bluuebunny/crossref_metadata_2025 huggingface dataset:
8192 A Two-Cycle Clinical Audit Testing Inpatient Management Of Hypophosphatemia In A UK District Hospital
Authors: Porto J , Ssemmondo E , Obike N , Abobaker A , March R , Tun N , Pawlak T
Published: October 2024

Disclosure: J. Porto: None. E. Ssemmondo: None. N. Obike: None. A. Abobaker: None. R. March: None. N. Tun: None. T. Pawlak: None.

Objective: A clinical audit was conducted to assess if there was any improvement in management of hypophosphatemia among patients admitted to the medical wards using the local Trust protocol, following structured edcational sessions to the junior doctors covering medical wards. Design and methodology: The 2 cycles of the audit were conducted between March 2020 and September 2021 in Scarborough district Hospital. The clinical notes of 52 patients (20 in the first cycle and 32 in the re-audit) with hypophosphatemia were reviewed. These were identified using the electronic laboratory results of patients within the study period. The aspects of the trust protocol for management of hypophosphatemia that were audited; documentation of symptoms associated with low phosphate levels, cardiac monitoring in severe hypophosphatemia, identification of the likely cause of hypophosphatemia, the presence or absence of associated acute kidney injury (AKI) and initiation of phosphate replacement. The results of the first audit were presented at the local hospital clinical governance meeting (August 2020). Following this, 2 teaching sessions and 2-case based discussion on hypophosphatemia were organised for all the doctors in the department of medicine. The re-audit was subsequently conducted after the fourth teaching session. The proportions of each audited item were compared between the first audit and the re-audit using Fisher exact probability test. Results:25% of patients in the first audit had severe hypophosphatemia compared to 28% in the re-audit. In patients with severe hypophosphataemia, only 33.3% had cardiac monitoring during the re-audit cycle compared to 60% in the first cycle, and the difference was not statistically significant (p=0.58). There was significant improvement in the documentation of symptoms of hypophosphataemia amongst inpatients during the re-audit cycle compared with the initial cycle; 62.5% vs only 10% (P 0.002). Most patients had an underlying cause of the hypophosphatemia identified (80% and 62.5%-first and second cycle respectively). AKI was associated with hypophosphataemia in 15% & 34.4% (P 0.2) in the first and second cycles respectively. Despite low phosphate levels, 25% and 28.1% at the initial audit and the second cycle respectively did not receive any form of phosphate replacement. Conclusion: The two-cycle clinical audit showed that the teaching sessions on management of hypophosphatemia increased the awareness of the importance to document whether the patients were symptomatic or asymptomatic following the drop in their phosphate levels, which can help to identify patients at risk of developing complications, such as cardiac arrythmias. However, these sessions were not sufficient to improve overall management of patients with low phosphate levels.

Presentation: 6/1/2024
7871 Investigating The Impact Of Prenatal Exposure To A Mix Of Endocrine-Disrupting Chemicals On Development: Behavioral, Physiological, And Transcriptomic Analyses
Authors: Streifer Madeline R , Thompson Lindsay , Gore Andrea C
Published: October 2024

Disclosure: M.R. Streifer: None. L. Thompson: None. A.C. Gore: None.

In recent decades, there has been a growing concern surrounding the presence of endocrine-disrupting chemicals (EDCs) in our environment and their potential implications on human health. Among these, prenatal exposure and subsequent effects on the developing neuroendocrine system have emerged as a subject of interest. This study aims to define the long term developmental, behavioral, and molecular effects of prenatal exposure to NeuroMix, a complex mixture of environmentally relevant EDCs. To this end, pregnant rat dams were fed either NeuroMix or vehicle, exposing the developing fetuses during critical periods of neuroendocrine development. The exposed offspring (F1 generation) were the experimental subjects, which were allowed to mature to adulthood, underwent behavioral testing, then were euthanized for brain tissue collection. Our study revealed noteworthy sex-specific effects, whereby exposed males exhibited reduced bodyweight and anogenital index, as well as delayed puberty. In contrast, females displayed no overt developmental abnormalities but exhibited heightened risk-taking behaviors in controlled behavioral experiments like the light:dark box. To unravel the molecular underpinnings of these observed effects, 3’ Tag-sequencing and transcriptomic analyses were performed on the arcuate nucleus (ARC) and ventromedial nucleus (VMN), two hypothalamic nuclei involved in hormonal regulation, metabolism, fear-based behaviors, and development. Results of Ingenuity Pathway Analysis (IPA) unveiled differentially expressed genes in both males and females, highlighting key pathways implicated in mitochondrial dysfunction and estrogen receptor signaling. Other notable pathways identified were related to cancer, neurological disorders, and endocrine system disorders. This comprehensive investigation highlights the impact of prenatal exposure to EDCs, influencing not only physiological parameters like body weight and puberty onset, but also behavioral phenotypes indicative of neurobiological alterations. The identification of disrupted molecular pathways provides valuable insights into the potential mechanisms linking EDC exposure to adverse health outcomes, warranting further exploration and consideration in the context of human health and environmental policy. Grant support: R01 ES029464.

Presentation: 6/1/2024
7899 Mixture Of Urinary Concentrations Of Phenols And Phthalate Metabolites In Relation To Serum Levels Of Lipid Biomarkers Among Pregnant Women: Results From The EARTH Study
Authors: Shen Xilin , Génard-Walton Maximilien , Williams Paige L , James-Todd Tamarra , Ford Jennifer B , Rexrode Kathryn M , Zhang Dan , Chavarro Jorge E , Hauser Russ B , Alarcon Lidia Minguez
Published: October 2024

Disclosure: X. Shen: None. M. Génard-Walton: None. P.L. Williams: None. T. James-Todd: None. J.B. Ford: None. K.M. Rexrode: None. D. Zhang: None. J.E. Chavarro: None. R.B. Hauser: None. L. Minguez Alarcon: None.

