellowship, he returned to the University of Utah in 1998 to join as endocrinology faculty in the Department of Medicine and the VAMC. He is currently appointed as Clinical Professor of Medicine and also serves as an adjunct Professor in departments of Surgery and Pathology. Dr. Abraham is passionate about medical education and actively involved with medical student, resident, and fellowship training in endocrinology both locally and nationally. He is the Director of the Thyroid and Parathyroid Tumor Program and is an expert in performing ultrasound evaluation of thyroid and parathyroid tumors, certified by the ECNU / AIUM to perform head and neck ultrasonography. His research and clinical contributions include developing unique techniques for parathyroid and medullary thyroid cancer localization, with a focus on thyroid and parathyroid disorders, endocrine surgery, and metabolism.

Research topics

• Internal medicine
• Medicine
• Pathology
• Cancer research
• Endocrinology
• Biology
• Psychiatry

Selected publications

• MON-536 Exogenous Cushing Syndrome Resulting from Undisclosed Dexamethasone in an Over-the-Counter Arthritis Supplement

  Journal of the Endocrine Society · 2024-10-01

  articleOpen accessSenior author

  Abstract S. Wagle: None. D. Abraham: None. Introduction: Exogenous Cushing syndrome is prevalent due to prolonged exposure to glucocorticoid-containing medications, often found in over-the-counter (OTC) products imported from overseas. We report a patient who developed Cushing’s Syndrome after self-medicating with an agent from Mexico called Artri King. Case Description: A 39-year-old female with a history of non-alcoholic fatty liver disease and arthralgia presented to the emergency department with epigastric pain, melena, 60 lbs weight gain, and bilateral lower leg swelling for 4 months. Her medications included Artri King for arthralgia (2 tablets twice daily for the last four months) and Spironolactone, for leg swelling. Vital signs revealed an elevated blood pressure of 141/108 mmHg and a BMI of 31.28 kg/m². Clinical examination revealed purplish wide striae, bruising, proximal muscle weakness, and peripheral edema. Laboratory testing showed a white blood cell count of 26.73 k/μL, a blood glucose level of 132 mg/dL, HgbA1C 5.9%, a cortisol level of 0.3 µg/dL, and an ACTH level of < 1.5 pg/mL. Her TSH was 3.07 mU/L with a free T4 of 0.6 ng/dL. Imaging studies, including computed tomography and magnetic resonance imaging, revealed a normal adrenal gland. Gastroscopy was unremarkable. An exogenous source for corticosteroids was suspected with suppressed ACTH levels and normal adrenal glands on imaging. Therefore, mass spec testing for corticosteroids was performed. Her serum dexamethasone level of 1076 ng/dL confirmed the diagnosis. Upon inquiry, the patient recalled that her symptoms began after starting the Artri King supplement. Discontinuation of Arti King for two days resulted in a cortisol level of 6.8 µg/dL suggesting rapid recovery of adrenal function. Discussion: Artri King, an OTC supplement marketed for joint pain in Mexico, recommends a dosage of two tablets three times daily. On April 20, 2022, the FDA issued public warnings against its use, as laboratory testing detected undisclosed amounts of dexamethasone and diclofenac, which were not listed on the product label. The presence of surreptitious steroids in supplements should be suspected in patients presenting with exogenous Cushing syndrome. Physicians should review self-administered supplements closely and counsel patients on the risks. Monday, June 3, 2024

  PublisherOA PDFDOI

• 6802 NRAS-Mutated Malignant Struma Ovarii with Papillary and Solid Histologic Variants

