bluuebunny/crossref_metadata_2025 huggingface dataset:
THU544 Prostatic Acid Phosphatase Is Negatively Regulated By Androgens And Persists In Castrate-resistant Metastatic Prostate Cancer
Authors: Rajagopalan Vinodh , Kirschenbaum Alex , Yao Shen , Levine Alice
Published: October 2023

Disclosure: V. Rajagopalan: None. A. Kirschenbaum: None. S. Yao: None. A. Levine: None.

Abstract: Prostate cancer (PCa) is the most common cancer and second leading cause of cancer death in American men. Most patients with metastatic PCa respond initially to androgen deprivation therapy (ADT) but the majority will progress to lethal, metastatic, castrate-resistant PCa (mCRPC). The identification of markers of mCRPC that are not regulated or negatively regulated by androgens can serve as markers and therapeutic targets in mCRPC. We hypothesized that prostatic acid phosphatase (PAP), a protein phosphatase and 5’ectonucleotidase that is expressed in both the cytoplasm and transmembrane (TM-PAP) of PCa cells, is negatively regulated by androgen signaling and can serve as a therapeutic target. Methods: Protein expression of PAP was assessed with western blotting in PCa cell lines. TM-PAP is identified by sub-cellular fractionation analysis, confocal microscopy, and flow cytometry. Effects of androgens and anti-androgens on PAP expression were assessed in VCaP cells with dihydrotestosterone (DHT) and Enzalutamide treatment followed by PAP, AR and PSA protein expression determined with Western Blotting. Loss of function analysis of PAP was performed with siRNA-mediated silencing and functional analysis was evaluated with migration and colony formation assays. Transcriptional regulation of PAP was determined by real time qPCR analysis. ChiPseq was done to confirm the binding of AR to PAP promoter. Results: All forms of PAP including TM-PAP are expressed in VCaP cell line. However, we did not detect PAP protein expression in-vitro in the LNCaP, C42B or 22Rv1 cell lines. In VCaP cell lines, we demonstrated that androgens decreased while anti-androgens increased PAP expression in a time and dose dependent fashion. Androgenic regulation of PAP occurred, at least in part, at the transcriptional level. We successfully knocked down TM and secretory PAP expression in VCaP cells using siRNA technology and showed that loss of PAP decreased migration and colony formation. Conclusions: The identification of markers of mCRPC that not regulated or negatively regulated by androgen could help identify recalcitrant tumor cells and mount targeted delivery of therapeutic agents. In the VCaP cell line, derived from a patient with mCRPC, TM and cytosolic PAP is one such protein that is negatively regulated by androgen signaling and may therefore serve as a viable therapeutic target in mCRPC.

Presentation: Thursday, June 15, 2023
THU548 The Role Of Sirtuin 3 In Endocrine Therapy Resistant Breast Cancer Cells Response To Fulvestrant
Authors: de Oliveira Karla Andrade , de Oliveira Andrade Fabia , Ozgul-Onal Melike , Yadav Anil , Onal Tuna , Jin Lu , Sengupta Surojeet , Clarke Robert
Published: October 2023

Disclosure: K.A. de Oliveira: None. F.D. Andrade: None. M. Ozgul-Onal: None. A. Yadav: None. T. Onal: None. L. Jin: None. S. Sengupta: None. R. Clarke: None.

Endocrine therapy can lead to cellular nutrient deprivation by reducing glucose and glutamine uptake and total cellular ATP production in breast cancer cells. The ability to bypass this metabolic stress is fundamental to how breast cancer cells regulate growth and acquire endocrine resistance. SIRT3, which can be activated by calorie restriction, modulates mitochondrial adaptation to low energy input. It has a key role in mitochondrial integrity and function, regulating cell survival, death, and metabolism, regulating the shift to amino-acid and fatty-acid catabolism. SIRT3 can maintain ROS levels at the appropriate levels for sustaining a proliferative phenotype, preventing apoptosis and promoting carcinogenesis. A role of SIRT3 in epigenetic regulation has also been reported. The ability of SIRTs to sense and respond to changes in energy, coupled with their intrinsic deacetylase/deacylase functions, could provide a mechanism for the cell to rewire signaling and maintain a newly acquired drug-resistant phenotype. Using antiestrogen sensitive (LCC1) and cross-resistant (LCC9) breast cancer cells, we confirmed higher expression of SIRT3 in LCC9, compared with LCC1 cells. Upregulation of SIRT3 expression within 24 hrs of Fulvestrant (ICI 1 µM) treatment (p=0.0176) in LCC1 was shown, whereas no effect was observed in LCC9 cells. Inhibition of SIRT3 activity, using the inhibitor LC0296 (15 µM), reduced growth rate in both LCC1 and SIRT3-silenced LCC9 cells under treatment with ICI (p<0.0001, p<0.001 respectively). Treatment with SIRTUIN 3 inhibitor and ICI induced caspase-independent cell death in LCC1 and SIRT3-silenced LCC9 cells compared to the untreated control and ICI only treated cells (p<0.001). The combination of SIRT3 inhibition (LC0296, 15 µM) and ICI treatment (0.5 µM) increased ROS production in LCC9-SIRT3 silenced cells in 24 hrs compared with the untreated control and ICI only treated cells (p<0.001). The combination of LC0296 and ICI induced a decrease in mitochondrial membrane potential and ATP production, and a decrease in glycolytic capacity and glycolytic reserve in both LCC1 and SIRT3-silenced LCC9 cells, compared with the untreated control (p<0.001). Moreover, ICI significantly reduced ATP production in the mitochondria of the SIRT3-silenced LCC9 cells (p<0.001) but not in the non-silenced (control) LCC9 cells. Taken together, these results show that SIRT3 may have a key role in determining the response to fulvestrant response in ER+ breast cancer cells; a more detailed understanding of this role for SIRT3 is under investigation in our laboratory.