Given the limited evidence on endocrine-disrupting chemicals (EDCs), evaluated as mixture, in relation to lipid biomarkers during pregnancy, we examined whether mixtures of urinary concentrations of bisphenol A (BPA), parabens and phthalate metabolites were associated with serum lipid levels among 175 pregnant women who enrolled in Environment and Reproductive Health (EARTH) Study from 2005 to 2017. The outcomes were assessed at one random timepoint pre women during pregnancy, including serum levels of total triglycerides, total cholesterol, high-density lipoprotein (HDL), non-HDL, and low-density lipoprotein (LDL). We grouped the chemical biomarkers [di(2-ethylhexyl) phthalate (DEHP) metabolites and BPA; other phthalate metabolites; parabens] assessed in urine collected at the same time and applied Bayesian Kernel Machine Regression (BKMR) and quantile g-computation to evaluate the associations while adjusting for confounders [urine specific gravity, age, pre-pregnancy body mass index (BMI), race, education level, infertility diagnosis, mode of conception, number of babies in this pregnancy and trimester]. In the adjusted BKMR models, we found no associations between the overall chemical biomarker mixture and lipid levels for example total cholesterol [mean difference (95% CRI, credible interval) = 0.02 (-0.31, 0.34)] and LDL [mean difference (95% CRI) = 0.10 (-0.22, 0.43)] when comparing concentrations at the 75th to the 25th percentile. When stratified by BMI, we found suggestive positive relationships between the paraben group and total cholesterol and LDL among women with high BMI [mean difference (95% CRI) = 0.16 (-0.23, 0.55) and 0.16 (-0.25, 0.57)], but not among women with low BMI [mean difference (95% CRI) = -0.02 (-0.16, 0.12) and -0.02 (-0.15, 0.12)]. Among the paraben group, propylparaben was driving the associations among high BMI group [mean difference (95% CRI) = 0.25 (-0.26, 0.75) and 0.35 (-0.25, 0.95)], but not among low BMI group [mean difference (95% CRI) = 0.00 (-0.06, 0.07) and 0.00 (-0.07, 0.07)]. In addition, we found suggestive positive associations of DEHP metabolites and BPA group with total cholesterol, non-HDL and LDL among women with lower BMI, but none of the chemicals was identified as an important contributor to these associations. This study highlights that the associations between EDCs and cardiovascular biomarkers, such as circulating lipids, differ by BMI among pregnant women.

Presentation: 6/1/2024
7784 Perspectives Of Anabolic Steroid Users On Steroid Use, Side Effects, And Patient Education
Authors: Lam David D , Potemkin Michael , Kreutz Jason , Shah Harshil , Patel Parth , Doyle-Baker Patricia K
Published: October 2024

Disclosure: D.D. Lam: None. M. Potemkin: None. J. Kreutz: None. H. Shah: None. P. Patel: None. P.K. Doyle-Baker: None.

Background: Details on first-hand perceived and experienced effects of anabolic steroids (AS) on users are sparse. Furthermore, there is limited information on what type of AS knowledge users possess, irrespective of current published works in AS pharmacology. This study aimed to identify insights of AS users regarding their knowledge and patterns of AS use, commonly experienced side effects, sources used for steroid education, and their unique needs as a population. Study Design: AS users from Calgary, Alberta, Canada of various sexes and ages ≥ 18 were recruited through gyms in Alberta with convenience and snowball sampling techniques. Participant-centered-qualitative research using semi-structured interviews was conducted. Participants discussed their experiences as a user and shared their understanding of AS, details of usage including compounds used, and their commonly experienced or perceived side effects through one-on-one interviews of varying durations. Interviews were coded using NVivo 14 Software prior to thematic analysis. Resulting codes were organized into overarching themes based on researchers' consensus. Results: Seven AS users were confidentially interviewed over Zoom. Several important themes emerged. There existed a wide variety of AS that users have identified, with some of the most commonly mentioned being Anavar, Nolvadex, Testosterone, and Trenbolone. Steroid users frequently identified increased strength with faster recovery from training and better overall appearance as prominent advantages of AS use. Conversely, hair loss, gynecomastia, acne, aggression, erectile dysfunction, altered libido, hypogonadism, infertility, and injection related discomfort were commonly identified disadvantages of AS use. Lastly, individuals using AS report having consulted many different sources to learn about appropriate dosing, techniques, and side effects. These sources ranged from peers, coaches, online forums, social media, and scientific research articles, but rarely included healthcare professionals. Conclusions: This study identified the need for education and research in exploring the impact of AS use. A variety of AS exist on the market, yet information pertaining to the side effect profiles of these AS from a patient’s perspective is lacking and exploration of this topic is warranted. Further investigation as to the impact of user education on their understanding of the risks versus the benefits of AS use must also be conducted.

Presentation: 6/1/2024
6625 Adrenocortical Oncocytoma: Illuminating The Clinical And Biological Behavior Of An Extremely Rare Tumor Of The Adrenal Gland
Authors: Usmani Hareem , Arguello Mingxue
Published: October 2024

Disclosure: H. Usmani: None. M. Arguello, MD: None.

