bluuebunny/crossref_metadata_2025 huggingface dataset:
SUN-568 Elevation of Serum Kisspeptin in Hypertensive Women
Authors: Raksadawan Yanint , Sitticharoon Chantacha , Boonpuan Peerada , Maikaew Pailin , Keadkraichaiwat Issarawan
Published: May 2020

Kisspeptin and leptin have been shown to have an effect on the cardiovascular system. This study aimed to compare serum kisspeptin and leptin levels between the non-hypertensive (non-HT) and the hypertensive (HT) groups with or without body mass index matching, and determine correlations between systolic blood pressure or diastolic blood pressure with serum kisspeptin and leptin levels as well as clinical and adipocyte parameters. 30 female patients who underwent abdominal surgery were recruited. Blood samples, anthropometric data, and tissue samples of visceral and subcutaneous fat were obtained. Serum kisspeptin levels (ng/ml) (non-HT=1.01±0.1 vs. HT=1.53±0.19), body weight (kg) (non-HT=55.45±3.37 vs. HT=63.69±2.42), waist circumference (cm) (non-HT=78.01±2.49 vs. HT=84.89±2.40), hip circumference (cm) (non-HT=92.94±2.18 vs. HT=99.43±1.85), plasma glucose (mg/ml) (non-HT=55.45±3.37 vs. HT=63.69±2.42), plasma insulin (μM/ml) (non-HT=4.64±0.92 vs. HT=7.13±0.85), the homeostatic model assessment for insulin resistance (HOMA-IR) (non-HT=0.94±0.20 vs. HT=1.72±0.22), and height of visceral adipocytes (μm) (non-HT=72.64±6.75 vs. HT=90.25±4.52) were significantly higher but the quantitative insulin sensitivity check index (QUICKI) (non-HT=0.41±0.01 vs. HT=0.36±0.01) was significantly lower in hypertensive compared to non-hypertensive subjects (p<0.05 all). Systolic blood pressure had significantly positive correlations with diastolic blood pressure

(R=0.568), glucose (R=0.526), the HOMA-IR (R=0.387), and serum kisspeptin (R=0.569), but has a significantly negative correlation with the QUICKI (R=-0.414). Diastolic blood pressure had positive correlations with body weight (R=0.477), waist circumference (R=0.517), hip circumference (R=0.578), glucose (R=0.533), the HOMA-IR (R=0.415), and width (R=0.436) and height (R=0.439) of visceral adipocytes, but has a negative correlation with the QUICKI (R= -0.464). In conclusion, kisspeptin, obesity especially visceral adiposity, and insulin resistance might contribute to increased blood pressure in hypertensive subjects.
OR10-01 Mild Maternal Sleep Disordered Breathing in Pregnant Women Affects Growth Patterns of Head Circumference and Adiposity During the First Three Years of Life
Authors: Brener Avivit , Lebenthal Yael , Levy Sigal , Dunietz Galit Levi , Sever Orna , Tauman Riva
Published: May 2020

Background

The intrauterine environment affects growth and adiposity acquisition from the fetal period until adulthood. Mild sleep disordered breathing (SDB) during pregnancy is a common underdiagnosed medical condition in healthy women. We aimed to investigate the interaction between maternal isolated SDB during the third trimester of pregnancy and the offspring’s growth and adiposity during the first three years of life.

Methods

Healthy pregnant women in the third trimester of an uncomplicated singleton pregnancy who were followed at the low-risk obstetric surveillance clinic of our hospital were recruited between 4/2013 and 5/2016. They were followed from enrollment until their offspring was three years old. During their third trimester of pregnancy, they underwent an ambulatory overnight sleep study by means of a validated sleep technology [SDB defined as apnea hypopnea index (AHI) ≥5]. Fasting blood samples were drawn on the following morning for glucose, insulin, HbA1c, lipid profile and C-reactive protein (CRP) levels. The offspring’s growth (length, weight and head circumference) and adiposity (subscapular and triceps skinfolds) parameters were measured at birth, 1 and 4 months, and 1, 2, and 3 years of age. Growth parameters were presented as standard deviation scores using the CDC growth charts. A general linear model was used to evaluate the interaction between maternal SDB and her offspring’s growth and adiposity measurements, after controlling for gestational week at delivery and maternal and paternal body mass index (BMI).

Results

Fourteen of 58 women (24.1%) were diagnosed with SDB (AHI range 5.3–14.7). They had a significantly higher mean BMI during the third trimester of pregnancy (30.1 ± 3.9 vs 27.2 ± 3.5, P = 0.011), elevated CRP levels, and decreased HDL-cholesterol levels (6.39 ± 2.29 mg/L vs 4.28 ± 2.15 mg/L, P = 0.003 and 67 ± 14 mg/dl vs 82 ± 19 mg/dl, P = 0.009, respectively) compared to women with normal sleep study results. Offspring of mothers with SDB had a smaller mean head circumference SDS at birth (-0.95 ± 0.70 vs -0.30 ± 0.71, P = 0.004), with a distinctive pattern of catchup growth by the end of the first year of life (P = 0.018). They also had increased mean adiposity at birth measured by triceps and subscapular skinfolds (6.8 ± 1.8 mm vs 5.4 ± 1.2 mm, P =0.002 and 5.8 ± 1.3 mm vs 5.0 ± 1.0 mm, P =0.019, respectively), with a distinctive pattern of increased triceps thickness at age 3 years (P = 0.001). There was no significant difference in offspring length or weight between groups.