Presentation: Thursday, June 15, 2023
THU550 The Splicing Factor SRSF6 Regulates Androgen Receptor Activity And Represents A Potential Therapeutic Target In Prostate Cancer
Authors: Luque Raul M , Montero-Hidalgo Antonio J , Gomez-Gomez Enrique , Olmos David , Gahete Manuel D , Jimenez-Vacas Juan M
Published: October 2023

Disclosure: R.M. Luque: None. A.J. Montero-Hidalgo: None. E. Gomez-Gomez: None. D. Olmos: None. M.D. Gahete: None. J.M. Jimenez-Vacas: None.

Background: Prostate cancer (PCa) is the fifth leading cause of cancer-related death worldwide. Finding novel therapeutic strategies to tackle PCa, especially its most advanced phenotype [i.e., castration-resistant prostate cancer (CRPC)], is urgently needed. In this sense, although the dysregulation of the splicing process has emerged as a distinctive feature of advanced PCa, the potential role that splicing regulators may play in this disease remain poorly understood. In this study, we aimed to analyse the levels, pathophysiological role and associated molecular landscape of the splicing factor SRSF6 in PCa. Methods: SRSF6 levels (mRNA, protein and CNA) were interrogated in seven well-characterized cohorts of PCa patients and in the Hi-MYC transgenic model. The effect of SRSF6 overexpression and silencing was tested in vitro (proliferation, migration, colony- and tumorspheres-formation) and in vivo (tumor growth of xenograft tumours). RNAseq was performed in 22Rv1 cells to analyse splicing and gene expression changes in response to SRSF6 silencing. Findings: Our results showed that SRSF6 levels (mRNA/protein) are upregulated in PCa vs non-tumour prostate samples, linked to clinical parameters of tumour-aggressiveness (e.g., Gleason score, T-stage, perineural infiltration, metastasis at diagnosis), and associated with poor prognosis (i.e., shorter disease-free survival time) in PCa patients. Moreover, SRSF6-overexpression increased, while its silencing decreased, functional parameters of aggressiveness in vitro and tumour growth in vivo. Mechanistically, SRSF6 modulation resulted in dysregulation of Androgen-Receptor (AR) activity through transcriptional control of APPBP2 and TOP2B. Discussion: SRSF6 could represent a new therapeutic target to inhibit persistent AR-signalling in advanced PCa. Funding: Spanish Ministry of Science, Innovation, and Universities (PID2019-105564RB-I00, FPU18/02485), Health Institute Carlos III (DTS20-00050), and CIBERobn.

Presentation: Thursday, June 15, 2023
THU558 Combination Therapy Of Acetyl-CoA Synthetase Inhibitor And Fulvestrant Reverse Epigenetic Alterations Of Metastatic Breast Cancer Cells And Reduce Cancer Cell Proliferation
Authors: Mogol Ayca N , Erdogan Zeynep Madak
Published: October 2023

Disclosure: A.N. Mogol: None. Z. Madak Erdogan: None.

Endocrine therapies exploit the hormone dependencies of the cancer cells in various ways, including by targeting estrogen receptor alpha (ERα) that is expressed by approximately 70% of human breast cancers. After treatment, recurrence and metastasis are still observed in 30-40% of ER+ patients and the 5-year relative overall survival rate for these patients is just 24%. Acetyl-CoA production significantly regulates histone acetylation and gene regulation, which support tumor progression. In our previous study, we showed the synergistic effect of the ERα agonist Fulvestrant (Fulv) and Acetyl-CoA Synthase Inhibitor (ACSI) in reducing cell viability in ER+ metastatic breast cancer (MBC) cells in vitro. To study the synergistic contribution of ACSS2 to endocrine resistance, we used ChIP analysis, which showed that ACSS2 was recruited to ERα binding sites with Fulv treatment in cell line xenograft tumors and PDX samples. We used the CUT&RUN method to investigate specific protein (H3k27ac, ERα and ACSS2) and DNA interactions in ER+ MBC cells globally. Enriched chromatin samples were then used for qPCR and sequencing. Combination therapy of the ACSI and Fulv significantly altered the epigenetic landscape of the breast cancer cells in a manner to decrease cell viability. High histone acetylation at lysine 27 residue was observed in Veh treatment group and combination therapy of ACSI+Fulv further decreased the enrichment of this histone modification in classical ER binding sites. Interestingly, ACSS2 binding was increased with Fulv treatment. Targeting epigenetic alterations caused by cancer cell adaptations is a novel approach that could potentially lead to new therapies to reduce metastasis mortality.

Presentation: Thursday, June 15, 2023
THU560 Serum miRNA-483 As A Diagnostic And Therapeutic Marker Of IGF-II-producing Non-islet Cell Tumor Hypoglycemia (NICTH)
Authors: Okazaki-Hada Mikiko , Nagao Mototsugu , Asai Akira , Fukuda Izumi , Eliasson Lena , Iwabu Masato
Published: October 2023

Disclosure: M. Okazaki-Hada: None. M. Nagao: Grant Recipient; Self; The Foundation for Growth Science. A. Asai: None. I. Fukuda: None. L. Eliasson: None. M. Iwabu: None.