Background: Only 120 cases of adrenocortical oncocytoma have been reported in English literature (1). Standardized diagnostic criteria, or a typical clinical or biological course, have yet to be established. 58 yo woman with PMH HTN, COPD, CREST syndrome on chronic prednisone, previous 38-pk yr smoker, pulmonary nodule, current vaper, was incidentally found to have a left adrenal mass when she went for CT abd pelvis with IV and oral contrast to evaluate for suspected diverticulosis and anemia. CT showed a mass in the left adrenal gland measuring 5.6 x 4.4 cm in size, heterogeneous in density, with possible areas of necrosis. It is unclear how long the adrenal mass was there since the patient never had a CT scan before. Patient was asymptomatic except 50 lb wt loss in the last couple of years with a feeble appetite, self-reported abnormal hair growth (no hirsutism on exam), voice deepening attributed to smoking, and HTN- well controlled with nifedipine. Patient has no FHx of endocrinopathy. Adrenal function tests wnl except for plasma free normetanephrines slightly high at 1.64 nmol/L, which was unlikely from tumor considering tumor size. Normal adrenal function tests included 11-deoxycortisol, DHEA-S, plasma-free metanephrine, aldosterone, renin, aldosterone: renin ratio, androstenedione, ACTH, 1 mg overnight dexamethasone suppression test.She underwent left-sided lap adrenalectomy 4 mos after discovery of adrenal mass, with no complications. 6 days after surgery, a left in JP drain caught on a door at patient’s home, causing splenic subcapsular tear requiring emergent splenectomy. The path report shows an encapsulated neoplasm consisting of sheet-like proliferation of eosinophilia polygonal cells with nuclear atypia, low mitotic activity, and no capsular or vascular invasion. Immunohistochemical markers show neoplastic cells positive for SF1, Mart1, inhibin (focal), and synaptophysin (focal); negative for CK-OSCAR, CK7, CK20, chromogranin, HMB45, and TTF-1, Ki67 and pHH3 show low proliferative index. The pathology slides were sent to U of M, where the diagnosis of adrenal cortical oncocytoma was made. Removal of oncocytoma has not affected patient’s weight, blood pressure, deep voice, or hair growth on 4 month follow up. Lin-Wiess-bisceglia system (2) suggests a benign lesion. But, as mutation rate for this rare tumor is unclear, plan for CT abd pelvis in 1 yr. Conclusion: This case elucidates the clinical and biological course and pathologic diagnosis of an exceedingly rare adrenal tumor. References: [1] Hong Y, Hao Y, Hu J, Xu B, Shan H, Wang X. Adrenocortical oncocytoma: 11 Case reports and review of the literature. Medicine (Baltimore). 2017 Dec;96(48):e8750. [2] Munoz de Nova JL, García-Sanz Í, del Campo Val L, Delgado Valdueza J, Martín-Pérez E. Oncocitoma: una lesión infrecuente en la glándula suprarrenal. Endocrinol Nutr. 2015;62:144-145.

Presentation: 6/1/2024
7088 Serum PFAS Concentrations And Lipid Health In Adolescents : A Cross-Sectional Study From Korean National Environmental Health Survey 2018-2020
Authors: Shin M , Kim S H
Published: October 2024

Disclosure: M. Shin: None. S. Kim: None.

Backgrounds: Perfluoroalkyl substances (PFAS), widespread environmental contaminants, have been implicated in dyslipidemia in adults, but their impact on adolescent lipid profiles remains unclear. This study examines the association between serum PFAS concentrations and subnormal lipid profiles in a representative sample of Korean adolescents. Methods: Utilizing data from the fourth cycle of the Korean National Environmental Health Survey (2018-2020), we conducted a cross-sectional analysis on adolescents aged 12-17 (N=818). Serum PFAS concentrations—specifically PFOS, PFOA, PFHxS, PFNA, and PFDeA—were stratified into tertiles. Adjusted percentage changes in lipid parameters and the odds of suboptimal lipid profiles were calculated using multivariable linear and logistic regression models, adjusting for potential confounders. Results: Higher PFAS concentrations, particularly in the top tertile, were significantly associated with altered lipid profiles. Increased PFOS in the upper tertile corresponded with raised HDL-cholesterol levels, while PFNA and PFDeA showed similar associations with LDL-cholesterol and non-HDL-cholesterol. The logistic regression analysis showed that for PFNA, adolescents in the highest tertile had increased odds of an elevated LDL- cholesterol (OR: 2.24; 95% CI: 1.12-4.48), and PFDeA was associated with an increased total cholesterol (OR: 1.80; 95% CI: 1.21-2.66) when compared to the lowest tertile. Other PFAS compounds did not demonstrate a consistent pattern of significant associations with lipid parameters. Conclusions: These results underscore the possible health consequences of PFAS exposure and the risk of dyslipidemia among adolescents. Additional studies are required to confirm these links and to understand the underlying mechanisms involved.

Presentation: 6/1/2024
8054 Temporal Trends In Thyroidal Endocrine Disruptor Exposure Among United States Reproductive-Age And Pregnant Women Over 20 Years And Differences By Socioeconomic Status
Authors: Han Cheng , Lee Sun , Pearce Elizabeth N
Published: October 2024

Disclosure: C. Han: None. S. Lee: None. E.N. Pearce: None.