Conclusions

Our findings suggest that isolated maternal SDB during pregnancy affected longitudinal head circumference growth and adiposity acquisition in the fetus and during the first three years of life.
SUN-577 Effect of Growth Hormone Replacement on Metabolic Profile and Vascular System in Adult Patients with Congenital Hypopituitarism
Authors: Biscotto Isabela Peixoto , Hong Valeria , Bortolotto Luiz , Carvalho Luciani Renata Silveira
Published: May 2020

Introduction: Growth Hormone (GH) stimulates two distinct processes: anabolic effect of GH on growth through IGF1, and catabolic effect of GH stimulating lipolysis. GH deficiency (GHD) in adulthood is characterized with abnormal body composition, impairment of physical capacity and lipid and glycemic metabolism, beyond increase cardiovascular risk (CVR) factors. While in acquired hypopituitarism, GHD is always associated with CVR in several studies and demonstrated human recombinant growth hormone replacement (hrGHr) improves CVR. In congenital hypopituitarism (CH), however, the consequences of GHD and hrGHr in adulthood are unclear. Objective: To evaluate daily hrGHr in metabolic profile and vascular system in adult patients with CH. Patients and Methods: Fifty-nine adults with CH were selected for the study. They were divided into 2 groups: 1- hrGHr: 15 male, 17 female with median age 35,8 yrs, hrGHr in adult life with 7.2 yrs median time in the dose of approximately 1U per day in order to keep IGF1 in the normal range for age and sex; 2- Without hrGHr: 12 male, 15 female with 38,4 yrs median age and without hrGHr in adult life of 10.6 yrs median time. Thirty-two healthy volunteers were selected as controls. Anthropometric parameters, dual-energy X-ray absorptiometry (DXA), lipid and glycemic profile, and structural and functional parameters of the arterial vessels (carotid intima media thickness, arterial stiffness and flow mediated dilation) were evaluated and compared between the groups. Results: In patients with rhGHr the abdominal waist/height (AW/H) ratio (0,49 ± 0,06), the fat percentage (30,7 ± 10,4) and fat index (7,6 ± 3,7) were lower than the group without replacement (p= <0,001, p= <0,001 and p= 0,028, respectively). The low values of the CA/H ratio, fat percentage and fat index were independent of the diagnosis ACTH deficiency with corticosteroid replacement. Higher triglycerides (111,7 ± 62,4) and lower HDLc (49,5 ± 19,1) levels in patients without hrGHr compared to controls (p= 0,020 and p= 0,005, respectively) were observed. There was no statistical difference between glycemic profile, metabolic comorbidities and structural and function parameters of the arterial vessels between groups and controls. Conclusions: GHD in CH does not lead to accelerated premature atherosclerosis and arteriosclerosis. The hrGHr in adults with CH have beneficial effects on lipid profile and body composition and hrGHr in adulthood should be individualized.
MON-692 Effect of High Salt Diet on Kidney Weight in Neonatal Streptozotocin Induced Noninsulin Dependent Diabetic Rats
Authors: Safta Loren , Levy-Basso Shiri , Levy Joseph
Published: May 2020

Diabetic kidney hypertrophy may contribute to the development of diabetic kidney disease. Hyperglycemia is recognized as a cause for the kidney endangerment. Salt may accelerate progression of kidney disease in diabetes. To further study the effect of high salt intake on kidney disease we used neonatal streptozotocin induced Noninsulin Dependent Diabetic (NIDD) rats fed ad libitum with regular Purina chow and 2% salt Purina chow. Rats in 5 groups were sacrificed at 6 weeks. Each group had 5–7 rats of diabetics on 2% salt and on regular chow and controls on 2% salt and on regular chow. Blood glucose in diabetics on salt ranged between 185±19–576±20 and in diabetics on regular chow 184±20–458±78 mg/dl. Controls on 2% salt 105±8.6–133±10.3 and controls on regular chow 110±8.9 - 130±3.11. Kidney weights in diabetics on salt was 1.85±0.09–2.0±0.06 gr, diabetics on regular chow 1.6±0.04 - 1.56±0.06 controls on salt 1.19±0.03–1.32±0.05 and controls on regular chow 1.23±0.03. Blood glucose in diabetics on salt and on regular chow was higher than in controls p˂0.05 but did not differ between the diabetic groups. Kidney weight was increased in both diabetic groups compared with controls p˂0.05 and was increased in diabetics on salt compared with diabetics on regular chow p˂0.05 at all glucose levels. Controls on salt and on regular chow had similar kidney weights. Also kidney weight relative to body weight was higher in diabetics than in controls p˂0.05 and was higher in diabetics on salt compared to diabetics on regular chow p˂0.05, but there was no difference between controls on salt and controls on regular diet. Kidney % of water was similar in all four groups but protein to kidney DNA ratio was higher in the diabetic groups p˂0.05 confirming the kidney hypertrophy. Insulin sensitivity measured in controls was not different between groups when glucose transport, glucose oxidation and lipogenesis were measured in fat cells showing no effect of salt on insulin sensitivity. We suggest that high salt intake is an additional risk factor for increased kidney weight in NIDDM that is additive to that of the prevailing glycemia.
MON-392 Bone Health in Diabetes - Are We Addressing It?
Authors: Thapa Rachana , Zambrano Pilar Ortegon , Bouchonville Matthew Frederick , Lovato Christina , Kapsner Patricia L
Published: May 2020

Osteoporosis is a silent disease with decreased bone strength and increased risk of low-trauma fractures. These fractures lead to significant morbidity and mortality and are a major source of medical costs as well as indirect costs from reduced quality of life, disability and death. Calcium and vitamin D (vit D) are important interventions in preventing and treating osteoporosis along with anti-osteoporotic agents. Patients with diabetes mellitus (DM) are at an increased risk of fractures, particularly hip fractures (1). Additionally, bone healing after a fracture is compromised in patients with DM (2). Therefore, addressing bone health can have a significant impact on the well-being of a patient with DM. Optimal management of DM requires a multidisciplinary approach with care that is typically focused on glucose, lipid, and blood pressure management. We hypothesized that bone health may not be addressed consistently in patients with DM due to the need to address these other aspects of their care. We, therefore, conducted a retrospective chart review of patients with DM over the age of 50 with the aim to determine if bone health is being identified and if treatment is being initiated.