Objective: Non-islet cell tumor hypoglycemia (NICTH) is known as the second major cause of spontaneous hypoglycemia next to insulinoma. Abnormal higher molecular weight forms of insulin-like growth factor II (IGF-II), so-called “big IGF-II”, are frequently detected in the sera of patients with NICTH. Thus, the disease is referred to as IGF-II-producing NICTH. We have previously reported a significant elevation of serum microRNA (miRNA)-483-5p and -3p levels in patients with IGF-II-producing NICTH. The miRNA-483 family are encoded in an intron of IGF2 gene and thus suggested to be co-expressed with IGF-II. The aim of this study was to validate the usefulness of miRNA-483 family as a diagnostic and therapeutic marker of IGF-II producing NICTH, then to examine if the IGF-II-producing tumor tissues could be the source of these circulating miRNAs Design: Serum samples from patients who had been suspected to have IGF-II-producing NICTH (n = 134) were tested. The presence of big IGF-II was confirmed by Western blotting, and miRNA-483-5p and -3p levels were evaluated by quantitative PCR. IGF-II level was also analyzed by ELISA. In addition, IGF-II, miRNA-483-5p and -3p levels were compared before and after tumor removal in serum samples from surgically treated patients with IGF-II-producing NICTH (n=21). Expression levels of miRNA-483-5p and -3p were also analyzed in the big IGF-II-expressing tumor tissues and the surrounding surgical margins (n=9). Results: Big IGF-II was detected in the sera of 91 out of 134 patients. IGF-II, miRNA-483-5p and -3p levels were significantly higher in sera with big IGF-II than in those without. The area under the receiver operating characteristic curve of miRNA-483-5p (0.85) for IGF-II-producing NICTH were higher than those of miRNA-483-3p (0.75) and IGF-II (0.75). After tumor removal, serum miRNA-483-5p level decreased (P=0.0025), but serum miRNA-483-3p and IGF-II levels did not change significantly. The expression levels of miRNA-483-5p and -3p in the tumor tissues were significantly higher than those in the surgical margins (18 and 51 times for miRNA-483-5p and -3p, respectively). Conclusion: The present study confirms that miRNA-483-5p and -3p are elevated in sera of patients with IGF-II-producing NICTH and shows that miRNA-483-5p is significantly reduced after the surgical removal of big IGF-II-producing tumors. These results highlight the usefulness of the miRNA-483 family as a diagnostic and therapeutic marker for IGF-II-producing NICTH, and strongly suggest that the tumors produce miR-483-5p and -3p in parallel with the production of big IGF-II.

Presentation: Thursday, June 15, 2023
FRI257 Adrenal Insufficiency Secundary Due Immune Checkpoint Inhibitors Therapy
Authors: Rivera Sandra Rocio , Valencia Javiera , Figueroa Elizabeth , Calisto Javiera
Published: October 2023

Disclosure: S.R. Rivera: None. J. Valencia: None. E. Figueroa: None. J. Calisto: None.

Background: Immune checkpoint inhibitors (ICIs) are new anticancer immunotherapies that can trigger a variety of immune related adverse events (irAEs) in different organs, including the endocrine system. Adrenal insufficiency is uncommon with a nonspecific clinical presentation that must be recognized in time due to its potential mortality. Clinical Case: 41 year old man diagnosed with papillary renal cell carcinoma. He underwent surgery, performing a ​​right radical nephrectomy plus bilateral lymphadenectomy. He started chemotherapy in March 2022 with ICIs, Nivolumab and Ipilimumab. Three months later he presents with myalgias, fatigue and 6 kilogram weight loss. Physical exam: in regular conditions, vital signs with blood pressure 70/40 mmHg, heart rate 84 bpm, with no signs of hyperpigmentation or dehydration. No evidence of clinical hyperthyroidism. Lab results: low ACTH levels: 6.4 pg/ml (9 - 69 pg/ml), low cortisol: 0.06 µg/dl ( 6.02-18.4 µg/dl), low TSH: 0.1 µU/ml ( 0.4- 4.2 µU/ml) and normal free T4: 1.01 ng/dl ( 0.93-1.7 ng/dl). Antibody tests were negative: anti thyroglobulin, anti TPO and TRAB. Normal thyroglobulin levels. Sellar MRI was requested: normal, metastasis were ruled out. Thyroid ultrasound: normal thyroid gland. Exclusion of exogenous use of corticosteroids and levothyroxine was done. Case was interpreted as an adrenal insufficiency due to hypophysitis with associated thyrotoxicosis. Treatment with hydrocortisone was started, while thyroid function progression was observed. In the following lab control, elevation of TSH was noted. Two months later, we documented elevation of TSH levels: 5 µU/ml and decline of free T4 levels: 0.58 ng/dl, starting levothyroxine supplementation. Patient had a favorable clinical evolution. Conclusion: Adrenal insufficiency due to hypophysitis is uncommon and is mostly linked to Ipilimumab use. In those cases pituitary gland MRI is often normal most of the time. Thyroid involvement, which is frequently seen with Nivolumab therapy, varies from thyrotoxicosis, hyperthyroidism and hypothyroidism. Usually produces chronic damage and needs permanent treatment. The potentially lethal nature of these events makes it essential for oncologists and endocrinologists to be aware of these manifestations in order to achieve early treatment.

Presentation: Friday, June 16, 2023
FRI258 A Diagnostic Journey To Autoimmune Polyendocrine Syndrome Type 2
Authors: Amankwah Samuel , Driscoll Henry Keane , Muojieje Chukwudi , Sanati Milad
Published: October 2023

Disclosure: S. Amankwah: None. H.K. Driscoll: None. C. Muojieje: None. M. Sanati: None.