Background: Widespread exposure to endocrine disrupting chemicals (EDCs) poses a risk to public health and environmental safety. Women of reproductive age and pregnant women may be uniquely vulnerable to adverse thyroidal effects of EDCs. A better understanding of thyroidal EDCs exposure is needed to inform public health strategies. Objective: To examine temporal trends in EDC exposure and their effects on thyroid function among reproductive-age and pregnant women in the U.S. over the last two decades, with a focus on the impact of socioeconomic status. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 in 25,320 reproductive-age women and 2,525 pregnant women to assess the levels of exposure to thyroid-disrupting chemicals, including dioxins, organochlorides, polyfluoroalkyl substances (PFAS) from serum samples, and polyaromatic hydrocarbons, perchlorates, and metabolites from personal care products, phthalates, and plasticizers from urine samples. We used Kruskal-Wallis tests to analyze changes in EDC exposures over the past 20 years and multivariate linear regression models to identify factors influencing these levels. Results: We found a significant decline in exposures to 20 types of dioxins, 7 organochlorides, 6 PFAS, 5 personal care product chemicals, 6 phthalate metabolites, perchlorate, and thiocyanate, but substantial increases in exposure to 2 polyaromatic hydrocarbons among reproductive-age women. Among pregnant women, trends were similar, with declines in exposures to dioxins, organochlorides, PFAS, and phthalate metabolites; whereas exposure to 3 Polyaromatic hydrocarbons, 1 personal care product chemical, nitrates, and thiocyanates increased. Linear regression indicated a significant positive association between socioeconomic status and the levels of dioxin and PFAS in both reproductive-age and pregnant women, and a negative association between socioeconomic status and perchlorate and polyaromatic hydrocarbons in the participants. Conclusion: The past two decades have witnessed a general decline in the levels of most thyroidal EDCs in U.S. reproductive-age and pregnant women; however, some, particularly polyaromatic hydrocarbons, exposures have increased, especially among women with lower socioeconomic status. This has the potential to worsen disparities in health outcomes. These findings highlight the necessity for targeted public health interventions to reduce the impact of EDCs on thyroid health and address socioeconomic health disparities.

Presentation: 6/3/2024
6451 Bone Health ECHO: Expanding Global Capacity To Deliver Best Practice Skeletal Healthcare
Authors: Michael Lewiecki E , Rothman Micol Sara , Bouchonville Matthew Frederick
Published: October 2024

Disclosure: E.M. Lewiecki: None. M.S. Rothman: None. M.F. Bouchonville: None.

1 Bone Health ECHO: Expanding Global Capacity to Deliver Best Practice Skeletal Healthcare E. M. Lewiecki MD,[1] M. S. Rothman MD,[2] M. F. Bouchonville II MD[1] [1]University of New Mexico Health Sciences Center, Albuquerque, NM, USA[2]University of Colorado School of Medicine, Aurora, CO, USA Disclosure: E. M. Lewiecki: Amgen: investigator, consultant, speaker; Radius: investigator, consultant; Ultragenyx: investigator; Kyowa Kirin: consultant, speaker; Angitia: consultant; Ascendis: consultant. M. S. Rothman: nothing to disclose. M. F. Bouchonville II: nothing to disclose. Background: Osteoporosis is a major public health concern worldwide, with one-half of women and one-fifth of men over the age of 50 years having an osteoporotic fracture in their remaining lifetime. Osteoporotic fractures are associated with an increase in morbidity, mortality, and loss of independence. The economic costs of osteoporotic fractures are high and expected to rise along with population aging. Despite the availability of many medications proven to reduce fracture risk, most patients who could benefit from their use are not receiving them. Although fears and misperceptions about medications can exacerbate this treatment gap, an additional pitfall is a shortage of bone health specialists across the US, particularly in rural areas. Given how far many patients have to travel to see a bone health expert, innovative strategies are needed to improve access to care. Introduction: Bone Health ECHO (Extension for Community Healthcare Outcomes) is a virtual community of practice consisting of a network of healthcare professionals who connect online, where all learn and all teach through discussion of patient cases and short didactic presentations. ECHO aims to improve health equity, allowing participants to provide better skeletal healthcare closer to home, at lower cost, with greater convenience than referral to an academic center. Methods: This is a progress report for the prototype Bone Health ECHO program at the University of New Mexico (UNM) Health Sciences Center in Albuquerque, NM, USA, and the development of similar programs worldwide, with data compiled by Project ECHO at UNM. Results: The UNM Bone Health ECHO program has been held weekly since 2015, with a progressive increase in average weekly attendance each year since then. A total of 17 Bone Health ECHO programs have been started, 9 in the United States and 8 in other countries. Each program functions independently while following the ECHO model of case-based learning. Conclusions: The experiences and lessons learned from current Bone Health ECHO programs provide a template for the development of additional programs, with the goal of reducing the burden of skeletal disorders worldwide.

Presentation: 6/2/2024
7746 Developing An Ambulatory Endocrinology, Diabetes And Metabolism Curriculum With On-Site Fellow Involvement
Authors: Mascaro Javier Ocampo , White Caitlin A , Nandiwada Deepa R
Published: October 2024

Disclosure: J. Ocampo Mascaro: None. C.A. White: None. D.R. Nandiwada: None.