A total of 100 patients (67 female, 33 male) were studied at the University of New Mexico Diabetes Comprehensive Care Center. Information regarding age, sex, DM type, vit D status and therapy, BMD, and FRAX score were collected. Vit D levels were checked in 68% female and 76% male patients. Mean vit D level was 31.8 ng/ml (reference range 30–100 ng/ml). Low vit D was identified in 33 patients of which only 18% were started on treatment. None of the 10 men identified received treatment for low vit D. BMD was obtained in only 21% of patients even though more than half met criteria for BMD screening based on age alone. Younger women (age < 65y) had more DXA scans performed than older women. Osteoporosis was diagnosed in one female and one male patient. Two female patients over age 65 met criteria for treatment based on FRAX. None of these 4 patients received osteoporosis therapy other than vit D replacement.

In conclusion, vit D levels were checked in the majority of our patients indicating that bone health is being considered to some extent. However, low vit D levels were treated in only a minority of women, and in none of the men. Also, none of the patients who met criteria for osteoporosis treatment were started on therapy suggesting a lack of appropriate interventions. Using the results from this study, we plan to improve our clinical practice by incorporating bone health more into the care of our patients with DM, identify those at risk for osteoporosis-related fractures, and institute appropriate interventions.

References:

1. Fan Y, Wei F, Lang Y, Liu Y. Osteoporosis Int 2016: 27: 219–228

2. Jiao H, Xiao E, Graves DT. Curr Osteoporosis Rep. 2015 Oct; 13(5): 327 – 335.
SAT-014 Insulin Treatment in Human Pregnancy Mitigates an Increased Risk of Postpartum Psychological Distress with Maternal Obesity in the Absence of a Pre-Existing Mood and Anxiety Disorder
Authors: Jarmasz Jessica S , Anderson Alexandrea , Bock Margaret E , Jin Yan , Cattini Peter A , Ruth Chelsea
Published: May 2020

BACKGROUND: Pregnant women with obesity are at increased risk for peripartum depression. Maternal obesity is also associated with reduced human placental lactogen (hPL) levels, and decreased hPL transcripts were reported in women with clinical depression. In addition, hPL production may be rescued in women with obesity that were subsequently diagnosed with gestational diabetes and treated with insulin (INS). Objective: Study the effect of INS treatment in pregnancy on the risk for postpartum psychological distress (PPD) in women with and without obesity. Study Design: Using data housed at the Manitoba Centre for Health Policy (2002–2017), cohorts of women (ages 15+) with a single live birth with and without obesity were developed using weight (≥85 and <65.6 kg, respectively) and an average (1.63 m) height. Pre-existing mood and anxiety disorders within 5 years preceding delivery as well as gestational hypertension were excluded. After randomly selecting 1 birth per mother, cohorts were stratified by INS treatment during the gestational period. The risk of PPD within 1 year of delivery was assessed by Poisson regression analysis. Models were adjusted for maternal age and area-level income at delivery. Results: The risk of PPD was 27% greater among women with obesity versus without (adjusted rate ratio (aRR)=1.27, 95% CI 1.16–1.4, p<0.0001). However, women with obesity treated with INS did not have a significantly different risk of PPD compared to women without obesity whether treated with INS (aRR=0.99, 95%CI 0.48–2.02, p=0.974) or not (aRR=1.16, 95%CI 0.86–1.56, p=0.328). This suggests that the risk of PPD among women with obesity may be reduced by INS treatment; however, our ability to detect a significant difference may be limited by small cohort numbers (46 women with obesity received INS in pregnancy) or confounders for receiving INS in pregnancy. Direct comparison of INS treatment within weight groups faced the same limitations but trended toward a reduction in women with obesity who received INS (aRR=0.91, 95%CI 0.68–1.22, p=0.531). The positive association between INS treatment in pregnancy and decreased risk of PPD in women with obesity was lost when pre-existing mood and anxiety disorder was not excluded. Inclusion of pre-existing diabetes in the adjusted models did not improve model fit or contribute significantly to the differences in PPD rates. Conclusions: Maternal obesity increases the risk for PPD but this risk may be reduced by gestational INS treatment in the absence of a pre-existing mood and anxiety disorders. This correlates with the decrease and increase in hPL levels reported previously with maternal obesity without and with INS treatment (for diabetes) in pregnancy, respectively. Thus, hPL levels may serve as a possible indicator of PPD risk and a potential target for gestational INS treatment.
SUN-478 Poorly Differentiated Thyroid Cancer Arising from a Hyperfunctioning Nodule Treated with I-131
Authors: Miller Eli , Anolik Jonathan Robert
Published: May 2020

Thyroid nodules are a common clinical problem with an incidence of up to 1% in men and 7–15% of cases representing thyroid cancer. Current American Thyroid Association guidelines do not recommend cytologic evaluation of hyperfunctioning nodules as they rarely harbor malignancy. We present a case of a hyperfunctioning nodule which years after ablation was diagnosed as a poorly differentiated thyroid cancer.

