Afreen Shariff

Overview:

Afreen Shariff, MD is an endocrinologist with expertise in endocrine disease in cancer patients. She is the Director of the Duke Endo-Oncology Program and an Associate Director for the Cancer Therapy Toxicity Program at the Duke Center for Cancer Immunotherapy. She holds a faculty appointment as an Assistant Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at Duke University School of Medicine.

Dr. Shariff completed her medical school in India from Deccan College of Medical Sciences, Internal Medicine training from East Carolina University’s Brody School of Medicine and fellowship in Endocrinology from Duke University School of Medicine. Her clinical work and research is focused on high value care for endocrine disease in cancer patients.

She also chairs the Oncoendocrinology Special Interest Group (SIG) with the Endocrine Society and influences global networking, clinical practice and education in the field of Oncoendocrinology. At Duke, Dr. Shariff's work includes developing interdisciplinary partnerships, creating the clinical infrastructure and framework needed for AI assisted clinical decision making to improve access and coordinated care for patients with cancer therapy related toxicities. She also hosts and produces the podcast series Checkpoint NOW that emphasizes shared decision making between oncologists and subspecialists

Positions:

Assistant Professor of Medicine

Medicine, Endocrinology, Metabolism, and Nutrition
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.B.S. 2008

University of Hyderabad (India)

Internal Medicine Residency

East Carolina University, Brody School of Medicine

Fellowship in Endocrinology, Metabolism and Nutrition, Medicine

Duke University School of Medicine

Publications:

The management of toxicities from immune, targeted and ADCs treatments in patients with urothelial cancer.

Newly approved systemic treatment options for metastatic urothelial cancer (mUC) have diversified treatments and improved responses and survival for chemotherapy refractory disease. These systemic treatments have associated toxicities which need appropriate management for patients to stay on treatment and potentially have longer benefit from treatment. We review the expected toxicities of immune checkpoint inhibitors, FGFR inhibitors such as erdafitinib, and antibody drug conjugates such as enfortumab vedotin and sacituzumab govitecan.
Authors
Atiq, S; Hirshman, N; Shariff, A; Zhang, T
MLA Citation
Atiq, Saad, et al. “The management of toxicities from immune, targeted and ADCs treatments in patients with urothelial cancer.Urol Oncol, Dec. 2021. Pubmed, doi:10.1016/j.urolonc.2021.10.002.
URI
https://scholars.duke.edu/individual/pub1505293
PMID
34973855
Source
pubmed
Published In
Urol Oncol
Published Date
DOI
10.1016/j.urolonc.2021.10.002

A RARE CASE OF PRIMARY HYPERPARATHYROIDISM, HYPEREMESIS GRAVIDARUM, AND WERNICKE ENCEPHALOPATHY.

OBJECTIVE: To describe a rare case of Wernicke encephalopathy (WE) as a result of hyperemesis gravidarum due to primary hyperparathyroidism (PHPT) in pregnancy. METHODS: We present the clinical presentation, supportive laboratory values, diagnostic dilemmas, treatment, clinical outcome, and supportive literature review of a patient with WE as a result of hyperemesis gravidarum due to PHPT in pregnancy. RESULTS: A 27-year-old previously healthy G1P0 female presented with initial symptoms of right upper-quadrant pain, nausea, vomiting, and paresthesias at 17.3 weeks of gestation. The patient later developed neurologic symptoms including acute encephalopathy, ataxia, and intranuclear ophthalmoplegia. The suspicion for WE was confirmed with characteristic findings on brain magnetic resonance imaging. WE was attributed to severe malnutrition from hyperemesis gravidarum and poor prenatal care. Hypercalcemia with an elevated parathyroid hormone level was identified following an unfortunate intrauterine fetal demise, raising suspicion for PHPT. PHPT was confirmed, and after undergoing successful parathyroidectomy, the patient regained normal neurologic function, with the exception of mild lower-extremity paresthesias. CONCLUSION: This case is an example where early recognition and treatment of hyperparathyroidism can be masked by severe malnutrition and present in an unusual way with neurologic symptoms of WE. Early recognition and suspicion are critical in preventing poor fetal outcomes and long-term consequences.
Authors
Stahl, J; Winters, N; Shariff, A
MLA Citation
Stahl, Jennifer, et al. “A RARE CASE OF PRIMARY HYPERPARATHYROIDISM, HYPEREMESIS GRAVIDARUM, AND WERNICKE ENCEPHALOPATHY.Aace Clin Case Rep, vol. 5, no. 2, Mar. 2019, pp. e108–11. Pubmed, doi:10.4158/ACCR-2018-0286.
URI
https://scholars.duke.edu/individual/pub1428727
PMID
31967013
Source
pubmed
Published In
Aace Clin Case Rep
Volume
5
Published Date
Start Page
e108
End Page
e111
DOI
10.4158/ACCR-2018-0286

