SARCOIDOSIS PRESENTING AS TESTICULAR MASS: CASE REPORT AND REVIEW OF THE LITERATURE. L. Corsino-Nunez 1 , M. Kam 1 , C. Kaye 1 ; 1 Wayne State University, Detroit, MI (Tracking ID #75657) LEARNING OBJECTIVES: To recognize sarcoid presenting as a testicular mass. CASE INFORMATION: Sarcoidosis a chronic multisystem disease of unknown etiology characterized by noncaseating granulomas. The most commonly involved organs are the lungs, lymph nodes, skin, uvea, liver and bone. Sarcoidosis of the male urogenital tract is uncommon. Physicians need to be aware of this occurrence especially in males with a known history of sarcoidosis. Case: A 31 y/o African American male presented to the Emergency Department complaining of dyspnea, fever and night sweats. Past medical history was significant for asthma. Admission physical exam was remarkable for bilateral, nontender, mobile, cervical lymph nodes and a right testicular mass. Chest-x-ray revealed mediastinal and bilateral hilar lymphadenopathy. Computarized Axial Tomography scan of the chest, abdomen, and pelvis was consistent for bilateral lymph nodes in the axillary and inguinal region. Ultrasonography of the right testicule was done and showed marked enlargement of the right epididymus and small hydrocele. Biopsy of one of the submandibular lymph node revealed non-caseating granulomas. A right orchiectomy was performed. The pathology report was consistent with non-caseating granuloma involving the epidiymis and focal testicular parenchyma. The spermatic cord was free of granulomatous inflammation. IMPLICATIONS/DISCUSSION: Discussion: Sarcoidosis with testicular involvement is rare. Only 0.2% of patients with sarcoidosis have urogenital involvement. Forty-three cases have been described in the English language medical literature. We want to enhance physicians' awareness of urogenital sarcoidosis and include in the differential diagnosis of a palpable testicular mass. The treatment for urogenital sarcoid is corticosteroids, identical to systemic sarcoid. Review of the literature shows that a great unnecessary percentage of patients with testicular sarcoid have undergone orchiectomy. Thus awareness of this condition may result in prevention of this radical approach in males who present with sarcoidosis and a testicular mass. LEARNING OBJECTIVES: To recognize Pott±Puffy Tumor as a complication of sinusitis. CASE INFORMATION: Pott±Puffy Tumor is defined as subperiostial abscess and osteomyelitis of the frontal bone seen as a complication of frontal sinusitis. With the advent of antibiotics, Pott±Puffy Tumor is a rarely recognized entity. A 31 y/o white female, previously healthy until one day prior to admission, presented with frontal headaches, dull in nature that progressively worsened, associated with remarkable forehead swelling, and dizziness. One week prior to admission she received a two-week course of cefuroxime for frontal sinusitis. Her past medical history was significant for fibrodysplasia of the ethmoidal sinus during childhood requiring five surgical interventions. Admission physical exam was remarkable for forehead swelling with tenderness over the frontal bone and absence of fever. Computerized axial tomography scan of the head revealed opacification of the frontal sinus. The frontal sinus was drained and a purulent discharge was obtained. Gram stain and culture showed no organisms or growth. Frontal headache and swelling improved after drainage. She was placed on ampicillin/sulbactam for a total of two months. She was scheduled for frontal sinus obliteration after completing the antibiotics. IMPLICATIONS/DISCUSSION: Pott±Puffy tumor represents a rare complication of frontal sinusitis. Only 21 cases have been reported after the antibiotic era, of wish 7 have presented in adults. The importance of making this diagnosis is to prevent expansion of the infection to the brain. We would like to highlight the importance of making an accurate diagnosis, especially in patients treated for frontal sinusitis. Five cases in which no organisms have been identified are reported in the literature. This entity can be successfully treated with antibiotics and drainage. LEARNING OBJECTIVES: Recognize the importance of secondary causes for hypertension. CASE INFORMATION: A 51 year old diabetic gentleman with obstructive sleep apnea treated with CPAP and a long-standing history of hypertension came to our clinic for a routine visit. Despite five anti-hypertensive medications, blood pressures remained near 180/100. This prompted a search for secondary hypertension. Studies were negative for renal vascular disease and pheochromocytoma as well as primary hyperaldosteronism. Despite preserved renal function, Nephrology consultation was obtained with the resulting suggestion that this may be a case of occult noncompliance. However, the patient regularly attended appointments and filled all of his antihypertensives in a timely manner. This convinced us to look further into additional possible rare causes for secondary hypertension. On one subsequent follow-up visit, the patient did complain of jaw changes and a thick tongue. He has coarse facial features, a large fleshy nose and large tongue along with multiple skin tags and large hands. The constellation of hypertension, sleep apnea, diabetes, and a documented history of carpal tunnel syndrome, along with his complaints and findings raised the possibility of acromegaly as a reason for refractory hypertension. For the initial workup, a screening insulinlike growth factor 1 level was then ordered, which returned at 2.5 times the normal range. A subsequent confirmatory glucose tolerance test with measurement of growth hormone levels then failed to show GH suppression with a glucose load, supporting the diagnosis of acromegaly. IMPLICATIONS/DISCUSSION: Acromegaly is a somatic growth and proportion disorder with elevated levels of GH and ILGF-1 found as hallmarks of this syndrome. It is most often caused by GH-secreting pituitary tumors. Some of its features include skeletal overgrowth, arthropathy, skin changes, cardiovascular disease and respiratory dysfunction. Hypertension is one important complication of acromegaly, with the prevalence of hypertension in acromegalic patients estimated to be about 35%, although there is no consensus in the medical literature regarding the exact mechanisms involved in its pathogenesis. While hypertension is a common condition treated by internists, fewer than 5% of cases are found to have secondary causes. This case highlights the need to consider rare causes of hypertension in patients resistant to treatment, and demonstrates why acromegaly should be considered in the differential.