  Journal of the Endocrine Society · 2024

  Senior authorCorresponding
  • Pathology
  • Medicine
  • Cancer research

  Abstract Disclosure: S. Wagle: None. L. Lomo: None. R.L. Dood: None. B. Chadwick: None. D. Abraham: None. Introduction: Struma ovarii is a mono-dermal teratoma of the ovary that is composed of more than >50% of mature thyroid tissue. It accounts for 5% of ovarian teratomas and 1% of ovarian tumors. Although rare, it is seen in women between 40-60 years of age. Most of these tumors are found incidentally. Malignant struma ovarii is even rarer and the mutational profile of these tumors is neither well studied nor understood. We present an uncommon case of malignant struma with NRAS p.Q61R mutation yet with papillary and solid histologic patterns. Case Description: A 53-year-old female with no significant medical or family history presented with acute worsening of chronic lower abdominal pain and irregular menstruation. Her symptoms developed gradually over 6 months. A pelvic and abdominal CT identified a 9.7 cm cystic left ovarian mass without evidence of ascites or peritoneal masses. She underwent laparoscopic left salpingo-oophorectomy. Histopathology examination of the ovarian tumor revealed classical type, well-differentiated papillary, and solid patterns of thyroid carcinoma. The cells revealed nuclear enlargement, irregular nuclei, finely dispersed chromatin, distinct nucleoli, and nuclear grooves. Due to the histologic pattern of classical papillary thyroid cancer, BRAF V600E pyrosequencing was conducted, which revealed wild-type BRAF. This was followed by NGS when NRAS p.Q61R pathogenic variant was identified. Her thyroid ultrasound did not reveal actionable nodules. A TSH (2.17mU/ml) and thyroglobulin (7.6 ng/ml, TG ab neg) levels are consistent with a normal functioning thyroid gland. This patient's tumor findings are unique in that papillary thyroid carcinoma (PTC) and solid growth patterns are typically associated with the BRAF V600E mutation but rarely seen in the context of an RAS mutation. Discussion: Typically, thyroid cancers with papillary and solid variant features are associated with the BRAF V600E mutation. RAS-type tumors have follicular histologic architecture. BRAF and RAS mutations are mutually exclusive in tumors. Our patient’s malignant struma is unique in that it contained a wild-type BRAF and was positive for NRAS p.Q61R mutation. However, the histology was that of papillary and solid patterns. NRAS mutation with papillary histology combination is rare and is seen in 12% of thyroid cancers. The mutational profile of malignant struma ovarii has not been fully understood or studied due to their rarity. Presentation: 6/3/2024

  PublisherDOI

• Molecular Profiling of 50 734 Bethesda III-VI Thyroid Nodules by ThyroSeq v3: Implications for Personalized Management

  The Journal of Clinical Endocrinology & Metabolism · 2023 · 59 citations

  • Medicine
  • Pathology
  • Internal medicine

  CONTEXT: Comprehensive genomic analysis of thyroid nodules for multiple classes of molecular alterations detected in a large series of fine needle aspiration (FNA) samples has not been reported. OBJECTIVE: To determine the prevalence of clinically relevant molecular alterations in Bethesda categories III-VI (BCIII-VI) thyroid nodules. METHODS: This retrospective analysis of FNA samples, tested by ThyroSeq v3 using Genomic Classifier and Cancer Risk Classifier at UPMC Molecular and Genomic Pathology laboratory, analyzed the prevalence of diagnostic, prognostic, and targetable genetic alterations in a total of 50 734 BCIII-VI nodules from 48 225 patients. RESULTS: Among 50 734 informative FNA samples, 65.3% were test-negative, 33.9% positive, 0.2% positive for medullary carcinoma, and 0.6% positive for parathyroid. The benign call rate in BCIII-IV nodules was 68%. Among test-positive samples, 73.3% had mutations, 11.3% gene fusions, and 10.8% isolated copy number alterations. Comparing BCIII-IV nodules with BCV-VI nodules revealed a shift from predominantly RAS-like alterations to BRAF V600E-like alterations and fusions involving receptor tyrosine kinases (RTK). Using ThyroSeq Cancer Risk Classifier, a high-risk profile, which typically included TERT or TP53 mutations, was found in 6% of samples, more frequently BCV-VI. RNA-Seq confirmed ThyroSeq detection of novel RTK fusions in 98.9% of cases. CONCLUSION: In this series, 68% of BCIII-IV nodules were classified as negative by ThyroSeq, potentially preventing diagnostic surgery in this subset of patients. Specific genetic alterations were detected in most BCV-VI nodules, with a higher prevalence of BRAF and TERT mutations and targetable gene fusions compared to BCIII-IV nodules, offering prognostic and therapeutic information for patient management.

