bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-288 TSH Deficiency in Patients on Somatostatin Analog for TSH-PitNET
Authors: Illouz Frederic , Chanson Philippe , Sonnet Emmanuel D , Brue Thierry Christian , Ferriere Amandine , Raffin-Sanson Marie-Laure , Vantyghem Marie-Christine , Raverot Gerald , Munier Mathilde , Rodien Patrice , Briet Claire 
Published: May 2020

Abstract
Background: Somatostatin analogs (SSA) are efficiently used to control central hyperthyroidism in patients with thyrotropin-secreting pituitary neuroendocrine tumor (TSH-PitNET). The aim of this study was to describe the frequency of thyrotropin (TSH) deficiency under SSA in patients with TSH-PitNET. Methods: We retrospectively recruited patients presenting a central hyperthyroidism due to TSH-PitNET. Inclusion criteria were patients treated in first, second or third line by short or long-acting SSA, with central hyperthyroidism before SSA. Patients treated by radiotherapy or dopamine agonist were excluded. TSH deficiency was defined by either a low FT4 or low FT4 and FT3, associated with non-elevated TSH concentrations during SSA therapy. We analyzed the frequency of TSH deficiency and the characteristics of patients with or without TSH deficiency. Results: 46 patients were included in the study. SSA were used as the first-line therapy in 21 of 46 patients (46%). Central hyperthyroidism was controlled in 36 of 46 patients (78%). TSH deficiency appeared in 7 of 46 patients (15%), after a median time of 4 weeks (4–7) after the starting of SSA, and for a median duration of 3 months (2.5–3). The TSH deficiency occurred after 1 to 3 injections of long-acting SSA. There were no differences in terms of clinical and hormonal features and size of adenomas between patients with or without TSH deficiency. Conclusions: In patients with central hyperthyroidism due to TSH-PitNET, SSA can induce TSH deficiency. Thyrotropic function should be assessed before each injection of SSA in order to adapt the frequency of injection when control of thyrotoxicosis rather than tumor reduction is purpose of the treatment.
SAT-275 Bitemporal Hemianopia as a Result of Cabergoline Therapy for Macroprolactinoma
Authors: Díaz-Balzac Carlos A , Williams Zoe R , Vates G Edward , Shafiq Ismat 
Published: May 2020

Abstract
Background: Cabergoline is first-line treatment for prolactin-secreting pituitary macroadenoma (prolactinoma). Side effects such as nausea, valvulopathy and neuropsychiatric symptoms are well recognized complications of its use. A rare complication is vision loss secondary to empty-sella syndrome. Clinical case: A 27-years old women was diagnosed in 2009 with macroprolactinoma with a prolactin level of 2,523.91ng/mL (normal 3.3-26.7ng/mL), during work up of frontal headaches, amenorrhea and infertility. The rest of her pituitary work up was normal. She was started on dopamine receptor agonist therapy with Cabergoline 0.25mg two times a week. Her headaches improved within a few month. The prolactin level normalized and MRI at 1 year after starting Cabergoline therapy showed significant decrease in pituitary adenoma to 3mm. She continued Cabergoline therapy for 3 years, after which time it was discontinued. For the next 6-8 years she was on and off Cabergoline therapy for mild elevation of prolactin and galactorrhea/headache symptoms, with improvement of symptoms on Cabergoline. However, nine years after diagnosis and Cabergoline treatment, she developed vision loss, characterized by bitemporal hemianopia. MRI showed partial empty sella with downward displacement of the optic chiasm. Cabergoline therapy was stopped with some improvement of visual symptoms on exam. Here latest prolactin level is at 134ng/ml. Surgical management with chiasmapexy is being explored. Conclusion: Vision loss secondary to optic nerve traction from chiasmal herniation in the setting of an empty sella can be a consequence of Cabergoline therapy. No predictors or risk factors are known for the development of this complication. Furthermore, no clear evidence is available of benefit from discontinuation/continuation of therapy. Novel surgical management with chiasmapexy is being explored as a solution to stabilize the optic chiasm and resolve visual symptoms without further complications.
MON-283 IGF-1 Levels During Normal Pregnancy
Authors: Thomas Guillermo Javier , Peverini Agustina , Smithuis Fernando , Fabbro Dolores , Tkatch Julieta , Rosmino Josefina , Aranda Claudio , Guitelman Mirtha , Oneto Adriana 
Published: May 2020