Background: Approximately 50-65% of patients with autoimmune adrenal insufficiency have one or more autoimmune endocrine disorders. This case demonstrates the importance of considering autoimmune polyendocrine syndrome (APS) when a patient presents with more than one autoimmune endocrine disorder. Case: A 29-year-old woman with history of idiopathic intracranial hypertension, hypothyroidism on levothyroxine 50 mcg daily, endometriosis, and chronic migraines complained of fatigue, word finding difficulty, misspeaking of words, and staring spells. An MRI of the brain w+wo IV contrast revealed hypo-enhancing appearance of the pituitary gland. The patient was referred to endocrinology by neurology. Hormonal work up was performed checking for prolactin, ACTH, morning cortisol, TSH, Free T4, FSH, LH, IGF-1 and a serum chemistry panel. Thyroid antibodies were also ordered to help understand the etiology of her hypothyroidism. Pituitary hormones were normal except elevated TSH and borderline low serum cortisol. Subsequently a co-syntropin stimulation test resulted in inadequate cortisol rise. ACTH level measured inappropriately low normal. The patient then started steroid replacement therapy. Thereafter, 21-hydroxylase antibodies, serum renin and aldosterone were checked to screen for Addison Disease. Her 21-hydroxylase antibody was positive, aldosterone level low, and renin elevated pointing to autoimmune adrenalitis etiology. Her thyroid antibodies were also positive indicating autoimmune thyroid disease. Considering these results, the condition of APS came into question. Hence, the patient was screened for type 1 diabetes mellitus which was positive for glutamic acid decarboxylase 65 antibody but negative for insulin and pancreatic islet cell antibodies. Her hemoglobin A1c was 5.0%. Due to her history of gluten intolerance, she was screened for celiac disease which was negative for t-Transglutaminase antibody. The patient’s fatigue improved on steroid replacement therapy. She became euthyroid after increasing her levothyroxine dose to 75 mcg daily, and repeated MRI a year later did not show pituitary abnormalities. Discussion: APS type 2 is a polygenic inherited disorder associated with HLA-DR3 and DR4 that affects adult females more than males. The syndrome is characterized by type 1 diabetes mellitus, autoimmune thyroid disease and Addison disease. Associated nonendocrine autoimmune syndromes include celiac disease, pernicious anemia, and atrophic gastritis. These characteristics overlap with APS type 1 except for autoimmune thyroid disease that presents with type 2. It should be noted that thyroxine therapy can precipitate a life-threatening Addison crisis in a patient with untreated adrenal insufficiency and hypothyroidism. Therefore, it is necessary to evaluate adrenal function in all hypothyroid patients in whom APS is suspected.

Presentation: Friday, June 16, 2023
FRI259 Antiphospholipid Syndrome And Adrenal Insufficiency: An Underrated Association
Authors: Khalid Sualeha , Arumugam Minni Shreya , Passarella Pasquale
Published: October 2023

Disclosure: S. Khalid: None. M. Arumugam: None. P. Passarella: None.

Introduction: Catastrophic Antiphospholipid Syndrome (CAPS) is a rare and life-threatening subtype of Antiphospholipid Syndrome (APS) that causes widespread vascular thrombi. Endocrine complications of APS are very rare, however the most common is Adrenal Insufficiency (AI). Overt AI is only found in 0.4% of patients with APS while only 0.5% of patients with AI are diagnosed with APS. Either thrombosis leading to infarction or hemorrhage can cause AI in patients with APS. Sometimes, adrenal insufficiency or crisis can be the primary presentation of APS. Here, we present a case of AI in the setting of CAPS. Case Presentation: A 17-year-old woman with past medical history of chronic immune thrombocytopenia was admitted to the intensive care unit due to cardiogenic and distributive shock. One week prior to her presentation she had developed a sore throat followed by progressive lethargy that eventually evolved into a state of unconsciousness and she was brought to the emergency department. Her presenting vital signs included temperature of 40.7 C and blood pressure of 89/36 mmHg. On physical exam, she appeared somnolent and pale, and had cool extremities. Labs on admission (11 pm) revealed cortisol level of 3.6 UG/DL (reference range 3.8-19.4 UG/DL), TSH 4.61 UIU/ml (reference range 0.45-4.5 UIU/ml), free T4 1.3 ng/dl (reference range 0.6-1.3 ng/dl), aldosterone 11.3 ng/dl (reference range supine < 3-39.2 ng/dl), sodium 135 MEQ/L (reference range 135-145 MEQ/L), and potassium 4.7 MEQ/L (reference range 3.5-5.2 MEQ/L). Echocardiogram was remarkable for new onset reduced ejection fraction of 25-30% and left ventricular thrombi. Additionally, brain MRI showed acute infarcts. Due to concern for an underlying rheumatological disease, extensive autoimmune work up was initiated, and she was started empirically on methylprednisolone 30 mg intravenous twice daily. To further evaluate thrombi, CT scan of the abdomen and pelvis was performed, revealing bilaterally enlarged and hypoenhancing adrenal glands likely related to ischemia or infarction along with left renal vein thrombosis. Laboratory work-up returned positive for anti-cardiolipin IgM and IgG antibodies. In the setting of multiple vascular thrombi and positive antibodies, she was diagnosed with CAPS. The diagnosis of AI was made due to a low cortisol level in a state of shock and was deemed secondary to CAPS. For the treatment of CAPS she was continued on methylprednisolone with a plan for a slow taper. To ensure mineralocorticoid replacement was adequate fludrocortisone was also added at a dose of 0.1 mg with close monitoring of electrolytes and vital signs. Conclusion: Our case illustrates a rare though potentially fatal endocrine complication of CAPS and highlights the importance of its awareness. Undiagnosed and untreated adrenal insufficiency can lead to extremely poor outcomes, including death.

Presentation: Friday, June 16, 2023
FRI271 A Case Of Autoimmune Polyglandular Syndrome Type 2 Presenting With Cardiac Symptoms
Authors: Lin Joanne , Lee Christopher , Crawford Andrew Robert , Taub Cynthia
Published: October 2023

Disclosure: J. Lin: None. C. Lee: None. A.R. Crawford: None. C. Taub: None.

Autoimmune polyglandular syndrome type 2 (APS 2) is characterized by the combination of autoimmune adrenal insufficiency with autoimmune primary hypothyroidism, and/or type 1 diabetes mellitus, as well as other autoimmune conditions. The estimated prevalence is reported to be 1.4-4.5 cases per 100,000 persons. Presenting symptoms are often nonspecific, leading to delayed diagnosis; however, manifestations can sometimes become rapidly life-threatening. Cardiac symptoms, rare but clinically significant, can be the first presentation for APS 2.