Background: Traditionally, Internal Medicine (IM) residency programs have favored inpatient learning opportunities, with limited exposure to outpatient subspecialties like Endocrinology, Diabetes and Metabolism (EDM). Understanding EDM concepts is critical for IM physicians. Over the last decade, programs have been able to increase outpatient component in their curriculum. Thoughtful educational interventions that bolster exposure to EDM topics for IM residents are necessary to both reduce gaps in medical knowledge and address dwindling numbers of applicants interested in pursuing a career in EDM. On-site EDM fellow participation presents a unique opportunity to achieve these goals. Methods: An electronic needs assessment was delivered to Primary Care (PC) IM residents at a large academic medical center. The survey included questions gauging their degree of confidence in diagnosing, managing, and counseling patients with frequent EDM concerns. All questions were answered using a Likert scale. Data was collected from August to October 2023 and used to design an educational intervention by a senior EDM fellow who is physically present at the primary care IM clinic monthly. This intervention encompassed didactic lectures, direct observation of patient counseling, and on-site curbside consultation. Results: 12 of 24 PC IM residents completed the survey. Most felt somewhat or extremely comfortable evaluating patients with diabetes mellitus (DM) type 2 (100%) and hypothyroidism (83%). When evaluating adrenal insufficiency, osteoporosis, adrenal incidentalomas and primary aldosteronism (PA), 91%, 67%, 67% and 67% of residents reported being extremely or somewhat uncomfortable, respectively. Residents reported being somewhat or extremely comfortable addressing lifestyle interventions for weight loss (83%), medications for DM2 (83%), and instructing patients how to take levothyroxine (67%). Residents felt most uncomfortable counseling patients about osteoporosis treatment, adrenal incidentaloma, osteoporosis screening, fall prevention, and insulin teaching, with 83%, 67%, 58%, 58%, and 58% of residents reporting being somewhat or extremely uncomfortable, respectively. Conclusion: This needs assessment highlighted PC IM residents at our institution were uncomfortable evaluating adrenal insufficiency, osteoporosis, adrenal incidentalomas, and PA. They were also uncomfortable counseling patients on these topics as well as fall prevention and insulin teaching. We describe an intervention by an on-site EDM fellow utilizing pre-clinic conferences, direct observation, and on-site curbside consultations. As IM training pathways have increased exposure to outpatient subspecialties, it is important to thoughtfully assess and design interventions to maximize trainees' learning potential, which can be accomplished with subspecialty fellow direction.

Presentation: 6/3/2024
7333 Does Allgrove Syndrome Have Endocrine Manifestations Beyond Adrenal Insufficiency?
Authors: Sathi Sri Ram Teja , Jara-Tantoco Mikaela , Anastasopoulou Catherine
Published: October 2024

Disclosure: S. Sathi: None. M. Jara-Tantoco: None. C. Anastasopoulou: None.

Background: Allgrove syndrome, initially described as a triad of alacrimia, adrenal insufficiency (AI), and esophageal achalasia (Triple A syndrome) is a multisystem disorder with a wide array of phenotypic presentations. Mutations involving the AAAS (achalasia-addisonianism-alacrimia syndrome) gene on chromosome 12q13 are the cause with a prevalence of 1 in 1 million population. To our knowledge, there are no reports of any other endocrine manifestations apart from AI and osteoporosis associated with this disorder. We describe a patient with a cluster of more endocrine diseases. Case: A 44-year-old hispanic female was diagnosed with Allgrove syndrome in the first decade of her life when she was found to have esophageal achalasia, AI, and absence of lacrimation. Physical exam revealed BMI of 18 kg/m2 without dysmorphic features, skin abnormalities, or neurological deficits. Thyroid gland size was within normal limits, and there was no evidence of thyroid eye disease. She had multiple hospitalizations with abdominal symptoms attributed to esophageal stricture and esophagitis resulting in an adrenal crisis each time. During one such hospitalization, she had symptoms suggesting hyperthyroidism including palpitations, weight loss, and heat intolerance. Workup was consistent with Graves’ disease, and she was started on methimazole 5 mg daily with good response. Further evaluation revealed that she became amenorrheic in her 20s. Workup was consistent with premature ovarian failure (POF). A DXA scan revealed very low bone mineral density consistent with osteoporosis (T scores; Hip: -3.8, Fem neck: -3.7, Lumbar Spine: -3.5). She had mild vitamin D deficiency but normal calcium and parathyroid hormone levels. The patient chose osteoporosis-specific treatment over hormonal replacement. Zoledronic acid was chosen considering her history of Heller myotomy and esophageal strictures. She was maintained on hydrocortisone 20 mg daily for her adrenal insufficiency. Lab work: FSH: 148 mIU/ml (3.5 - 12.5)LH: 58.4 mIU/ml (2.4 - 12.5)Estradiol: <5 pg/mL (12.5 - 166)TSH: <0.01 mIU/mL(0.35 - 4.94)T4 Free: 2.45 ng/dL (0.7 - 1.48)TSI %: 412(<140)PTH: 17 pg/mL (15 - 65)Learning points: Allgrove syndrome is a rare autosomal recessive inherited disorder with 70% of the patients developing the classic triad of alacrimia, esophageal achalasia, and AI. Early onset osteoporosis that is not completely explained by glucocorticoid use, has been described. We present a patient with Allgrove syndrome with additional disorders of hyperthyroidism and POF which are known risk factors for osteoporosis. It is unclear if these additional endocrine abnormalities are manifestations of Allgrove syndrome or just coincidental. Further evaluation of known cases of Allgrove syndrome for these disorders can help answer this question.

Presentation: 6/3/2024
7870 Exploring The Role Of ChatGPT In Pediatric Endocrinology Education; Exam Preparation And Question Generation
Authors: Tarkoff Joshua , Martinez Sanchez Andrea G
Published: October 2024

Disclosure: J. Tarkoff: None. A.G. Martinez Sanchez: None.