  PublisherOA PDFDOI

• Acute kidney injury, necrotizing pancreatitis and nephrocalcinosis: A rare presentation of primary hyperparathyroidism

  The American Journal of the Medical Sciences · 2022-12-18 · 2 citations

  letter
  PublisherDOI

• Nonsurgical Treatment of Thyroid Cysts, Nodules, Thyroid Cancer Nodal Metastases, and Hyperparathyroidism: The Role of Percutaneous Ethanol Injection

  Elsevier eBooks · 2020-11-04 · 1 citations

  book-chapter1st authorCorresponding
  PublisherDOI

• SAT-457 The Association Between Thyroid Stimulating Hormone and Severe Depression: A Historical Cohort Study

  Journal of the Endocrine Society · 2020 · 1 citations

  • Medicine
  • Internal medicine
  • Endocrinology

  Abstract Introduction: Hypothyroidism is implicated in the pathophysiology and clinical course of mood disorders. This study aimed to investigate the association between TSH and severe depression. Methods: The historical cohort included all consecutive adult patients (≥ 18 years) who had a TSH and PHQ-9 questionnaire data within 6 months of index visit, between October 2016 and July 2019, at the University of Utah Health. Data on demographics, hypothyroidism, TSH, PHQ-9, thyroid hormone replacement (THR), and antidepressant medications were extracted electronically. T-test and chi-square were used to compare continuous and categorical variables respectively. Logistic regression and one-way ANOVA were used to evaluate the association between TSH and depression severity. A sub-group analysis was performed among mood disorder patients without a diagnosis of overt hypothyroidism, comparing euthyroid patients (TSH 0.3-4) and patients with sub-clinical hypothyroidism based on TSH 4-10. Results: The cohort included 26,722 patients, mean age 46.3 years, 79.5% Caucasian, 68% females, and mean BMI 30. Mean PHQ-9 score was 8.2, 10% patients had severe depression (PHQ-9 ≥20), and 51% were on antidepressants and 26% on mood stabilizers. Mean TSH was 2.85, 19% patients had a diagnosis of hypothyroidism, and 20% patients were on THR. Patients with severe depression were more likely to have a higher mean TSH (p=0.06), be on antidepressants (p= <0.0001), and have a higher BMI (p=0.0003). There was a positive correlation between TSH and PHQ-9 score (p= 0.04). TSH was associated with severe depression, odds ratio 1.006 (1.003-1.009), after adjusting for potential co-variates. Hypothyroid patients who were on THR had a lower mean PHQ-9 score (p= <0.0001) as compared to hypothyroid patients not on THR. Patients with TSH from 7-10 had a higher PHQ-9 score as compared to those who had a TSH from 4-7 (p= <0.003). Conclusion: Severe depression was associated with higher TSH. Subclinical hypothyroidism with TSH above 50th percentile was associated with higher PHQ-9 scores. Future RCTs should evaluate the effect of THR in (a) patients with severe depression and (b) patients with mood disorders who have subclinical hypothyroidism.