34 year old male with history of asthma presents with nausea and chest pain, found to have pericarditis that was complicated by pericardial tamponade and cardiogenic shock requiring emergent pericardiocentesis and mechanical support with veno-arterial extracorporeal membrane oxygenation. Stress dose steroids were given due to concern for fulminant myocarditis. His condition improved with glucocorticoid treatment, but the etiology of his acute decompensation was unclear. He completed the prednisone taper before discharge and was started on amiodarone for atrial flutter. He presented with recurrent symptoms a week later. Cardiac MRI showed pericarditis without myocarditis. PET scan showed pericardial inflammation without evidence of malignancy or vasculitis. Broad infectious workup including viral studies was negative. An extensive biochemical workup showed low serum aldosterone and high renin activity while on prednisone. Autoimmune workup was positive for 21-hydroxylase antibody, thyroid peroxidase antibody, and homozygous for celiac HLA DQ8, suggestive of APS 2. Patient was started on levothyroxine for subclinical hypothyroidism with TSH >20. Interleukin blockade with anakinra was initiated, and patient was discharged with 25mg of daily prednisone pending insurance authorization for anakinra. A month later, patient re-presented with pericarditis. Patient received stress dose steroids, and was started on fludrocortisone. Levothyroxine was stopped because of amiodarone induced thyrotoxicosis. Patient was discharged on a prednisone taper regimen, and anakinra was approved a month later.

Few case reports have described the association between APS 2 with pericardial tamponade. In healthy patients presenting with unexplained pericarditis, autoimmunity should be considered as a differential diagnosis as it can rapidly become life-threatening requiring urgent intervention. It is important to recognize for these patients, they are at risk for recurrent pericarditis and cardiac tamponade.

Presentation: Friday, June 16, 2023
SAT263 Osteocalcin Promotes Cortisol Production In Human Adrenal Cells
Authors: Scheske Rachel , van Rooyen Desmaré , Rainey William E
Published: October 2023

Disclosure: R. Scheske: None. D. van Rooyen: None. W.E. Rainey: None.

Background: Osteocalcin (OCN) is a peptide exclusively produced by osteoblasts in bone. In an uncarboxylated form, OCN has been shown to function as a hormone affecting physiological processes such as reproduction and energy metabolism in mice and humans. Murine studies have shown that uncarboxylated OCN upregulates fetal mouse glucocorticoid production through a unique regulatory axis between osteoblasts and adrenal cortex cells. The increase in adrenal steroid production has been attributed to OCN heightening adrenocorticotropic hormone (ACTH). The influence of adrenal glucocorticoids on glucose metabolism and bone composition is well studied but the effect of OCN on human adrenal steroidogenesis remains unknown. Herein, we hypothesized OCN would stimulate cortisol production in human adrenal cells. Methods: OCN’s effect on adrenal glucocorticoid production was investigated using primary cultures of human adrenal cells (PAC). Cells were treated for 24h with 1000 nM OCN with/without cAMP/protein kinase A (PKA) signaling pathway agonists (ACTH, forskolin, 8-bromo cAMP (8Br-cAMP), and dibutyryl cyclic AMP (dbcAMP)). Cortisol levels were quantified using an enzyme-linked immunosorbent assay. RNA was isolated and assessed by quantitative real-time PCR (RT-qPCR) to identify changes in transcript levels of enzymes catalyzing glucocorticoid production: cholesterol side-chain cleavage enzyme (CYP11A1), 17α-hydroxylase/17,20-lyase (CYP17A1), and 11β-hydroxylase (CYP11B1). Results: Cortisol production in PAC were significantly induced by all tested agonists; ACTH (22-fold), forskolin (27-fold), 8Br-cAMP (26-fold), and dbcAMP (30-fold) relative to basal. Although OCN, alone, did not significantly increase cortisol in this cell model, co-treatment with ACTH increased cortisol levels 1.4-fold (40.1 ng/mL; p<0.0001) compared to ACTH (28.2 ng/mL). Similarly, co-treatment with forskolin or 8Br-cAMP increased cortisol, relative to the respective agonists, by 1.3-fold (p<0.001) and dbcAMP by 1.2-fold (p<0.01). RT-qPCR analysis showed no changes in CYP11A1 or CYP17A1 transcript levels in co-treatments with OCN and ACTH relative to ACTH. However, CYP11B1 mRNA levels, relative to the respective controls, were increased in samples co-treated with OCN and ACTH/-agonist. OCN co-treatments with ACTH, forskolin, 8Br-cAMP and dbcAMP increased CYP11B1 levels by 1.8-, 1.4-, 1.3-, and 1.2-fold, respectively. Conclusion: Data presented in this study show stimulatory effect of OCN on human adrenal cells. OCN, in the presence of ACTH and other PKA agonists, increased cortisol production via upregulating CYP11B1 transcript levels. Defining the mechanism and receptor interaction through which OCN functions in human adrenal cells remain to be determined.

Presentation: Saturday, June 17, 2023
SAT270 Parity Increases Corticosterone Response To Restraint-induced Stress After Mild Blast Traumatic Brain Injury In Mice
Authors: Anisowicz Sarah , Loayza Careaga Mariella Bodemeier , John Wu T
Published: October 2023

Disclosure: S. Anisowicz: None. M. Bodemeier Loayza Careaga: None. T. Wu: None.