Primary Adrenal Insufficiency from Immune Checkpoint Inhibitors

Objective: To describe a rare case of primary adrenal insufficiency (PAI) from immune checkpoint inhibitors (ICPIs). Methods: We describe the clinical presentation, supportive laboratory findings, long-term outcomes, and a review of the current available literature on PAI following administration of ipilimumab and nivolumab. Results: A 49-year-old Caucasian male with stage IIIB metastatic melanoma and failed standard chemotherapy and monotherapy with ipilimumab was started on nivolumab in addition to ipilimumab. Two months after starting the combination therapy, he presented with weakness, lethargy, nausea, and diarrhea for 1 to 2 weeks. Since there was a concern for treatment-associated endocrinopathy, an 8 AM cortisol and adrenocorticotrophic hormone (ACTH) were measured and noted to be 5.4 μg/dL (normal, 5 to 25 μg/dL) and 224 pg/mL (normal, 15 to 66 pg/mL), respectively. The cortisol was interpreted as normal, and follow-up was arranged in the endocrinology clinic. ACTH was drawn at the same time but reported after discharge. He presented again in 2 weeks with progressive symptoms, and a prestimulus cortisol was 1.6 μg/dL and 60 minutes after cosyntropin administration did not change, at 1.7 μg/dL. The patient was diagnosed with PAI based on additional data that included a plasma ACTH concentration of 827 pg/mL, elevated renin, and undetectable aldosterone with concurrent hyponatremia and hyperkalemia. He was treated with glucocorticoid and mineralocorticoid replacement and has since been in cancer remission. Conclusion: This case exemplifies how the diagnosis of a classic disease can be confounded in a complex patient and adds to the list of endocrinopathies from ICPI, where a high clinical suspicion should be maintained. Abbreviations: ACTH adrenocorticotrophic hormone anti-CTLA-4 Ab anti–cytotoxic T-cell antigen 4 antibody ICPI immune checkpoint inhibitor PAI primary adrenal insufficiency PD-1 programmed death 1 PDL-1 programmed death ligand 1
Authors
Shariff, AI; D'Alessio, DA
MLA Citation
Shariff, A. I., and D. A. D’Alessio. “Primary Adrenal Insufficiency from Immune Checkpoint Inhibitors.” Aace Clinical Case Reports, vol. 4, no. 3, May 2018, pp. 232–34. Scopus, doi:10.4158/ACCR-2017-0133.
URI
https://scholars.duke.edu/individual/pub1510952
Source
scopus
Published In
Aace Clinical Case Reports
Volume
4
Published Date
Start Page
232
End Page
234
DOI
10.4158/ACCR-2017-0133

Iatrogenic Cushing's syndrome presenting with adrenal insufficiency in 2 patients receiving dexamethasone for metastatic colorectal cancer through an intrahepatic arterial infusion pump

Authors
Ferreira, MN; Shariff, AI
MLA Citation
Ferreira, M. N., and A. I. Shariff. “Iatrogenic Cushing's syndrome presenting with adrenal insufficiency in 2 patients receiving dexamethasone for metastatic colorectal cancer through an intrahepatic arterial infusion pump (Accepted).” Current Problems in Cancer: Case Reports, vol. 7, Sept. 2022. Scopus, doi:10.1016/j.cpccr.2022.100177.
URI
https://scholars.duke.edu/individual/pub1527024
Source
scopus
Published In
Current Problems in Cancer: Case Reports
Volume
7
Published Date
DOI
10.1016/j.cpccr.2022.100177

Evaluation of a deep learning supported remote diagnosis model for identification of diabetic retinopathy using wide-field Optomap

Background: We test a deep learning (DL) supported remote diagnosis approach to detect diabetic retinopathy (DR) and other referable retinal pathologies using ultra-wide-field (UWF) Optomap. Methods: Prospective, non-randomized study involving diabetic patients seen at endocrinology clinics. Non-expert imagers were trained to obtain non-dilated images using UWF Primary. Images were graded by two retina specialists and classified as DR or incidental retinal findings. Cohen's kappa was used to test the agreement between the remote diagnosis and the gold standard exam. A novel DL model was trained to identify the presence or absence of referable pathology, and sensitivity, specificity and area under the receiver operator characteristics curve (AUROC) were used to assess its performance. Results: A total of 265 patients were enrolled, of which 241 patients were imaged (433 eyes). The mean age was 50±17 years, 45% of patients were female, 34% had a diagnosis of diabetes mellitus type 1, and 66% of type 2. The average Hemoglobin A1c was 8.8±2.3%, and 81% were on Insulin. Of the 433 images, 404 (93%) were gradable, 64 patients (27%) were referred to a retina specialist, and 46 (19%) were referred to comprehensive ophthalmologist for a referable retinal pathology on remote diagnosis. Cohen's kappa was 0.58, indicating moderate agreement. Our DL algorithm achieved an accuracy of 82.8% (95% CI: 80.3-85.2%), a sensitivity of 81.0% (95% CI: 78.5-83.6%), specificity of 73.5% (95% CI: 70.6-76.3%), and AUROC of 81.0% (95% CI: 78.5-83.6%). Conclusions: UWF Primary can be used in the non-ophthalmology setting to screen for referable retinal pathology and can be successfully supported by an automated algorithm for image classification.
Authors
Lee, T; Hu, M; Gao, Q; Amason, J; Borkar, D; D'Alessio, D; Canos, M; Shariff, A; Pajic, M; Hadziahmetovic, M
MLA Citation
Lee, T., et al. “Evaluation of a deep learning supported remote diagnosis model for identification of diabetic retinopathy using wide-field Optomap.” Annals of Eye Science, vol. 7, June 2022. Scopus, doi:10.21037/aes-21-53.
URI
https://scholars.duke.edu/individual/pub1524927
Source
scopus
Published In
Annals of Eye Science
Volume
7
Published Date
DOI
10.21037/aes-21-53

Research Areas:

Immune Checkpoint Inhibitors
Immune-related Adverse Events
Immunotherapy
Immunotherapy--Complications