Abstract
Pregnancy is associated with a physiological GH excess, where maternal pituitary GH is suppressed by effect of placental GH on the hepatic receptor, increasing IGF-1 serum levels1. However, it is also described that estrogens and progesterone are responsible for reduction in IGF-1 by direct hepatic action through the inhibition of the JAK-STAT pathway that results in GH resistance, being more clear at the beginning of pregnancy.2 Acromegaly is a rare disorder in which GH axis is deregulated and IGF-1 is the most reliable biochemical marker for diagnosis and monitoring. It is know that secondary hypogonadism associated with these pathology decreases fertility rates. Nonetheless, improvement of acromegaly treatment and greater access to assisted reproductive technology increase pregnancy rates in this population. The follow-up of pregnant acromegalic women acquires relevance for the comorbidities of this association and depends on the adequate interpretation of the IGF-1 values. Then, due to changes in concentration and action of IGF-1 during pregnancy3, it is important that each laboratory establish their specific reference values. For that reason we analyzed serum samples from 80 healthy pregnant women living in the Metropolitan Area of Buenos Aires (AMBA): 22 were in the 1st trimester (1T), 29 in the 2nd (2T) and 29 in the 3rd (3T). All women were between 30 and 40 years old, had no endocrinopathies or metabolic diseases. Serum IGF-1 was measured by Immulite 2000 Siemens, and Prism8 GraphPad was used for statistical analysis, calculating ranges for each trimester defined as 2,5 and 97,5 percentiles. Ranges obtained were: 64,5-165,0 ng/ml, 78,9-201,0 ng/ml and 96,1-344,0 ng/ml for 1T, 2T and 3T, respectively. Significant differences were observed between 3T and the other trimesters (1T and 2T). We also compared these ranges with our reference values from healthy non-pregnant women in the same age, and found that 3T has significantly higher values ​​of IGF-1 (55,8-188,4 ng/ml vs. 96,1-344,0 ng/ml respectively). In conclusion, IGF-1 levels during the first two trimesters of pregnancy remain within the normal range, and there is a significant increase during the third trimester. Given that IGF-1 plays an essential role during pregnancy, it is important to report ranges in healthy pregnant women to contribute in the follow-up of patients with acromegaly who get pregnant. Although our results are in agree with the available literature, it is necessary to increase the number of healthy pregnant women to establish reference values of IGF-1.
1Frankenne et al (1988). The physiology of growth hormones in pregnant women and partial characterization of the placental GH variant. Journal of Clinical Endocrinology and Metabolism 66:1171-1180
2Leung et al (2004). Estrogen regulation of growth hormone action. Endocrine Reviews 25:693-72
3Muhammad et al (2017). Pregnancy and acromegaly. Pituitary 20:179-184
MON-120 The Implementation of a Scholarly Activity Curriculum: Impact Assessment
Authors: Mosaferi Tina , De Silva Jayamalee , Leung Angela M , Praw Stephanie Smooke 
Published: May 2020

