Ambrish Mithal, M.D., D.M.
Chairman, Head Of Department, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana.
Senior Consultant, Endocrinology & Diabetes, Department of Endocrinology, Indraprastha Apollo Hospitals, New Delhi.

    
Residence Cum Clinic
C -5/47, Grand Vasant, Vasant Kunj,
New Delhi - 110 070
(consultation by appointment only)
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Research Activities
 While Dr. Mithal has interest in all areas of clinical endocrinology, his particular area of research interest is bone and mineral metabolism.
(see curriculum vitae for details). Some of his more important contributions in this area are

  1. Study of bone metabolism in skeletal fluoride toxicity: Crippling bone disease due to fluoride toxicity is a major public health problem in certain parts of India. Our studies showed for the first time that skeletal fluoride exposure results in major alterations in bone metabolism. We also demonstrated the modifying influence of calcium and protein nutrition on the skeletal manifestations of fluorosis.

  2. Calcium sensing receptor: I have been involved in several studies on the calcium sensing receptor in Professor Ed Brown’s lab at the Brigham and Women’s Hospital, Boston. during 1993-1995. This receptor was cloned by Brown in 1992 and is considered one of the most important discoveries in endocrinology in recent times.

  3. Osteoporosis: defining BMD standards in the Indian population. For the last five years I have been engaged with my collaborators in various studies trying to define the optimum BMD standards in Indians to facilitate the diagnosis of osteoporosis in Indians. Some part of this work was presented at the American Society of Bone Mineral Research- Adult Bone and Mineral Working Group, 2004, where it was chosen for the Boy Frame Award.

  4. Primary hyperparathyroidism in Indians: Our studies, over the years, have shown that the presence of severe bone disease in Indians with primary hyperparathyroidism is largely linked to vitamin D nutrition. We have also demonstrated dramatic recovery of the skeleton following successful parathyroidectomy. These studies have helped in our understanding of bone biology and the capacity of the bones to recover.

  5. Vitamin D deficiency in Indians: Our studies have demonstrated a high prevalence of vitamin deficiency in healthy urban Indians. We have also shown the time course and profile of skeletal recovery following treatment of osteomalacia. The observation of vitamin D deficiency in urban Indians has major public health implications for India.

  6. New therapeutic agents for osteoporosis: I have conducted two drug trials (raloxifene and tibolone) for osteoporosis at Indraprastha Apollo Hospitals.

  7. Diabetes: ongoing drug trials: I am presently principal investigator in the ORIGIN trial, a multinational, multicentric trial evaluating the ability of early initiation of insulin to reduce cardiovascular events. I am also principal investigator in a multinational trial involving a new molecule for treating type 2 diabetes, which is due to start in September this year.
Teachings
Teaching has always been a high priority and an extremely satisfying activity for me. I have been involved in mentoring more than 12 DM students and 3 PhD students. All of these are placed in reputable academic and professional positions. After moving to the corporate sector I have delivered numerous talks and CMEs often totaling 50 per year. I have initiated the process for accreditation of our department at Indraprastha Apollo Hospital for DNB. As director of the ISBMR- International Osteoporosis physician education initiative, I am responsible for developing and executing education modules regarding osteoporosis for the entire country.