Background: Traumatic brain injury (TBI) is a common problem worldwide, with an estimated incidence of 69 million injuries per year. In the US military, one of the most common forms of TBI during operational deployments after Sep 11, 2001 was the blast TBI, thought to be responsible for over 80% of TBI sustained in theater. One consequence of TBI is dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. HPA axis dysregulation is linked to increased risk for psychiatric disorders. Furthermore, prior research has shown that TBI may dysregulate the HPA axis in a sex-dependent manner. Throughout a female’s life span, there are several sentinel events of hormonal consequence, including pubarche, menopause, and parity, which are known to be times of changes in risks for psychiatric disorders. Objectives: The role of parity on TBI response has not yet been studied, though parity has been shown to decrease fear-related behaviors and decreased corticosterone load in multiparous mice when compared to nulliparous (NP) controls. Our objective is to determine if parity alters corticosterone (CORT) response to restraint, a mild psychological stressor, in mice exposed to mild blast TBI (mbTBI). Methods: One hundred thirteen NP or primiparous (PP) C57Bl6/J mice were randomly assigned to receive sham or mbTBI. Among those that received mbTBI (19.2 ± 0.12 psi), 32 were NP and 24 were PP. Among sham mice, 32 were NP and 26 were PP. All mice received isoflurane anesthesia prior to sham or mbTBI treatment. At 7-8 days after mbTBI, half the mice within each treatment group were subjected to a mild 20-min restraint before being anesthetized by CO2 followed by collection of trunk blood. Serum was harvested and analyzed for CORT concentrations by ELISA (Enzo Life Sciences). Results: All mice that received mbTBI had a longer (p<0.05) righting time compared to those that did not. There was no main effect of parity in the righting time (p>0.1). PP mice who experienced mbTBI demonstrated a greater (p<0.05) CORT response to restraint (157.3 ± 21 pg/mL) when compared to NP mice (95.9 ± 7.2 pg/mL). CORT response to restraint did not differ (p>0.1) between NP and PP mice who did not experience mbTBI (96.1 ± 7.6 vs 109.2 ± 16 pg/mL). Conclusions: Our data indicates that mbTBI alters HPA axis reactivity in PP mice compared to NP mice, increasing the CORT response to restraint induced stress. Parity alone did not alter CORT response to restraint stress or baseline CORT levels. The results of our finding highlight the importance of parity as a factor in an individual’s lifespan.

Presentation: Saturday, June 17, 2023
SAT278 Thyroid Hormones Regulate 11bhsd Enzymes: A Novel Function In Glucocorticoid Hormone Metabolism
Authors: Bessiene Laura , Perrot Julie , Hescot Segolene , Bourdin-Pintueles Alexandra , Vitellius Geraldine , Sachs Laurent M , Kamenicky Peter , Lombes Marc , Pussard Eric , Viengchareun Say , Martinerie Laetitia
Published: October 2023

Disclosure: L. Bessiene: None. J. Perrot: None. S. Hescot: None. A. Bourdin-Pintueles: None. G. Vitellius: None. L.M. Sachs: None. P. Kamenicky: None. M. Lombes: None. E. Pussard: None. S. Viengchareun: None. L. Martinerie: None.

Glucocorticoid hormone metabolism is regulated by 11-beta hydroxysteroid dehydrogenase enzymes: 11βHSD2, mostly expressed in the distal nephron, converts corticosterone into 11-dehydrocorticosterone in rodents, while 11βHSD1 catalyzes the opposite reaction in liver. Glucocorticoid hormone metabolism may be altered under pathophysiological conditions of hypothyroidism. However, direct functional relationship between glucocorticoid and thyroid hormones (T3) signaling pathways remains elusive. Identification of putative Thyroid Response Elements (TRE) in the promoter regions of hsd11b2 and hsd11b1 genes suggested that T3 might directly regulate expression and/or activity of these enzymes.We used human translational studies, a mouse model of hyperthyroidism and murine renal and hepatic cell lines to investigate the role of thyroid hormones in glucocorticoid hormone metabolism.In hypothyroid patients, the urinary [E]/[F] ratio measured by LC-MS/MS technology, showed a 60% decrease (P<0.05), compared to age- and sex- matched euthyroid controls, suggesting a regulation of glucocorticoid metabolism by T3. Similarly, a significant positive correlation was observed between the urinary [E]/[F] ratio and serum T4L concentration in hyperthyroid patients before and after normalization of T4L levels.Administration of T3 in drinking water, mimicking a mouse model of hyperthyroidism, led to significant increase in renal 11βHSD2 mRNA (P<0.05) and decrease in liver 11βHSD1 mRNA and protein levels (P<0.01), compared to control mice.Finally, T3 induced an increase in 11βHSD2 transcript levels in renal KC3AC1 cells (P<0.01) and a decrease in 11βHSD1 mRNA levels in hepatic HepG2 cells (P<0.01). 11βHSD2 activity increased by 20% (P<0.05). In HEK 293T cells, T3 transactivated hsd11b2 promoter via the Thyroid Receptor α1 (TRα1). ChIP experiments further demonstrated a T3-dependent specific recruitment of TRα1 onto hsd11b2 promoter. Altogether, these findings demonstrate that T3 directly regulate expression and activity of 11βHSD enzymes, thereby controlling glucocorticoid hormone metabolism and action.

Presentation: Saturday, June 17, 2023
SAT281 Screening For Adrenocortical Insufficiency In Patients With X-linked Adrenoleukodystrophy
Authors: Berquist John , Kiani Rabia Nadeem , Wahl Matthew Patrick
Published: October 2023

Disclosure: J. Berquist: None. R.N. Kiani: None. M.P. Wahl: None.

Background: A 41-year-old male initially presented to neurology clinic for complaints of poor balance, lower extremity weakness, and numbness. He previously had exam findings of lower extremity spasticity and hyperreflexia, distal vibratory loss, positive Romberg, and difficulty with Tandem gait. His symptoms had been progressive following an ankle sprain 8 years earlier and he was treated with physical therapy and baclofen. He is highly active otherwise and enjoys rock climbing, which was difficult to do given his symptoms. Clinical Case: Genetic screening was performed to evaluate for hereditary spastic paraparesis, which resulted positive for a mutation in the ABCD1 gene with a p.Lys336Glu mutation of uncertain significance. Interestingly, this ABDC1 variant was not detected in submitted maternal sample, hence patient’s mutation likely occurred de novo. This variant is not established in population databases (gnomAD no frequency) but has been observed in at least one individual with clinical features of adrenomyeloneuropathy. X-linked adrenoleukodystrophy causes impairment of beta oxidation that leads to accumulation of saturated very long chain fatty acids (VFLA) in multiple tissues. There are many clinical phenotypes, but they are hallmarked by neurologic signs and symptoms. Although neurologic symptoms can often develop in childhood, they can be delayed and present in adulthood, as can adrenal insufficiency (AI). However, males are overwhelmingly likely to develop adrenocortical insufficiency compared to females. Our patient presented with a BMI of 22.94, HR 50 bpm, and blood pressure 120/76; reflecting his active lifestyle. Recent electrolytes were within normal limits, AM cortisol was 13.0, and ACTH 544.0 Given the elevated ACTH and known cause of adrenal insufficiency, we proceeded with ACTH stimulation test. Peak cortisol resulted at 13.1 (at 60 minutes) and he was started on replacement glucocorticoid therapy per body-surface area. Upon further literature review, patients can also develop loss of mineralocorticoid production. Renin and aldosterone were ordered and were both within normal limits. Conclusion: Males with adrenoleukodystrophy are at a much higher risk of developing adrenal insufficiency (AI) compared to females. Additionally, AI will often develop later in life, so a low threshold for screening should be present for the endocrinologist. Mineralocorticoid deficiency can also develop, although not as commonly. Loss of adrenal function can lead to patient demise, and therefore adrenal function needs to be closely evaluated in people with leukodystrophy.