Large language models (LLMs) hold substantial promise for improving physician knowledge and expertise. Their role in medical education and the generation of diverse diagnoses can be crucial, potentially leading to positive effects on clinical outcomes. The New England Journal of Medicine pediatric case challenges have examined ChatGPT [1]. Yet, its performance in specialized areas like Pediatric Endocrinology remains unexplored. This study assesses the effectiveness of ChatGPT 4 in responding to questions from the Pediatric Endocrine Self-Assessment Program (PESAP). It also examines if the AI is suitable for creating an educational quiz for residents and fellows. Methods: ChatGPT 4 underwent testing with questions from the 2021-2022 version of PESAP, utilizing the prompt: “Can you assist from the perspective of a pediatric endocrinologist with the following patient case”. Responses were evaluated for initial correctness, and performance was analyzed across various competency categories corresponding to the 7 “umbrella sections” of the tool (Adrenal, Bone, Carbohydrate and Lipid Metabolism/Obesity, Growth, Pituitary, Reproductive System, and Thyroid). Subsequently, we personalized the model by incorporating the questions and detailed responses from the PESAP. This customization resulted in a model that was then utilized to create a 10-question proof-of-concept quiz for four board-certified pediatric endocrinologists. The quiz included a scoring system designed to measure the extent and depth of ChatGPT knowledge. Results: ChatGPT 4 accurately answered 52% of PESAP questions, demonstrating varying performance across specific categories, ranging from 30% (Adrenal) to 78% (Reproductive System). In 16 questions, ChatGPT 4 did not provide an initial answer, requiring a specific request for a response. For questions related to thyroid cancer, explicit prompts were necessary to instruct responses based on the American Thyroid Association 2015 guidelines. In the endocrinologist quiz, the average score was 80%, ranging from 60% to 100%. Discussion: Currently, using ChatGPT 4 as the final diagnostic tool, especially in pediatric endocrinology, should be approached with caution, based on our assessment. However, when incorporating distinct Pediatric Endocrinology case studies, ChatGPT 4 successfully generated valuable educational questions, reinforcing fundamental concepts in the field. We anticipate that as LLMs advance and receive direct medical training, the out-of-the-box diagnostic accuracy will improve, leading to a transformative impact on medical education through this technology. References: 1. Barile J, Margolis A, Cason G, et al. Diagnostic Accuracy of a Large Language Model in Pediatric Case Studies. JAMA Pediatr. Published online January 02, 2024.

Presentation: 6/3/2024
9374 Gender Disparities In Endocrinology And Metabolism-Related Readmissions Following Covid-19 Hospitalization
Authors: Krueger Noelle , Alfar Hadeel , Shaka Abdultawab , Seares Marie Jennifer , Lanka Lavanya , Shaka Hafeez
Published: October 2024

Disclosure: N. Krueger: None. H. Alfar: None. A. Shaka: None. M. Seares: None. L. Lanka: None. H. Shaka: None.

Gender Disparities in Endocrinology and Metabolism-related Readmissions Following COVID-19 Hospitalization Authors: Noelle Krueger, Jennifer Marie Seares, Hadeel Alfar, Lavanya Lanka, Abdultawab Shaka, Hafeez Shaka. Introduction: Coronavirus disease 2019 (COVID-19) is a viral disease responsible for the devastating pandemic that began at the end of 2019. It has been associated with an increased risk of a variety of endocrine disorders. In this study, we identified the causes, predictors, and gender disparities of 30-day and 90-day endocrinology and metabolism readmissions (EMR) after COVID-19 related hospitalizations utilizing National Readmissions Database (NRD) 2020. Methods: We utilized the National Readmission Database from 2020 to identify hospitalized adults with a principal diagnosis of COVID-19 infection. We included subjects who were readmitted within 30 days and 90 days after index admission. We excluded subjects with elective and traumatic admissions. We utilized a multivariate Cox regression model to identify independent predictors of readmission. Results: During the study period, there were 1,024,492 index hospitalizations with a primary diagnosis of COVID-19 infection in the 2020 NRD database, 644,903 (62.9%) were included for 30-day readmission analysis, and 418,122 (40.8%) were included for 90-day readmission analysis. Of these, 2496 (0.3%) and 2929 (0.7%) were EMR for 30 and 90 days respectively. The most common causes of EMR were hypo-osmolarity with electrolyte dysfunction (41.7%), Type 2 DM with complications (32.9%) and Type 1 DM with complications (6.5%). Cox regression analysis adjusting for confounders revealed that female sex was associated with higher odds of 30-day (aHR=1.21; 95% CI 1.079-1.364; p=0.001) and 90-day (aHR=1.13; 95% CI 1.028-1.258; p=0.001) EMR cases. Being discharged against medical advice was also strongly predictive of readmission in 30 days (aHR=2.06; 95% CI 1.412-2.999; p<0.001) Conclusion: Our study demonstrates that female gender and being discharged against medical advice carry higher odds of 30-day and 90-day EMR. Identifying risk factors and common causes of readmission may assist with lowering the burden of endocrinologic disorders in patients with COVID-19 infection.

Presentation: 6/2/2024
9220 Machine Learning Methods In Differential Diagnosis Of Genetically Confirmed Multiple Endocrine Neoplasia Type 1 And Its Phenocopies
Authors: Trukhina Diana , Voronov Kirill , Mamedova Elizaveta , Solodovnikov Alexander , Belaya Zhanna
Published: October 2024

Disclosure: D. Trukhina: None. K. Voronov: None. E. Mamedova: None. A. Solodovnikov: None. Z. Belaya: None.