Abstract
Introduction:
As detailed in the 2018 ACGME Common Program Requirements statement for fellowship institutions, “The physician is a humanistic scientist who cares for patients. This requires the ability to think critically, evaluate the literature, appropriately assimilate new knowledge, and practice lifelong learning.” Endocrinology fellowship programs are tasked with the expectation of creating an environment that fosters scholarly pursuit. It is under the discretion of each program to consider its institutional resources and community needs in order to meet this ACGME requirement.1
With the goal of enhancing trainee scholarly activity, our fellowship program created a Scholarly Activity Curriculum in 2017. The core curriculum pillars include delineating a yearly timeline of objectives and expectations, facilitating regular individual mentoring, permitting allotment of protected time, and advocating involvement in faculty scholarship and national conferences.
Objective:
To assess the impact of the 2017 Endocrinology Fellowship Scholarly Activity Curriculum with respect to its ability to increase trainee scholarship.
Methods:
The scholarly activities of the fellowship classes of 2017-2020 were extracted from archived Fellow Scholarly Activity Update presentations and exit-interview curricula vitae. The activities were categorized as conference presentations (oral/poster), basic scientific research, clinical scientific research, quality improvement, book chapters, review articles, case reports, and teaching activities. With the 2017 and 2018 classes representing the pre-curriculum study group and the 2019 and 2020 classes representing the post-curriculum study group, the number of activities per study group per scholarly category were tabulated and compared.
Results:
An increase in scholarly activity was noted in five of the delineated categories: conference presentations (80%), clinical scientific research (86%), review articles (100%), case reports (100%), and teaching activities (38%). The remaining three categories of basic scientific research, quality improvement, and book chapters showed no change.
Conclusions:
The implementation of the 2017 Endocrinology Fellowship Scholarly Activity Curriculum was associated with a rise in trainee scholarly activity. Four of eight categories showed an 80% or more increase. Interestingly, the fellows involved in basic scientific research both pre and post-curriculum implementation were limited to those in the Specialty Training and Advanced Research (STAR) Program. Finally, identifying the need to increase involvement in quality improvement research, our program has implemented a 2019 Quality Improvement Curriculum.
1Common Program Requirements (Fellowship). ACGME. https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. 2018. Accessed Nov 2019.
MON-206 Diagnosis of Non-Functional Masses in Adrenal Gland Topography - Experience of a Tertiary Health Center
Authors: Brondani Vânia Balderrama , Charchar Helaine , Tanno Fabio Y , Srougi Victor , de Freitas Ricardo M C , Fenelon Sandro S , Pereira Maria A A , Chambo Jose L , Mendonca Berenice B , Almeida Madson Q , Villares Fragoso Maria Candida Barisson 
Published: May 2020

Abstract
Introduction: Masses in adrenal topography are diagnosed frequently due to the increase in radiological imaging in clinical practice. Adrenal incidentalomas occur between 4% and 10% of the patients above 50 years undergoing abdominal imaging, and the majority are benign pathologies. Objective: To analyze the characteristics of the masses located in adrenal gland topography not originating from the adrenal gland. Methods: We retrospectively assessed patients from our tertiary hospital who underwent surgical treatment for masses in adrenal gland topography between 2006 and 2018. All patients had hormonal evaluations, according to the European and American Societies of Endocrinology guidelines. Two expert radiologists reviewed all images. Forty-six patients were included in the study, and the surgical specimens were analyzed by the same experienced pathologist. Patients with confirmed adrenocortical carcinoma (ACC) were excluded from this cohort. Results: Thirty-two (69.6%) patients were female. The median age was 49.5 years old (range 18-82yo). Abdominal or lumbar pain was the most frequent reason for medical investigation (43.5%). Adrenal incidentalomas represented 38.4% of the cohort. None of these patients had any clinical signs of adrenal hyperfunction, nor hormonal alteration. Twenty-four patients (52.17%) presented a mass on the left side, and only two cases presented bilateral adrenal masses. The median size was 8.6cm (1.3-18cm). The mean of Hounsfield Units (HU) on a non-contrasted CT was 25HU (0-50HU). Several etiologies were found: 8 cases (18%) of ganglioneuroma; 6 cases (13,5%) of adrenal cysts; 4 cases (9%) of leiomyosarcoma and adrenal hemorrhage; 3 cases (6.5%) of infectious disease; 2 cases (4.5%) of lymphangioma, schwannoma, and sarcoma. We also found single cases of renal cell carcinoma, poorly differentiated small cell neuroendocrine carcinoma, hepatocellular carcinoma, high grade dedifferentiated liposarcoma, epithelioid neoplasia, epithelial neoplasia with neuroendocrine differentiation, malignant peripheral nerve sheath tumor of the adrenal gland, poorly differentiated neuroblastoma, high grade lymphoma, myelolipoma, acute splenitis, arteriovenous malformation, and prostate cancer metastasis. Discussion and Conclusion: Ganglioneuroma was the most frequent diagnosis in adrenal incidentalomas in our cohort. In general, these conventional radiological exams could not differentiate lesions originated in the adrenal glands from lesions of other origins. In this large cohort, we could identify non-adrenal origin in approximately 45% of the patients with masses in the adrenal topography.
SUN-605 Mediastino-Abdominal Lipomatosis: Deep Accumulation of Fat Mimicking a Respiratory Disease
Authors: Correa Ricardo Rafael , Elshimy Ghada , Alsayed Mahmoud 
Published: May 2020