A 38 year old male had a 4cm thyroid nodule discovered in 1994. Nuclear Medicine (NM) imaging revealed a warm nodule though patient was euthyroid. Biopsy was benign with good sample. Nodule was followed with serial ultrasound (US) and TSH. In 2008 he became hyperthyroid. Scan showed hot nodule and he was given 27.3 mCi I-131 with normalization of the TSH. In 2013 patient again developed hyperthyroidism. NM imaging showed a hot nodule. After 29.5 mCi I-131 he became hypothyroid requiring levothyroxine. Intermittent US showed stability. In early 2019 nodule was 3.7cm, solid and hypoechoic but more heterogeneous. Despite TIRADS recommendation that nodule no longer be followed by US, FNA was performed and revealed Bathesda IV cytology. Gene classification with Thyroseq revealed a TERT mutation. On total thyroidectomy pathology demonstrated a 4.5cm poorly differentiated carcinoma thought to be of follicular origin. Tumor was partially encapsulated with multiple areas of vascular invasion and extensive tumor necrosis. Tumor was present at inked margin but no extrathyroidal extension was noted. There was a <1mm metastasis noted in 1 peri-isthmus lymph node. One month post operatively thyroglobulin was 123.5 ng/mL. I-123 whole body scan demonstrated bilateral uptake in the region of the thyroid suggesting adenopathy; there were similar findings on FDG-PET scan but no adenopathy was identified on US or the CT portion of the PET. Patient was treated with 129mCI of I-131 with focally intense activity in the lower neck on post treatment scan but nothing elsewhere. Follow up lab testing is pending.

Though thyroid nodules are a common clinical problem, there are only isolated case reports of hyperfunctioning nodules being later found to have thyroid cancer. One retrospective series of over 6000 patients found a thyroid cancer prevalence of 0.15% in hyperthyroid patients treated with I-131.i Poorly differentiated thyroid cancer is thought to occur as a mutation from a differentiated cancer. Here, we present a novel case of the 25 year course of a benign, hyperfunctioning nodule later mutating into an aggressive poorly differentiated cancer. We hypothesize that this nodule mutated late in the course as it was clearly benign on initial biopsy and had a benign course until recent events. This case supports periodic screening of hyperfunctioning nodules after ablation, especially if the nodule does not shrink significantly after I-131.

Endnotes

i Angusti T et al. The Journal of Nuclear Medicine 41(6):1006–1009.
SAT-214 Steroid Induced Pheochromocytoma Crisis
Authors: Eagan Danielle , Pena Juan Munoz , Barb Diana
Published: May 2020

BACKGROUND:

The factors triggering adrenergic crisis in pheochromocytoma are most often related to induction during anesthesia or manipulation of tumor during surgery. A variety of drugs have also been reported to be associated with adrenergic crisis, however there are only scarce case reports on pheochromocytoma crisis induced by steroids. Here we present a case of steroid induced pheochromocytoma crisis.

Clinical Case:

58 year-old female with history controlled hypertension on Lisinopril 10 mg daily, presented to hospital with two day history of fatigue, shortness of breath, and abdominal pain. A CT chest and abdomen showed emphysema and an indeterminate right adrenal gland nodule. Due to patient symptoms and findings of emphysema patient was started on Prednisone 40 mg daily. Home Lisinopril was restarted and patient was placed on sodium restriction. Ten hours after the start of prednisone the patient developed sudden onset hypertension with BP >200/100 mmHg for which she was given labetalol intravenously. The patient developed orthostatic hypotension hours after with BP readings as low as 50s/40s. Due to labile BP a work-up for adrenal adenoma was started. Plasma and urine metanephrines and noremetanephrines returned 7–11 times and 4–15 times above upper limit of normal (ULN) respectively. Plasma and urine metanephrines were repeated when patient was off steroids and normotensive and still returned abnormally high (about 2–3 times ULN) along with elevated urine catecholamines (epinephrine 6.5 times ULN and with only a slight elevation in norephinephrine and normal dopamine levels). A dedicated adrenal scan showed a 2.2 cm right adrenal mass with homogeneous enhancement, 130 HU, with an absolute and relative washout of 65% and 44% respectively, not consistent with a benign adenoma. Patient was placed on a high salt diet along with fluids and doxasozin. Once appropriately alpha blocked, metoprolol was added prior to surgery.

Clinical lessons:

In the setting of labile BP, one should keep a high clinical suspicion for pheochromocytoma. Orthostatic hypotension here was related to epinephrine predominance pattern of secretion and volume depletion. Steroids should be avoided in patients with known pheochromocytoma or in those with an adrenal adenoma without a negative biochemical workup for a pheochromocytoma as it could precipitate an adrenergic crisis possibly by inducing catecholamine synthesis and release and sensitizing target organs to the effects of catecholamines.

Reference:

1. Rosas AL, et al. Pheochromocytoma crisis induced by glucocorticoids: a report of four cases and review of the literature. European Journal of Endocrinology (2008) 158 423–429.
SUN-929 An Unusual Presentation of Insulinomas-Profound Hypophosphatemia
Authors: West William , Uwaifo Gabriel Ikponmosa
Published: May 2020