  PublisherOA PDFDOI

• MON-304 Prolactin as a Surrogate Marker to Predict Long Term Postoperative Hypopituitarism After Transsphenoidal Resection of Pituitary Adenomas

  Journal of the Endocrine Society · 2020-04-01

  articleOpen access

  Abstract Transsphenoidal surgery (TSS) is the first line treatment for pituitary adenoma. A well-known complication of TSS is hypopituitarism with a reported risk of 5-25% after resection of pituitary adenomas. A decrease in postoperative prolactin concentration was shown to be associated with postoperative hypopituitarism in a previous report. We hypothesized that in addition to clinical factors (preoperative hypofunction and adenoma size), biochemical factors (change in prolactin concentration and immediate post-operative hypofunction) can aid in predicting long term hypopituitarism as defined as ≥1 biochemically confirmed hypofunctioning pituitary axes 3 years after resection. A retrospective analysis of all patients undergoing TSS for both functioning and non-functioning pituitary adenomas at a tertiary center from January 2013 through December 2015 was performed. Prolactinomas were excluded. Of the 75 patients included, 21.3% (n=16) had at least one pituitary axis requiring replacement at 3 years post operatively. Mean age at presentation was 55 ± 16 years, 55% were female and 81% were Caucasian. Mean adenoma size was no different between normal pituitary function and hypopituitary groups (24.0 ± 11.9 mm versus 25.3 ± 10, p=0.7). Factors associated with long term hypopituitarism were older age (mean age 64 ± 4 years versus 53 ± 2 years, p = 0.02), preoperative secondary adrenal insufficiency (AM cortisol 6.4 ± 3.7 vs 12.0 ± 6.5 µg/dL; p = 0.03), preoperative secondary hypothyroidism (0.8 ± 0.2 vs 12.0 ± 6.5 ng/dL; p < 0.01), low immediate postoperative cortisol (5.3±3.1 vs 26.1±18.3 µg/d; p<0.01), and persistence of adrenal insufficiency (10.7% vs 2.7%; p<0.01) and secondary hypothyroidism (13.3% vs 5.3%; p<0.01) at 3 months. Change in prolactin concentration from preoperative to postoperative day 1-7 was not significantly different between groups (p=0.09) due to the higher variability in the hypopituitary group (median 0.2 ng/mL, IQR -0.5 - 0.8 ng/mL) compared to the normal pituitary function group (median 0.7 ng/mL, IQR 0.5-0.8 ng/mL). Adenoma size, optic chiasm and cavernous sinus involvement were not associated with long term hypopituitarism. In patients who developed postoperative hypopituitarism, there was a higher frequency of adenoma persistence or recurrence (20% vs 47%). There was a high rate of patients lost to follow up (56%). Older age, the presence of preoperative secondary adrenal insufficiency and hypothyroidism, and low day 1-7 postoperative cortisol concentration are factors that can be used to deem a patient high risk for future hypopituitarism. These patients should have close follow up with continued screening postoperatively. Contrary to prior reports, adenoma size and parasellar involvement were not associated which may be suggestive of surgical expertise. Prolactin concentrations proved not to be a good surrogate marker to predict long term hypopituitarism.

  PublisherDOI

• Contributors

  Elsevier eBooks · 2020-11-04

  book-chapter1st authorCorresponding
  PublisherDOI

• Molecular Profile and Clinical Outcomes in Differentiated Thyroid Cancer Patients Presenting with Bone Metastasis

  Endocrine Practice · 2019-08-14 · 8 citations

  articleSenior authorCorresponding
  PublisherDOI

• Abstract #1221 Real World Experience with Thyroseq V3 Genomic Classifier in Thyroid Nodules with Indeterminate Cytology: Results of Testing of the First 3,783 Consecutive Samples

  Endocrine Practice · 2018-04-01

  article
  PublisherDOI

Frequent coauthors

• Yuri E. Nikiforov

  University of Pittsburgh Medical Center

  4 shared

• Barbara Chadwick

  4 shared

• Gregory W. Randolph

  Massachusetts Eye and Ear Infirmary

  3 shared

• Victor Bernet

  Jacksonville College

  3 shared

• Pramod Kumar Sharma

  2 shared

• Steven P. Hodak

  2 shared

• R. Michael Tuttle

  Memorial Sloan Kettering Cancer Center

  2 shared

• Elie Klam

  University of Utah

  2 shared

Labs

• Huntsman Cancer Institute - Cancer Research North CenterPI

Awards & honors

• AACE Jack Baskin Endocrine teaching award (2016)