Background. MEN-1 is a rare autosomal dominant disorder caused by mutations in the MEN1 gene encoding the menin protein (gMEN1). This syndrome is characterised by the occurrence of parathyroid tumours, gastroenteropancreatic neuroendocrine tumours, pituitary adenomas, and other endocrine and non-endocrine neoplasms. If a patient with the MEN-1 phenotype does not have any mutation in the MEN1 gene, the condition is considered a phenocopy of the syndrome (phMEN1). The goal of this study was to develop a machine learning algorithm to estimate the probability of gMEN-1 vs phMEN-1 based on easily available clinical features at first line differential diagnostics. Materials and methods. A single-center, one-stage, cohort, retrospective study was carried out. Patients were randomly stratified into 2 cohorts: training (80%) and test (20%). Eight machine learning algorithms were used to develop predictive models: Logistic Regression, k-nearest neighbors (kNN), Naive Bayes, binary decision tree (CART), C5.0 decision tree algorithms, Bagged CART, Random Forest, Gradient Boosting (Stochastic Gradient Boosting, GBM). Results. The study included 95 patients with genetically confirmed gMEN-1 syndrome and 60 patients with its phenocopies. As a result of preliminary data processing and selection for the most informative features, the final variables for the classification and prediction of gMEN-1 syndrome were identified: the number of affected parathyroid glands, age at diagnostics, pancreatic tumour existence, heredity, type of pituitary adenoma secretion, and gender. The kNN algorithm demonstrated the best diagnostic performance in a training sample (ROC-AUC - 0.96, sensitivity - 84%, specificity - 100%), which was confirmed in a test sample (ROC-AUC - 1.0; sensitivity - 94.4%, specificity - 100%) to determine genetically confirmed MEN-1 syndrome. Conclusion. The k-nearest neighbours (kNN) algorithm may be used as a first-line differential diagnostics method to select patients to be refered for genetic testing for gMEN-1.

Presentation: 6/1/2024
7055 Metabolic Disorders In Thalidomide Embryopathy
Authors: Tanabe Akiyo
Published: October 2024

Disclosure: A. Tanabe: None.

Thalidomide embryopathy (TE) is a congenital limb defect that occurs in neonates born to pregnant women who have taken thalidomide. Typical abnormalities of the TE are upper limb hypoplasia and and/or auditory dysfunction. In Japan, thalidomide was marketed as an agent for sleep-induce and digestive ulcers from 1958 to 1962. Up to now, approximately 290 cases have been certified and are supported by the government as drug-induced disease. Currently, many of the victims are in their late 50s, and in addition to congenital disabilities, various health issues such as lifestyle-related diseases can be developed. We investigated their metabolic condition using data of medical health checkup between 2017 and 2018. Fifty-one Japanese cases of TE (28 men and 23 women) were included in this study. The mean age was 56.4±1.6 years in men and 55.9±1.2 years in women. The prevalence of upper limb deformities was 64% in men and 74% in women; the remaining patients had only hearing impairment. The mean body mass index (BMI) was 22.7±2.1 in men and 22.5±4.0 in women. Eleven percent of men and 17% of women had a BMI between 25-30, while 9% of women and no men had a BMI of 30 or greater. Liver dysfunction was seen in 32% of men and 9% of women. The mean high-density lipoprotein cholesterol level was 60±17 mg/dL in men and 68±18 mg/dL in women. The mean low-density lipoprotein (LDL) cholesterol level was 120±28 mg/dL in men and 136±35 mg/dL in women, with 25% of men and 48% of women had LDL level of 140 mg/dL or greater. The mean triglyceride (TG) level was 144±85 mg/dL in men and 116±61 mg/dL in women, with 43% of men and 17% of women had a level of 150 mg/dL or greater. The mean HbA1c level was 6.0±1.0% in men and 5.9±0.4% in women. The prevalence of impaired glucose tolerance was 25% in men and 13% in women. Fatty liver (FL) evaluated by ultrasonography or CT scan was 61% in men and 39% in women. The patients with FL showed significantly high body fat percentage and TG level in men, high alanine aminotransferase, γ-glutamyl transpeptidase and TG levels in women, respectively, compared to the patients without FL. The prevalence of hypertriglyceridemia was significantly higher in men with FL compared with men without FL. There was no significant difference in with or without the upper limb abnormalities in both groups. Although without obvious overweight, more than 40 % of the patients had dyslipidemia and 50% of the patients had FL. The limb abnormalities can result in movement limitations however other factors may be involved in the development of metabolic disorders in TE. The results of this study provide valuable information for future health management in thalidomide embryopathy. (This study was conducted by a research grant from the National Center for Global Health and Medicine, Japan: 21A1015 and a Grant-in-Aid from the Ministry of Health, Labour, and Welfare, Japan: 20KC2005, 23KC2017).

Presentation: 6/2/2024
6569 An Increase, Rather Than Absolute Amount, Of Corticotropin-Releasing Hormone (Crh) Drives Mouse Anxiety-Like Behavior
Authors: Rose Friedman Hannah , Gaston Lindsey , Chan Li , Majzoub Joseph A
Published: October 2024

Disclosure: H.R. Friedman: None. L. Gaston: None. L. Chan: None. J.A. Majzoub: None.