Presentation: Saturday, June 17, 2023
SAT283 The Incidence Of Worsening Symptoms Of Adrenal Insufficiency And COVID-19 Infection After Receiving COVID-19 Vaccine In Patients With Adrenal Insufficiency: A Survey-based Study
Authors: Al Sibai Khaled , Lundholm Michelle D , Nachawi Noura , Baikovitz Jacqueline , Bena James , Cecilia Lansang M
Published: October 2023

Disclosure: K. Al Sibai: None. M.D. Lundholm: None. N. Nachawi: None. J. Baikovitz: None. J. Bena: None. M. Lansang: None.

Introduction: There is uncertainty if COVID-19 vaccine administration can induce enough stress to precipitate worsening of adrenal insufficiency (AI) or even adrenal crisis. The aim of the study is to evaluate the incidence of worsening symptoms of AI after receiving the COVID-19 vaccine in patients with AI. Methods: This is a single-center survey study of patients with either primary or secondary AI by ICD code in our electronic medical record. Diagnoses were confirmed with chart review and patients were included if on stable physiologic glucocorticoid replacement doses for at least 3 months prior to COVID-19 vaccination. These patients were sent a survey asking about the date/type of vaccine, the occurrence of AI symptoms, and if they took a higher dose of oral GC, or took injectable GC, or sought a higher level of medical care. Results: There were 340 eligible patients, and 61 patients to date have completed the survey (18% response rate). Responders were 64% female, 41% with primary AI, and 56% with secondary AI. The median age was 57 (IQR 50, 68) years with a median hydrocortisone-equivalent replacement dose used of 20 (IQR 20, 25) mg daily. Each vaccination was treated as a separate event. A total of 194 COVID vaccination events were recorded, which included 35 (18%) vaccination events when higher doses of GC were used, 35% of which were after onset of symptoms. Mild AI symptoms, i.e., fever, weakness, nausea/vomiting, diarrhea, and dizziness, body aches, and weakness occurred in 62% of events. The most reported symptoms were body aches and weakness (48% and 35% respectively). Severe AI symptoms, i.e., low blood pressure and fainting, occurred in 4.6% of events. The need to use injectable GC, seeking medical care or ED visits occurred in 5.7%. There was no significant difference in seeking medical care nor using injectable GC for patients who took stress dose GC vs those who did not (OR 0.69, 95% CI 0.10,4.88, p=0.7). Conclusion: At present analysis, the incidence of worsening AI-related symptoms was high after COVID-19 vaccination (62%). Most reported symptoms were mild and self-limited that did not require a higher level of medical care. About 6% of survey takers used injectable GC or sought a higher level of care. Our preliminary results do not support routine prophylactic stress-dose GC for receiving COVID-19 vaccines in patients with AI. We estimate another 100 patients to complete our survey.

Presentation: Saturday, June 17, 2023
SAT287 Clinical And Biochemical Characteristics In Female Adolescents Diagnosed With Non-classic Congenital Adrenal Hyperplasia (NCCAH)
Authors: Hayes Dorado Juan Pablo , Calla Ayala Marco Antonio , Lafuente Rodrigo Zapata , Bustencio Cristian Ramos , Montalvo Claudia Gorena , Porcel Ivana Chiri
Published: October 2023

Disclosure: J. Hayes dorado: None. M. Calla Ayala: None. R. Zapata Lafuente: None. C. Ramos Bustencio: None. C. Gorena Montalvo: None. I. Chiri Porcel: None.

The aim of this study was to evaluate the clinical and biochemical characteristics in female adolescents diagnosed with NCCAH in comparison to female age-matched healthy controls. A total of 39 female adolescents, aged 10-15 years, were enrolled in this study, including 24 patients with NCCAH (mean age 12.9±1.4 years) and 15 healthy controls (mean age 13.2±1.1 years). Data was collected on anthropometry, clinical features of hyperandrogenism (hirsutism, acne, alopecia) and menstrual irregularities, and ovarian ultrasound was performed. Hormonal and metabolic markers were assessed. Hirsutism was present in 91.7% of the NCCAH females and 46.7% of the controls (p<0.001), while acne and alopecia were defined in 83.3% and 66.7% of the NCCAH patients, respectively, compared to 33.3% and 26.7% of the healthy females (p acne <0.0001 and p alopecia =0.003). No significant difference was found in the rate of menstrual disorders between the groups. The BMI and waist circumference did not differ between NCCAH females and healthy controls. No significant difference was found in the parameters of lipid and glucose metabolism between the groups. Testosterone and basal levels of 17 OH Progesterone were significantly higher in NCCAH females (p<0.01). Polycystic ovaries were detected by ultrasound in 8.3% of the NCCAH and 6.7% of the controls, without significant difference between the groups. NCCAH in female adolescents is characterized by clinical and biochemical hyperandrogenism. No significant difference was found in the rate of menstrual disorders, the BMI, waist circumference and the parameters of lipid and glucose metabolism between the groups.