BACKGROUND: Insulin induces intracellular shift of phosphorus, causing hypophosphatemia. This is mild, transient and quiescent in normal persons. Persistent hyperinsulinemia in patients with depleted phosphorus stores can cause profound symptomatic hypophosphatemia. Clinical Case: A 36yr old man with MEN 1 presented in follow-up. His original manifestation of MEN 1 was familial primary hyperparathyroidism (pHPT) for which he had parathyroidectomy in 2009. At one of his endocrine clinic visits, he was noted to have asymptomatic hypophosphatemia with serum phosphorus of 2.4 (2.7–4.5 mg/dL) and mildly elevated PTH of 89 (9–77 pg/mL). This was presumed to be due to mild persistent/recurrent pHPT, and he was advised to increase dietary phosphorus intake. About a year later, he presented to the emergency room (ER) with palpitations and marked asthenia. Serum phosphorus was 1.0. He was treated with intravenous phosphorus and discharged on oral phosphorus replacement with advice to increase his dietary phosphate intake. Despite this, he continued to have recurrent spells of dizziness, weakness, palpitations, and marked hypophosphatemia several requiring repeat ER visits. His degree of mild pHPT remained stable and imaging studies to identify a possible cause for tumor induced osteomalacia with phosphate wasting was unrevealing. He volunteered at a follow up visit that he had a long history of low blood sugar spells (confirmed by fingerstick) that he had learnt to manage with frequent carbohydrate rich snacks. This prompted the consideration of a possible insulinoma as the cause for his persistent hypophosphatemia. Despite significant hypoglycemia on an abbreviated supervised fast, an OGTT and mixed meal test showed profound severe insulin mediated hypoglycemia. CGMS also showed multiple extended early morning severe hypoglycemic spells <50mg/dl over a 2 wk period. Multiple imaging tests were negative but a Gallium Dotatate scan revealed multiple areas of uptake in his pancreas. Endoscopic ultrasound of the pancreas demonstrated multiple masses in the pancreas: one 7 x 5 cm mass in the body and one 4 x 4 cm mass near the neck of the pancreas. Fine needle aspiration biopsy revealed well-differentiated neuroendocrine tumors. He had distal pancreatectomy and tumor enucleation of 5 tumors identified on intraoperative sonography. Histopathology confirmed multiple neuroendocrine tumors, with immunostaining for insulin. He has had no further episodes of hypophosphatemia since despite being off oral phosphate supplements. Conclusion: Profound hypophosphatemia can be the dominant presentation of persistent hyperinsulinemia seen in patients with insulinoma. Insulinomas and other causes of persistent hyperinsulinemia need to be considered in the differential diagnosis of persistent/recurrent hypophosphatemia.
MON-501 Physician-Reported Misuse of Thyroid Ultrasound
Authors: Chen Debbie W , Reyes-Gastelum David , Radhakrishnan Archana , Hamilton Ann S , Ward Kevin C , Haymart Megan R
Published: May 2020

BACKGROUND: Over the past four decades, there has been a substantial increase in the incidence of thyroid cancer with studies suggesting that greater use of thyroid ultrasound contributes to the rise in incidence. However, little is known about physician reported practice patterns on ultrasound use.

Methods: Patients diagnosed with differentiated thyroid cancer in 2014–15 from the Surveillance, Epidemiology and End Results registries of Georgia and Los Angeles were surveyed and asked to identify the surgeon who performed their thyroid surgery, and the endocrinologist and other doctors most involved in their thyroid cancer treatment decision making. We surveyed all physicians identified by more than one patient, and a random sample of physicians identified by one surveyed patient (N=610; 65% response rate). Surveyed physicians were asked to identify the clinical scenarios in which they would schedule a thyroid or neck ultrasound. We generated descriptive statistics for all categorical variables and used multivariable logistic regression to identify factors associated with thyroid ultrasound misuse.

Results: The cohort consisted of primary care physicians (PCPs; N=162), endocrinologists (N=176), otolaryngologists (N=130), and general surgeons (N=134). In addition to physicians reporting ultrasound use for accepted reasons such as palpable nodule on exam (98%), large goiter (92%), and nodule seen on other imaging test (88%), a substantial number of physicians endorsed ultrasound use for clinically unsupported reasons: patient request (33%); abnormal thyroid function tests (28%); and positive thyroid antibodies (22%). In multivariable analysis, compared to PCPs, endocrinologists, otolaryngologists, and general surgeons were significantly more likely to schedule an ultrasound in response to patient request (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.27–5.11; OR 2.98, 95% CI 1.57–5.79; OR 2.14, 95% CI 1.17–3.97, respectively). Physicians in private practice were more likely to schedule an ultrasound for abnormal thyroid function tests (OR 2.44, 95% CI 1.33–4.73) and positive thyroid antibodies (OR 2.47, 95% CI 1.27–5.21) compared to those in academic medical centers. Physicians who managed ten patients or less, compared to more than 50 patients, with thyroid nodules in the past 12 months were less likely to schedule an ultrasound for positive thyroid antibodies (OR 0.43, 95% CI 0.19–0.95).

Conclusion: Physicians report scheduling thyroid ultrasound for reasons not supported by clinical guidelines and in conflict with the Choosing Wisely recommendations. Understanding why physicians use thyroid ultrasound and factors that correlate with clinically unsupported reasons is essential to creating targeted educational interventions to improve physician adherence to guidelines, reduce unnecessary imaging, and curb the overdiagnosis of low-risk thyroid cancer.
SAT-638 An Academic Center Experience with the Eversense Continuous Glucose Monitoring System and Assessment of Intrapatient Variability with Repeated Same-Pocket Insertion
Authors: Lee Warren , Gierman Jim , Hirsch Irl B , Wright Lorena Alarcon Casas
Published: May 2020

BACKGROUND:

The Eversense continuous glucose monitoring (ECGM) system is a 90-day implantable device approved for patients with diabetes. The manufacturer recommends alternating arms each subsequent insertion to ensure adequate healing. To date, the intra-patient sensor variability using the same subcutaneous pocket has not been evaluated. We aim to assess change in glucometrics upon continuous use and the use of the same insertion pocket.

Methods:

Retrospective study (October 2018-October 2019), that included all patients using the ECGM. Demographics, and glucometrics data: transmitter wear time (TWT), average glucose (AG [mg/dL]), coefficient of variation (CV), time in range (TIR), time below range (TBR) and time in serious hypoglycemia (SH) data were obtained. Paired T-test was used to compare means (±SD) of the initial 90 days of sensor data (P1) with data of subsequent device insertions, grouped by periods of data time: period 2, 3 and 4 (P2, P3, P4). Analysis was done as a group, by insertion period, and by cohorts: cohort 1: same subcutaneous pocket, cohort 2: alternating insertion site.