Approximately 300 million people have an anxiety disorder. We previously found that anxiety-like behavior (AB) is decreased in mice which lack hypothalamic (HT) Crh (1), so we hypothesized that increased HT Crh, due to primary adrenal insufficiency (PAI), would induce increased AB. To evaluate this, we compared AB in wildtype (WT) mice to those with global deletion of either the Crh gene (CrhKO) or the Mrap gene (MrapKO, causing PAI (2)), measuring: 1) HT Crh mRNA by in situ RNAscope, 2) stress-induced (after 15 min of restraint) plasma corticosterone (CORT) and adrenocorticotropin hormone (ACTH) by ELISA, and 3) AB with elevated plus maze (EPM), and open field (OF) automatically-recorded behaviors. Comparisons were evaluated by ANOVA with post hoc Bonferroni corrections vs. WT. As expected, Crh mRNA was highest in MrapKO (n=16) compared to WT (n=11), and undetectable in CrhKO (n=10), and post-restraint CORT was highest in WT (11±2 mcg/dL), and undetectable in CrhKO and MrapKO. CrhKO mice displayed decreased AB (increased EPM open arm duration) vs. WT animals (140±11 vs. 68±8 s, respectively, P<0.0001). However, AB was comparable between MrapKO (97±10 s) vs. WT (68±8 s; P=0.0807) despite higher HT Crh mRNA in the former. To determine if chronically high vs. a dynamic rise in Crh mRNA is associated with increased AB, we treated MrapKO mice with dexamethasone (DEX) for 5-8 weeks to suppress HT Crh mRNA and assayed hypothalamic-pituitary-adrenal axis function and behavior both on DEX (MrapKO-D; N=4) and 1-week post-withdrawal (MrapKO-DW; N=5). As expected, ACTH was highest in the MrapKO-DW vs. WT (1689±535 vs. 378±35 pg/mL, respectively; P<0.0001) and undetectable in MrapKO-D. Notably, MrapKO-DW mice displayed increased AB (decreased OF center duration) vs. WT animals (56±3 s vs. 114±10 s; P=0.0439). In summary, AB was not present in MrapKO mice with chronically elevated HT Crh mRNA but only developed after they were DEX-treated followed by withdrawal from treatment. These data suggest that in mice, a dynamic rise in HT Crh, but not a chronically elevated level, drives AB, and suggest that Crh is a possible target for anxiety treatment. References: (1) Zhang R et al., Mol Psychiatry. 2017 May;22(5):733-744. (2) Novoselova TV et al., FASEB J. 2018 Jun 7;32(11):fj201701274RR

Presentation: 6/2/2024
8463 Navigating Medical Decisions: A Study Of Second Opinions From Both The Physician And Patient Standpoints
Authors: Derevyanko Olga
Published: October 2024

Disclosure: O. Derevyanko: None.

Background: In contemporary healthcare, the concept of seeking second opinions has become increasingly prevalent, shaping the dynamics of patient-physician relationships. This study aims to delve into the multifaceted landscape of second opinions, examining the perspectives of both doctors and patients. As medical decision-making becomes more collaborative, understanding the factors influencing the second opinion process is crucial for enhancing patient outcomes and fostering effective communication within the healthcare system. Objectives: • To identify patterns and discrepancies between doctors' and patients' viewpoints on the importance and impact of second opinions.• To provide insights that can contribute to the development of strategies for improving the second opinion experience for both doctors and patients.• To assess how often patients seek for second opinion MethodsA comprehensive survey conducted among 756 doctors endocrinologists in social media Instagram , aiming to explore their attitudes and concerns regarding patients seeking second opinions in medical practice and 787 patients to find out how many of them seek for a second opinion. Results: Out of the surveyed doctors, 51.3% (n=388) expressed a positive and accepting attitude toward patients seeking second opinions. This majority acknowledged the importance of patient autonomy and the right to seek additional perspectives on their medical conditions.A significant portion, 34.5% (n=261) of doctors, voiced concerns related to potential drawbacks associated with second opinions. These concerns primarily revolved around the possibility of patients receiving conflicting advice or experiencing delays in crucial treatment decisions.A noteworthy 14.2% (n=107) of doctors indicated concerns related to the potential impact of second opinions on the trust between doctors and patients. This subset of professionals expressed apprehensions about how seeking additional perspectives might influence the doctor-patient relationship. 554 out of 787 patients reported about seeking for the second opinion most of the time. Conclusion: The insights gleaned from this survey shed light on the complex landscape of doctors' perspectives on second opinions. Recognizing the nuances within these attitudes is imperative for developing strategies that support collaborative decision-making and patient-centered care in the medical community. This research contributes valuable insights to the ongoing discourse surrounding patient autonomy and doctor-patient relationships.

Presentation: 6/3/2024
7419 Navigating The Diagnostic Maze Of Pseudohypoglycemia In A Young Adult Male With Severe Hypertriglyceridemia: A Novel Case Report
Authors: Muojieje Chukwudi , Hotiana Mateen
Published: October 2024

Disclosure: C. Muojieje: None. M. Hotiana: None.

Objective: This case report aims to shed light on the challenges of diagnosing and managing pseudohypoglycemia, particularly in the absence of Whipple's triad, and to explore its rare association with severe hypertriglyceridemia. Methods and Results: We present a 26-year-old Caucasian male with a history of depression, anxiety, and recently diagnosed hyperlipidaemia who presented to Cabell Huntington Hospital with intermittent chest pain and multiple episodes of syncope. Laboratory findings revealed low sodium (128 mmol/L) and significant discrepancies in blood glucose levels (52 mg/dL in laboratory tests vs. 93 mg/dL in point-of-care tests). The managing team initiated an evaluation for hypoglycaemia based on the low serum glucose values by ordering c-peptide, insulin and pro-insulin (normal findings). Endocrinology was consulted for further management of pseudo hypoglycaemia. Consultation led to further investigations, revealing severely elevated triglycerides (2,568 mg/dL), cholesterol (478 mg/dL), low HDL (26 mg/dL), and very low-density VLDL (514 mg/dL). The stat glucose test showed a level of 103 mg/dL, while the routine glucose test on the same sample was less than 10 mg/dL, and the point-of- care glucose test was 90 mg/dL. An A1c test returned normal at 4.9%, and the patient had no history of diabetes or insulin use. Conclusion: This case highlights the complexities in diagnosing pseudohypoglycemia, a condition that can present with falsely low glucose readings in the absence of clinical hypoglycemia symptoms. The significant hypertriglyceridemia observed in this patient suggests a potential novel association. The findings emphasize the need for comprehensive evaluation in cases of discordant glucose readings and suggest a potential new frontier in understanding and managing pseudohypoglycemia. Physicians should be aware of rare instances of in vitro glycolysis leading to pseudohypoglycemia and consider lipid profiles in their diagnostic process.

Presentation: 6/3/2024