Social
I have therefore been involved in various public awareness projects and programs since the start of my career. I have held numerous free camps in rural areas of UP. Presently I am involved in spreading public awareness about endocrine disorders (in particular diabetes and osteoporosis) through print and electronic media and direct public awareness talks/programs in association with Apollo Hospitals, Helpage India, Delhi Medical Association, Indian Medical Association, Indian Society for Bone and Mineral Research, Delhi Diabetes Forum, Delhi Diabetes Research Centre.
Some Important Original Publications
  1. Mithal A, Trivedi N, Gupta SK, Kumar S, Gupta RK, Radiological spectrum of endemic fluorosis : Relationship with calcium intake. Sketetal Radiol 22;257, 1993.
  2. Trivedi N, Mithal A, Gupta SK, Godbole MM, Reversible impairment of glucose tolerance in patients with endemic flurosis. Diabetologia, 36;826,1993.
  3. Mithal A, Kifor O, Vassilev P, Krapcho K, Thun RS, Fuller F, Nemeth E, Hebert SC, Brown EM. Reduced responsiveness of cultured parathyroid cells to extracellular calcium is associated with decreased extracellular calcium receptor expression. Endocrinology 136;3087,1995.
  4. Garrett JE, Tamir H, Kifor O, Simin RT, Rogers KV, Mithal A, Gagel RF, Brown EM. Calcitonin-secreting cells of the thyroid express an extracellular calcium sensing receptor gene. Endocrinology 136;5202,1995.
  5. Varrault A, Pena MSR, Goldsmith PK, Mithal A, Brown EM, Spiegel AM. Expression of G protein alpha subunit in the bovine parathyroid. Endocrinology 136;4390.1995.
  6. Tewari BD, Godbole MM, Chattopadhyay N, Mandal A, Mithal A. Learning disabilities and poor achievement motivation due to prolonged iodine deficiency. Am J Clin Nutr 63;782,1996.
  7. Butters RR, Chattopadhyay N, Neilson P, Smith CP, Mithal A et al. Cloning and characterization of calcium sensing receptor from the hypercalcemic NZ white rabbit reveals unaltered responsiveness to extracellular calcium. J Bone Miner Res 12;568,1997.
  8. WHO Global Task Force for Osteoporosis. Interim report and recommendations. Osteoporosis International; 10;259 - 264, 1999.
  9. Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J. Unique clinical characteristics of primary hyperparathyroidism in Indians. Brit J Surg 88;708, 2001.
  10. Rao DS, Agarwal G, Talpos GP, Phillips ER, Bandeira F, Mishra SK, Mithal A. Role of vitamin D and calcium nutrition in disease expression and parathyroid tumor growth in primary hyperparathyroidism: A global perspective. J Bone Miner Res, in press.
  11. Agarwal G, Mishra SK, Kar DK, Singh AK, Arya V, Gupta SK, Mithal A. Recovery pattern of osteitis fibrosa cystica in primary hyperparathyroidism patients following succesful parathyroidectomy. Surgery, in press.
Books Edited
  1. Mithal A, Rao DS, Zaidi M. Metabolic Bone Disorders. An ISBMR publication, Dec 1998.
Selected Reviews and Chapters
  1. Chattopadhyay N, Mithal A, Brown EM. The calcium receptor. A window on the physiology and pathophysiology of mineral metabolism. Endocrine Reviews, 17:289,1996.
  2. Mithal A, Skeletal Fluorosis. In: Molecular and Cellular Biology of Bone (ed. Zaidi M), JAI press, Connecticut, USA.1998.
  3. Mithal A, Singh AK. Endemic fluorosis and calcium intake. In: Calcium and Bone Development (eds. Bonjour JP, Tsang R) Nestle Nutrition Workship Series, Lipincott Raven Publishers, New York, 1998.
  4. Mithal A, Gupta SK. Skeletal effects of fluorosis. In: Metabolic Bone Disorders (eds. Mithal A, Rao DS, Zaidi M). An ISBMR publication. 1998.
  5. Mithal A. Normal Metabolism. In: Pediatric Endocrine Disorders. (eds. Desai MP, Bhatia V, Menon PSN). Orient Longman, 2001.
  6. Mithal A. Evaluation of children with bone and mineral disorders. In: Pediatric Endocrine Disorders. (eds. Desai MP, Bhatia V, Menon PSN). Orient longman, 2001.
  7. Mithal A, Gertner J, Bhatia V. Metabolic Bone disease. In: Pediatric Endocrine Disorders. (eds. Desai MP, Bhatia V, Menon PSN). Orient Longman, 2001.
  8. Mithal A, Bandeira F, Meng X, Siverberg SJ, Shi Y, Mishra SK, Griz L, Macedo G, Celdas G, Bandeira C, Bilezikian JB, Rao DS. Clinical presentation of primary hyperparathroidism: India, Brazil and China. In: The Parathyroids: Basic and clinical aspects. (eds. Bilezikian JP, Marcus R, Levine MA) Academic Press, San Diego, 2001.