Abstract
Introduction: Multiple systemic lipomatosis (MSL) is a rare disorder with unknown etiology. It is characterized by the massive development of non-encapsulated lipomas in subcutaneous tissues. Lipomatosis of the face, head, neck, extremities, abdomen, and pelvis have been reported in the literature. Case: We report a case of a 65 years old female (BMI: 34 kg/m2) with past medical history of hypertension, hyperlipidemia(DLD) diabetes mellitus type 2 and sleep apnea that was brought into emergency room (ER) for worsening shortness of breath. In the ER, she was having an oxygen saturation of 75% and required intubation. The patient was afebrile, with a BP of 120/75 mm Hg and a heart rate of 70/minute. Trans-thoracic echocardiogram revealed normal ejection fraction and normal pulmonary pressure with no wall motion abnormality. CXR showed no infiltration or consolidation. CT angiogram (CTA) ruled out pulmonary embolism but it was notable for large deposits of fat involving the abdomen and thorax, with invasion into the mediastinum and the space between the liver and diaphragm. Mesenteric fat was increased. Tissue was biopsied, which confirmed the diagnosis of fatty invasion. Discussion: Abdominal lipomatosis is characterized by massive enlargement of the abdomen due to intraperitoneal and retroperitoneal fatty deposits. Phenotypically patients can appear to be thin or obese, however, it is more common in the overweight population like our patient. Mediastinal lipomatosis is a benign cause of mediastinal widening, however patients can develop respiratory symptoms like exertional dyspnea due to compression of airways. MSL affects white caucasian between 25-60 years old and it is associated with DLD, impaired glucose tolerance, hyperuricemia, macrocytic anemia, and peripheral neuropathy. The pathophysiology is not fully understood, some theories stated that it is related to defective lipid mobilization in lipomatocytes, other suggested disorder in the mitochondria of brown fat. Conclusion: CT and MRI of the abdomen and chest are very helpful in the diagnosis of MSL but a tissue biopsy is what makes the final diagnosis. There is no definitive treatment; the recommendations are a healthy lifestyle including a low-fat diet, abstinence from alcohol and exercise. In severe cases, surgery is recommended.
SAT-469 Vitals for the Prompt Recognition of Myxedema Crisis in a Critically Ill Patient
Authors: Funke Katalina , Aljehani Faisal , Loftley Aundrea 
Published: May 2020

Abstract
Myxedema coma is a rare but life-threatening condition if not treated promptly. The time from initial presentation to diagnosis may be prolonged in patients with severe illness whose presenting features are common to myxedema crisis. A 94-year-old male admitted to the neuroscience intensive care unit for acute stroke monitoring after intra arterial thrombolysis was treated for myxedema three days after initial labs revealed severe hypothyroidism and a myxedema score greater than 60. A diagnostic scoring system for the diagnosis of myxedema coma gives points for the following to easily identify patients with high likelihood of decompensated state of extreme hypothyroidism. Given the potential for under recognition of myxedema crisis in severe illness the clinician must pay close attention to vital signs and have a high level of suspicion for myxedema crisis and low threshold for treatment if myxedema score indicates high likelihood despite concomitant critical illness
SUN-182 Rare Case of Adrenocortical Carcinoma with Tumor Extension into the Inferior Venacava, Right Atrium and Right Ventricle
Authors: Siddiqi Asmat Qayoom , Cryar Keith , Yang Jungyoon 
Published: May 2020