Results:

Nine female, 7 male patients, age 37±11 years old, weight 85±10 Kg. Fourteen with T1DM, one with T2DM and one from pancreatectomy. There were 7 patients in each cohort, 2 patients had only one device inserted resulting in only 1 period of 3-month data; 7 patients had 2 consecutive devices inserted i.e. 2 consecutive 3-month periods of data (P1 and P2), 4 had 3 consecutive devices inserted, three 3-month periods of data (P1, P2 and P3) and 3 had 4 consecutive devices inserted, i.e. four 3-month consecutive periods of data (P1, P2, P3 and P4).

Baseline, first insertion, initial 3-month period of data (P1) showed TWT 69.7±23 for the entire group, AG 175±30 mg/dL, CV 36.7±7.6, TIR 52.6±17, TBR 2.69±2.5, SH 1.5±2.3.

We found no statistical significance for TWT, AG, CV, and TIR, as a whole and when analyzed by cohorts and period of data: P1 vs P2, P1 vs P3, P1 vs P4. TBR and SH decreased with continuous ECGM use. TBR mean difference comparing P1 vs P2, P3 and P4 was -0.15±0.9 (p=0.9), 1.16±1.8 (p=0.02), and 1.8±1.6 (p=0.001) and for SH -0.05±0.8 (p=0.8), 0.6±1.3 (p=0.09), and 0.9 ±1 (p=0.004).

There were 3 device failures; 2 post first insertion, one post repeat insertion in the same pocket. No infections, or serious bleeding were observed.

Conclusions:

Continuous ECGM use decreased time below range and time in serious hypoglycemia, without change in TWT, AG, TIR and CV. There was no significant intrapatient variability comparing consecutive device insertions regardless of whether patients elected to use the same pocket or alternate arms, suggesting that using the same insertion pocket may have the same efficacy as placement into a fresh insertion site, while decreasing the number of punctures, pain, procedure time, risk of bleeding and infection.
MON-104 The Relationship Between Metabolic Syndrome Indicators and Body Composition Measured by Bioelectrical Impedance Analysis Methods in Obese Children
Authors: Kim Seulki , Lee Yoonji , Lee Na-yeong , Lee Seonhwa , Choi Yujung , Ahn Moon Bae , Kim Shin Hee , Cho Won kyung , Cho Kyung Soon , Jung Min Ho , Suh Byung-Kyu
Published: May 2020

Purpose: This study aimed to compare obesity indices with impedance analyzed body composition data, and to investigate the association between impedance analyzed body composition data and the prevalence of metabolic syndrome.

Methods: 123 prepubertal children (49% girls 3-to-8- year-old, 51% boys 3-to-9-year-old) who are below or equal to body mass index (BMI, kg/m2) 85th percentile were retrospectively reviewed. Height, weight, waist circumference, blood pressure, serum lipid profiles, fasting plasma glucose and serum insulin were measured. Body fat percentile (BFP), fat-free mass (FFM) were measured by BIA and fat mass index (FMI), fat-free mass index (FFMI) were calculated. We investigated the relationship between metabolic syndrome indicators and body composition measured by BIA. Metabolic syndrome (MetS) was defined as including more than or equal to three of the metabolic abnormalities according to the modified National Cholesterol Education Program Adult Treatment Panel III.

Results: The overall prevalence of MetS was found to be 15.4%(19/123). The prevalence of MetS, MetS indicators, and body composition measured by BIA were not significantly different between males and females. BMI z-score was positively correlated with BFP, FMI and FFMI (r=0.51, P=0.001; r=0.63, P=0.001; r=0.29, P=0.001, respectively), so was waist-to-height ratio (WHR) (r=0.57, P=0.001; r=0.70, P=0.001; r=0.33, P=0.001). Homeostatic model assessment for insulin resistance (HOMA-IR) index was associated to BFP, FFM, FMI, and FFMI (r=0.305, P=0.003; r=0.359, P=0.001; r=0.331, P=0.001; r=0.24, P=0.018, respectively). Regression analysis showed chronological age (CA) and BMI z-score affect HOMA-IR (β=0.61, P=0.001; β=0.93, P=0.002, respectively) and CA was considered as a potential risk factor of MetS (Odd ratio of 3.09 and 95 % confidence interval of 1.25–7.65).

Conclusion: BIA seems to be a good tools for measuring obesity but not a good tool for predicting complications of obesity in prepubertal children. Further study is needed on the risk factors for complications of obesity in prepubertal children.
MON-054 First Report of Monozygotic Twins with Russell Silver Syndrome in China: Recombinant Growth Hormone Therapy and 3-Year Observation
Authors: Liu Shu , Jiang Jianhui
Published: May 2020

BACKGROUND: Russell Silver syndrome (RSS) is a rare genetic condition that includes an important index of suspicion when a child presents with hemihyperthrophy. There are more than 400 cases described in the literature, but twin pairs with RSS have rarely been reported. Up to now only six monozygotic twin pairs have been described [1]. However, this has not been reported in east Asian population yet.

Clinical Case: A 4 years and 9 months old monozygotic twin girl with a history of growth retardation was admitted to our hospital. The first impression of the patient was: poor growth, specific facial features, asymmetry of the lower and upper limbs for length and width. Detailed physical examination revealed a small triangular face with prominent forehead, micrognathia, lips with downturned corners, and fifth finger clinodactyly on bothhands. On admission into our hospital, the examination measured a weight of 9.0 kg (-4.9SD) and a length of 88.4 cm (-5.2SD). Anthropometrically she was classified as second grade malnutrition according to World Health Organization (WHO) charts. By contrast, her twin sister was physically and anthropometrically normal.