Presentation: Saturday, June 17, 2023
SAT296 Ambulatory 24-hour Tissue Microdialysis Of Cortisol And Metabolites, A Tool For Precision Management In Addison’s Disease
Authors: Botusan Ileana , Berinder Katarina , Methlie Paal , Upton Thomas , Zavala Eder , Simunkova Katerina , Vassiliadi Dimitra Argyro , Marinelli Isabella , Russell Georgina M , Grytaas Marianne Aardal , Tsagarakis Stylianos , Lightman Stafford Louis , Husebye Eystein Sverre , Kampe Olle , Oksnes Marianne , Bensing Sophie
Published: October 2023

Disclosure: I. Botusan: None. K. Berinder: None. P. Methlie: None. T. Upton: None. E. Zavala: None. K. Simunkova: None. D.A. Vassiliadi: None. I. Marinelli: None. G.M. Russell: None. M.A. Grytaas: None. S. Tsagarakis: None. S.L. Lightman: None. E.S. Husebye: None. O. Kampe: None. M. Oksnes: None. S. Bensing: None.

Background: The autoimmune attack on the adrenals in AD (Addison’s disease) results in lack of the vital hormones cortisol and aldosterone, rendering AD patients dependent on life-long hormone replacement therapy. Current therapies cannot replicate the physiological well-tuned, circadian and ultradian hormonal oscillations properly, probably contributing to increased mortality, morbidity and reduced quality of life. No established biomarker for treatment monitoring exists hampering treatment optimization. Ambulatory 24-hour dynamic steroid profiling may represent a novel therapy-monitoring tool, providing new insights in different replacement therapy regimes. Aim: We aimed to assess 24-hour profiles of free cortisol and metabolites in patients with AD on different glucocorticoid replacement therapies (GRT) and compare the results with healthy volunteers (HV). Material and methods: The study includes 41 patients with AD on different GRT regimes (hydrocortisone, cortisone acetate, modified release hydrocortisone) and 214 healthy participants. Twenty minute microdialysis fractions were collected ambulatory from abdominal subcutaneous tissue over 24 hours using a novel and portable microdialysis fraction collector (U-RHYTHM). Steroid hormones were analyzed by ultrasensitive liquid chromatography tandem mass spectroscopy (LC-MS/MS). Dynamic biomarkers were used to define hormone parameters in both healthy and hormone-replaced participants, and to assess the “time in range” for patients on GRT compared with the profiles of healthy controls. Results: Free cortisol and cortisone levels were measurable in all AD patients, while 18- hydroxycortisol, and corticosterone were detected only in a few AD patients suggesting the persistence of residual adrenal function. Lower cortisol levels during night were observed in AD compared with controls. Ambulatory 24-hour dynamic steroid profiling revealed marked interindividual variations partially depending on the type of GRT and dosing-regime. Conclusions: The 24-hour profiles of free cortisol and cortisone differs between patients with AD and healthy volunteers. Ambulatory 24-hour microdialysis samplings may provide a novel dynamic tool to monitor GRT in AD providing opportunity for individual dose adjustment.

Presentation: Saturday, June 17, 2023
SAT301 Patient-centered Outcomes Measures To Assess Quality Of Life In Adrenal Insufficiency Treatment
Authors: Hover Whitaker J , Lowe Katherine E , Lowe Melissa E , Kallet Julia G , Slovick Michal F , Majka Susan L , McDermott Michael T , Regan Elizabeth A
Published: October 2023

Disclosure: W.J. Hover: None. K.E. Lowe: None. M.E. Lowe: None. J.G. Kallet: None. M.F. Slovick: None. S.L. Majka: None. M.T. McDermott: None. E.A. Regan: None.

Individuals with adrenal insufficiency (AI) have been shown to have reduced quality of life in spite of hormone replacement. Although late-stage insufficiency and adrenal crisis may show signs including hypotension and electrolyte abnormalities, patient-reported symptoms may predict outcomes in AI and can be a key factor in understanding poor quality of life in adrenal insufficiency. The SF-36, a generic quality of life (QoL) survey has been reported in adrenal insufficiency but may lack disease-specific domains to define QoL deficits in AI. An AI disease-specific QoL survey, the AddiQoL has also been validated. We evaluated the AddiQol and SF-36 for distinguishing the health status of AI patients in terms of diagnosis, medication use and risk of crisis using a patient registry.

Methods: We identified 344 individuals from the MyAI patient registry who had provided responses to both the AddiQoL and SF-36. We compared the AddiQoL overall score with three domains of the SF-36: physical function, role physical, vitality, and the physical and mental component scores (PCS and MCS).

Results: Respondents were from all 50 US states with 83% female and mean (SD) age of 50 (15) years. AI diagnosis was Primary 63%, Central 32% and congenital adrenal hyperplasia 5% based on self-report and confirmation with medical records. Both the SF-36 and AddiQoL identified reduced QoL in the AI participants and were significantly correlated: PCS to AddiQoL 0.73 and MCS to AddiQoL 0.63. Role Physical, Vitality and General Health were the most reduced domains with mean values of 38.4 (43.5), 35.6 (24.5) and 40.8 (24.7) respectively. Primary AI showed significantly better QoL than Central AI by both SF-36 and AddiQol [80.3(15.1) vs 69.9 (14.2), p<0.001]. Respondents who reported an adrenal crisis within the past year had significantly lower AddiQol [72.8(15.4) vs 82.3 (15.4), p<0.001] and SF-36 scores. Respondents who were currently treated with hydrocortisone (HC) had better QoL than those on Prednisone [HC 78.1 (15.2), Prednisone 74.1 (15.9), p=0.02 adjusted for diagnosis group].

Conclusions: In a geographically broad cohort of US AI patients, we confirm significant reductions in QoL in spite of treatment. Both the SF-36 and AddiQoL were able to distinguish differences in QoL by diagnosis, risk of adrenal crisis and medication. Further work to define specific patterns of high-risk symptoms may improve early diagnosis of impending crisis.

Presentation: Saturday, June 17, 2023