Abstract
Introduction: Adrenocortical carcinoma is a rare and highly aggressive malignancy with an incidence rate of 1-2 per million population per year. It is an aggressive tumor with early metastasis to lungs, liver, bone and lymph nodes. Venous tumor thrombosis to inferior venacava (IVC), atrium or ventricle is rare and is considered as a tumor extension instead of metastatic disease, but with a poor prognostic outcome.
Clinical Case: We present a rare case of adrenocortical carcinoma with tumor extension into the IVC, right atrium and right ventricle. A 62-year-old female with history of breast cancer on anastrozole presented to the clinic for a routine screening colonoscopy. Patient was noted to have uncontrolled hypertension before the procedure, so was sent to the ER. Upon further interviewing she complained of increasing abdominal distension, hirsutism, and bilateral lower extremity swelling over the past six months. CT abdomen revealed a large 10 x11 x13 cm heterogeneously enhancing mass arising above the right kidney, with extensive tumor extension into the IVC, right atrium and right ventricle. MRI too characterized a large mass in the right adrenal gland with tumor thrombus extension into the IVC, right atrium, and right ventricle. Hormonal studies demonstrated elevated cortisol, dehydroepiandrosterone-sulfate and testosterone levels. A 1 mg dexamethasone suppression test inadequately suppressed cortisol levels, consistent with Cushing’s syndrome due to endogenous over secretion of cortisol. Free plasma and urine metanephrine levels were normal. Plasma renin and aldosterone concentration were within normal limits. With the cooperation of a multidisciplinary team, patient underwent right adrenalectomy with removal of tumor thrombus from right atrium and right ventricle under cardiopulmonary bypass. Surgical pathology confirmed adrenocortical carcinoma. She was started on mitotane as adjuvant therapy. Patient was also noted to have a lung nodule with biopsy showing oncocytic neoplasm favoring metastasis from adrenal cortex. She did receive chemotherapy for the lung metastasis with decrease in the size of the nodule.
Conclusion: Adrenal cortical carcinoma is a rare disease and the venous tumor thrombus to IVC, atrium and ventricle is even rarer and has a poor prognostic outcome. Complete tumor resection is the only curative approach with adjuvant therapies aiming to decrease the risk of recurrence only. Due to the aggressive nature of the tumor and quick development of metastasis, early diagnosis gives the best chance of resection and hence the greatest chances of survival.
OR14-03 The Transcriptional Coactivation Function of EHMT2 Restricts Chronic Glucocorticoid Exposure Induced Insulin Resistance
Authors: Lee Rebecca Arwyn , Tsay Ariel , Chang Maggie , Li Danielle , Wang Jen-Chywan 
Published: May 2020

Abstract
Glucocorticoids are required for metabolic adaptations during times of stress. However, chronic glucocorticoid exposure is associated with metabolic disorders such as insulin resistance. Glucocorticoids mainly convey their signals through an intracellular glucocorticoid receptor (GR). GR is a transcription factor that requires interactions with transcriptional coregulators to modulate the transcription of GR primary target genes, which in turn regulate specific aspects of physiology. Euchromatic Histone Methyltransferase 2 (Ehmt2) is a transcriptional coregulator for GR that can act as a corepressor or a coactivator. We found that glucocorticoid-induced insulin resistance was exacerbated when Ehmt2 levels were reduced in the liver. Intriguingly, this phenotype resulted from the transactivation function of Ehmt2. This is because a mutation at the lysine 182 automethylation site, which is required for the coactivation but not the corepression function of Ehmt2, results in similar exacerbated GC-induced insulin resistance. These results suggest that Ehmt2 coactivation dependent GR primary target genes restrict the extent of glucocorticoid-induced insulin resistance. Gene expression analysis identified Dusp4 (a.k.a. Mkp-2) as an Ehmt2 coactivation dependent GR-activated gene, which when overexpressed in liver, attenuated glucocorticoid-induced insulin resistance. Thus, we have identified a novel GR-Ehmt2-Dusp4 axis that plays a key role in controlling the extent of the development of insulin resistance. Notably, the classical view of how GC induce hepatic insulin resistance is that GR activates genes that inhibit insulin signaling and enhance hepatic gluconeogenesis. Our study, however, provides a revolutionary concept in which the extent of GC-induced insulin resistance is controlled by the balance of GR-activated genes that promote insulin sensitivity or insulin resistance.