Intrauterine growth retardation, postnatal growth retardation, normal head circumference and asymmetry of the body were the major criteria that made the clinical diagnosis of Russell-Silver syndrome. Confirmation of Russell-Silver syndrome was made based on clinical findings, birth history and results of molecular genetic testing showed hypomethylation of the paternal imprinting center 1 (IC1) of chromosome 11p15.5.

Recombinant human growth hormone (rhGH) was administered by subcutaneous injection once daily, in the evening, at a dose of 0.05 mg/ kg/day. The check-up visits in the outpatient were held every three months, and the following issues were evaluated: response to treatment, tolerability, and laboratory test results, with particular emphasis on carbohydrate metabolism and bone age progression. Currently, after 28 months of rhGH treatment, the girl has grown 18 cm, reaching a body height of 106.5 cm (-3.2SD, ΔHt SDSCA: 2SD). Her current weight is 14.1 kg (-2.9SD, ΔWt SDSCA: 2SD). So far, no serious adverse events have been observed.

Conclusion: This is the first case of monozygotic twin with Russell Silver syndrome reported in east Asian population. The possibility of rhGH treatment can be considered in cases of documented GH deficiency in patients with Russell Silver syndrome, under close endocrinic supervision.
OR21-01 Pre-Operative Calcitonin Value as a Predictive Factor of Cancer Related Death in Sporadic Medullary Thyroid Carcinoma
Authors: Matrone Antonio , Cappagli Virginia , Donati Delio Stefani , Prete Alessandro , Valerio Laura , Giani Carlotta , Bottici Valeria , Viola David , Agate Laura , Molinaro Eleonora , Vitti Paolo , Elisei Rossella
Published: May 2020

Introduction: Medullary thyroid carcinoma (MTC) is a rare tumor, it originates from the C cells producing calcitonin (CT) and can occur as sporadic or associated to germline RET mutation. The initial treatment is represented by total thyroidectomy associated with central compartment lymph nodes dissection and possible extension to the laterocervical compartment. CT is the main marker of follow-up of MTC, conversely its pre-operative role as diagnostic and prognostic factor is still debated. The aim of the present study was to evaluate several predictive factors of cancer related death in a large series of sporadic MTCs. Patients and Methods: We evaluated 537 consecutive patients surgically treated for sporadic MTC, from 2000 to 2019, and followed at the Operative Unit of Endocrinology 1 of the University of Pisa. We evaluated epidemiological, clinical and pathological data and pre and post-operative CT values, and their correlation with cancer related death. Results: At the end of the follow-up (average 75 months), 300/537 (55.9%) pts were cured, 100/537 (18.6%) pts showed biochemical disease, 88/537 (16.4%) pts showed metastatic disease and 49/537 (9.1 %) pts died for the disease. The factors significantly correlated with the cancer related death to the univariate analysis were the male gender, dimension of the primary tumor> 4 cm, the presence of lymph node metastasis to histology (N1) and/or distant metastasis (M1) at the time of diagnosis, multifocality, minimal extrathyroidal extension (mETE), initial staging, pre-operative CT values> 500 pg/ml and post-operative> 20 pg/ml. At multivariate analysis, statistical significance persisted only for pre- and post-operative CT and for the staging. Conclusions: 1) In our study we observed a significant improvement in the outcome and survival in the medium-long term of sporadic CMT patients, compared to the previous studies. 2) A more advanced staging at the time of diagnosis has been confirmed as a negative prognostic factor and it is evident that an early diagnosis is an essential requirement for improving cancer related death. 3) This is the first study that showed, in a large monocentric series of sporadic MTCs, as pre-operative CT represents a prognostic factor associated with cancer related death, as well as the value of post-operative CT.
MON-125 Structure, Process and Outcomes of Transitional Care in Endocrinology: Pilot Results from the Intersect Study (International Study of Endocrine Care During Transition to Adult-Oriented Care)
Authors: McGauley Colleen , Shen Hongjie , de Graaff-Herder Laura , Hauschild Michael , Dwyer Andrew A
Published: May 2020

BACKGROUND: Structured transitional care (TC) is the planned, purposeful transfer from pediatric to adult care that aims to maintain high quality, developmentally appropriate continuous care. Relatively little is known about how endocrine TC is structured internationally, the process of TC and what outcomes are a priority for endocrine TC. This pilot study aimed to better understand endocrine TC and identify key elements for successful implementation internationally. METHODS: The Donabedian framework (structure-process-outcome) guided the international web-based survey examining TC programs for adolescents and young adults (AYAs) 16–25 years-old. The survey examined: 1) best practices i.e. six core elements of TC (Center for Health Care Transition Improvement ‘Got Transition’); 2) nursing involvement; 3) perceived importance of the ‘10 priority outcomes’ identified by an international multidisciplinary Delphi process (Fair et al. JAMA Pediatrics, 2016); and 4) promoters/barriers to implementation. Descriptive analysis was conducted for close-ended questions and thematic analysis for open-ended questions. Rankings by endocrine clinics were compared to the ‘10 priority outcomes’. RESULTS: Invitations were sent to authors of publications/posters on endocrine TC from the past 10 years. Eight responses were recorded from academic medical centers across seven countries with structured (n=3), semi-structured (n=2) and unstructured TC (n=3). Only 2/8 received institutional funding. Two practices involved nurses in assessing transition readiness and cited direct clinical care, therapeutic education and emotional support for AYAs/families as important contributions. Groups lacking nursing involvement expressed desire for a nursing role if financed. The most commonly used ‘Got Transition’ core elements were: providing supporting materials, confirming adult visit and consulting with adult providers. Only one group formally collected TC outcome data. “Self-management” was rated the most important TC outcome. “Understanding the condition/complications” and “attending medical appointments” were seen as having relatively higher priority for endocrine TC. Barriers related to lack of financial support and low institutional priority. Involving key stakeholders facilitated implementation. Having a dedicated nurse was noted as an opportunity for improving TC. CONCLUSIONS: Implementation of structured TC has been piecemeal and most practices do not fully utilize recommended best practices (‘Got Transition’). Few practices formally collect outcome data. The major perceived barrier to implementing TC is financial. Practices incorporating nurses value discipline-specific contributions. These pilot data point to a role for nursing in providing comprehensive, high quality, comprehensive care for AYAs with chronic endocrine conditions.
SAT-446 Transcriptome Comparison of a Natural T3 Regulated Process and a Treatment with T3
Authors: Buisine Nicolas , Rigolet Muriel , Duvernois-Berthet, Master Evelyne , Sachs Laurent M
Published: May 2020