  9. Bonjour JP, Martin TJ, Mithal A. Pathophysiology of osteoporosis. In: WHO Global Guidelines for Osteoporosis, in press.
  10. Chattopadhyay N, Mithal A. When calcium becomes hormone. Recent Research Progress in Endocrinology, in press.
  11. Mithal A, Naik V. Diagnosis of metabolic bone disorders. API Text Book of Medicine, in press.
  12. Mithal A, Brown EM. Overview of calcium homeostasis and the calcium receptor in the parathyroid and C cells. The Calcium Receptor, eds Chattopadhyaya N and Brown EM, in press.
Selected Talks and Presentations
  1. Antithyroid drugs: The Indian Experience. India - USA Symposium on Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India, Dec 26-31, 1990.
  2. Endocrinology of fluorosis. India - USA Symposium on Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India, Dec 26-31, 1990.
  3. Endemic skeletal fluorosis in India. Thirteenth Annual Meeting of the American Society for Bone and Mineral Research, San Diego, California, USA, Aug 24-28, 1991.
  4. Pancreatic beta cell function in endemic fluorosis. XIXth Conference of the International Society for Fluoride Research, Kyoto, Japan, Sep 8-11, 1992.
  5. The radiological spectrum of endemic fluorosis. XIXth Conference of the International Society for Fluoride Research, Kyoto, Japan, Sep 8-11, 1992.
  6. Reduced responsiveness of cultured parathyroid cells to extracellular calciums associated with decreased extracellular calcium receptor expression. The Endocrine Society, Anaheim, CA, USA, jun 15-18, 1994.
  7. Skeletal fluoride toxicity in children: Clinical, radiologic and metabolic profile. Sixteenth Annual Meeting of the American Society for Bone and Mineral research, Baltimore, USA, Sep 9-12, 1995.
  8. Physiology of parathyroid glands - molecular basis of calcium sensing. Indo Japanese Workship on Parathyroid Surgery, Lucknow, Jan 23-24, 1996.
  9. Skeletal fluoride toxicity: endocrine and metabolic aspects. Joint meeting of the International Congress of Endocrinology and the Endocrine Society, San Francisco. CA, USA June 11-15, 1996.
  10. Biochemical markers of bone turnover in endemic fluorosis: Bone and Mineral Division, Henry Ford Hospital, Detroit, USA.
  11. Skeletal fluorosis. Division of Clinical Pathophysiology, University Hospital, Geneva, Jun 28, 1996.
  12. The Calcium Sensing Receptor: New insights into mineral ion metabolism. Aging Seminar, Kawasaki University School of Medicine, Kurashiki, Japan, Aug 23, 1996.
  13. Endemic skeletal fluorosis: Department of Medicine, Kitasato University School of Medicine, Yokohama, Japan, Sep 10, 1996.
  14. The Calcium Sending Receptor: New insights into mineral ion metabolism. Research Institute of Environmental Medicine, Nagoya University, Japan, Sep 16, 1996.
  15. The diagnosis of osteoporosis: State of the art. Annual Conference of the Endocrine Society of India, Cochin, Dec 1-3, 1996.
  16. Clinical relevance of the Calcium Sensing Receptor. Endocrinology, Metabolism and Diabetes, Banglore, India, Dec 6-8, 1996.
  17. Endemic fluorosis and calcium intake. Nestle nutrition workshop on calcium and bone development, Puebla city, Mexico, Feb 23-25, 1997.
  18. Post operative thyroxine suppressive therapy. How much is safe? Indo-Japanese workshop on Thyroid Cancer, Lucknow, May 22-24, 1997.
  19. Skeletal effects of fluorosis. International CME on Metabolic Bone Disorders, Annual Conference of the Endocrine Society of India, Lucknow, Dec 16, 1997.
  20. Recent advances in vitamin D metabolism. Endocrine Club, India International Centre, New Delhi, Feb 28, 1998.
  21. Vitamin D status in urban North Indian Adults. American Society for Bone and Mineral Research, St Louis, USA, 1999.
  22. Spectacular recovery of BMD in osteomalcia following vitamin D therapy. American Society for Bone Mineral Research, (Adult Bone and Mineral Working Group), Toronto, Canada, Oct, 2000.
  23. Lack of ethnic differences in the relationship between parathyroid gland mass and vitamin D status in primary hyperparathyroidism. Endocrine Society (USA), Denver, Colorado, Jun 18-22, 2001.
  24. Rapid and marked recovery of Bone Mineral Density following vitamin D treatment in osteomalacia. Japanese Society for Bone and Mineral Research, Nagoya, Japan, Aug 8-11, 2001. (AWARD for outstanding paper)

For Further Assistance:

Contact for Appointments: At Medanta: 93 508 76124      At Apollo & Vasant Kunj Clinic: 98 104 74552  (10 A.M. - 5 P.M., Monday - Saturday)