Thyroid hormones (TH) act mainly on the expression of the genome. It is well accepted that differential gene expression following treatment with TH recapitulates the expression profiles taking place during natural processes induced by these hormones. Although both processes seem to correlate at the scale of a few target genes, this hasn’t been addressed in a systematic manner. Our objectives were first to compare transcriptome variations after TH treatment with transcriptome variations during a TH controlled natural process and second to evaluate the proportion of the direct TH-response. The measurement of gene expression at genome scale (transcriptome) is obtained by sequencing all the messenger RNAs (RNA-seq). Direct response was sorted out by linking the transcription start sites of target genes using RNA-PET analysis with TR binding sites mapping using chromatin interaction analysis by paired-end tag sequencing (ChIA-PET). Indeed, ChIA-PET not only allow to map TR binding sites but also the physical interactions between them and transcription start sites of regulated genes. Our model is one of the striking developmental processes orchestrated by TH: amphibian metamorphosis. Tadpole transformation is marked by dramatic changes including de novo morphogenesis (limb), tissue remodelling (brain, intestine...) and organ resorption through apoptosis (tail). These changes involve cascades of gene regulation initiated by TH and their receptors. Because metamorphosis has close and interesting parallels with the perinatal period in mammals (including human), metamorphosis is thus an attractive model to analyze in a physiological context, the functions and mechanisms of action of TH. Here, we have focused on one Xenopus tropicalis organs, the tail fin skin which will disappear through cell death. We have compared natural metamorphosis with 24h of 10nM triiodothyronine (T3) treatment. We were able to observe several differences between T3 treatment and natural development. First, the genes regulated by T3 only correspond to a proportion of genes differentially expressed during metamorphosis. Second, T3-response genes start to be regulated well before tail regression (several days). Finally, T3-direct target genes represent a few percent of all the genes differentially expressed during tail regression. In conclusion, the comparison of transcriptomes of natural and induced metamorphosis allow us to reach a more precise understanding of TH action
SUN-633 Increased Risk of Gestational Diabetes Mellitus in Egyptian Females Undergoing In Vitro Fertilization in Alexandria
Authors: Amin Noha Gaber , Ghanem Yehia Moustafa , El Kassar Yasser Saad , Shalaby Mai
Published: May 2020

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most frequent maternal complications during pregnancy. It has been estimated that most of the cases of hyperglycemia during pregnancy are attributed to GDM (75–90%). Pregnancy complicated with GDM is associated with adverse acute and long term consequences for both mother and infant. Risk factors for GDM include; a previous history of GDM, a family history of type 2 DM, advanced maternal age, overweight, and polycystic ovary syndrome (PCOS). This was an observational prospective study, using data of pregnant women conceived following in vitro fertilization (IVF) and spontaneously, aimed to determine the risk of GDM among Egyptian females following IVF compared to spontaneous pregnancy. The present study included two age and BMI- matched groups. Group I (GpI): 55 pregnant females conceived by IVF, and Group II (GpII): 55 pregnant females conceived spontaneously. We excluded females with a history of pre-pregnancy diabetes, glucose intolerance, corticosteroid therapy, twin pregnancy, and age above 39 years. In addition to detailed history taking, clinical examination and routine laboratory investigations, one- step oral glucose tolerance test (OGTT) was performed at gestational week 20 and 28 in all subjects. Fetal biometric measurements were performed in the third trimester using ultrasonography assessment.

Results: On using the one-step strategy (75 gm OGTT test) to screen for GDM at 28 weeks of gestation; GDM was statistically significantly higher in Gp I (who had undergone IVF) compared to Gp II (spontaneous pregnancy) (20% and 5.5% respectively), p= 0.022. Moreover, it was also noticed that GDM occurred earlier on screening at 20 weeks of gestation in Gp I (16.4%) compared to (3.6%) in Gp II, p= 0.026. Among subjects who had undergone IVF (Gp I), 18.2% had a history of PCOS. There was no statistically significant difference in the incidence of GDM among subjects with PCOS compared to those without a history of PCOS at gestational week 20 and at week 28 in Gp I (p=0.661, and p=0.099 respectively). Data of fetal biometry done at the third trimester showed no significant statistical difference in head circumference, biparietal diameter, abdominal circumference or femur length between both groups. However, fetal body weight was significantly higher in the IVF group (Gp I) compared to (Gp II), p=0.003.Conclusion: These findings show that IVF may increase the risk for GDM, moreover, GDM occurs earlier, recommending selective early screening for GDM in this population. References: Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2014; 103, (2) 176–85.