bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-614 Prediction of Hypertension, Diabetes and Fractures in Eucortisolemic Women by Measuring Parameters of Cortisol Milieu
Authors: Chiodini Iacopo , Morelli Valentina , Aresta Carmen , Gaudio Agostino , Eller-Vainicher Cristina , Zhukouskaya Volha V , Merlotti Daniela , Orsi Emanuela , Barbieri Anna Maria , Fustinoni Silvia , Polledri Elisa , Gennari Luigi , Falchetti Alberto , Carnevale Vincenzo , Persani Luca , Scillitani Alfredo 
Published: May 2020

Abstract
Purpose. Cortisol secretion, peripheral activation and sensitivity seem to be associated with hypertension (HY), type-2 diabetes (T2D) and fragility fractures (FX) even in eucortisolemic subjects. The aim of the present study was to determine the cut-off(s) of the parameters of cortisol secretion and peripheral activation for predicting the presence of HY, T2D and FX (comorbidities). Methods. In 206 postmenopausal females (157 with ≥1 comorbidities and 49 without any), we assessed the ratio between 24-hour urinary free cortisol and cortisone (R-UFF/UFE, cortisol activation index), cortisol after 1mg-overnight-dexamethasone (F-1mgDST, cortisol secretion index), and the GC receptor N363S single-nucleotide polymorphism (N363S-SNP, cortisol sensitivity index). Results. The cut-offs for F-1mgDST and R-UFF/UFE set at 0.9 μg/dL (Area Under the Curve, AUC 0.634±0.43, p=0.005) and 0.17 (AUC 0.624±0.5, p=0.017) respectively, predicted the presence of ≥1 comorbidities. The presence of F-1mgDST &gt;0.9 μg/dL plus R-UFF/UFE &gt;0.17 showed 82.1% specificity for predicting the presence of ≥1 comorbidities, while the simultaneous presence of F-1mgDST ≤0.9 μg/dL and R-UFF/UFE ≤0.17 showed 88% sensitivity for predicting the absence of comorbidities. The F-1mgDST &gt;0.9 μg/dL or R-UFF/UFE &gt;0.17 was associated with 2.8 and 2.1 fold increased risk of having ≥1 comorbidities, respectively. The F-1mgDST ≤0.9 μg/dL plus R-UFF/UFE ≤0.17 or F-1mgDST &gt;0.9 μg/dL plus R-UFF/UFE &gt;0.17 was associated with 2.8 fold reduced or 4.9 fold increased risk of having ≥1 comorbidities regardless of age, BMI and N363S-SNP. Conclusions. F-1mgDST &gt;0.9 μg/dL and R-UFF/UFE &gt;0.17 may be used for predicting the presence of ≥1 among HY, T2D and fragility FX.
SUN-LB82 Coexistence of Medullary Thyroid Cancer With Graves Disease: A Case Report
Authors: Okoli Ogochukwu , Resta Christine A 
Published: May 2020

Abstract
A 59 year old woman presented with enlarged thyroid, weight loss, and hot flushes. She had previously been treated for a thyroid problem in 2013 but was lost to follow up.
On exam, she had a diffusely enlarged thyroid gland, without distinct nodule. She had brisk DTR’s and mild tremor. Lab results confirmed hyperthyroidism:TSH &lt;0.01 mIU/L (0.27 to 4.2) FT4 2.4 ng/dL (0.9 to 1.8) FT3 7.95 pg/mL (1.8 to 4.6). TSI was 307 % (&lt;140%).
Thyroid ultrasound showed a few sub-centimeter nodules, and 2 clinically significant nodules on the right--1.5 x 1.2 x 1.4 cm, cystic with calcifications; and 1.3 x 0.7 x 1.2 cm hypoechoic. I-123 thyroid uptake/scan showed 61% uptake and 2 right sided cold nodules. FNA biopsy showed medullary thyroid carcinoma (MTC) with staining positive for calcitonin and negative for thyroglobulin. CT thyroid showed no adenopathy. Serum calcitonin was 71 pg/mL (&lt;5), and CEA was elevated 5.4 ng/mL (&lt;2.5). Work up was negative for pheochromocytoma and hyperparathyroidism.After pretreatment with methimazole, she underwent total thyroidectomy with bilateral TE groove dissection. Surgical pathology confirmed MTC pT1b pN1a. She was started on levothyroxine therapy post operatively.
Discussion There are multiple reports of thyroid carcinoma (papillary and follicular) in Graves disease, but rarely MTC.1 A recent systematic review reports only 21 total cases of MTC in patients with hyperthyroidism, of whom 15 had Graves disease.2 MTC is derived from C-cells from the thyroid gland rather than from follicular cells. TSI, therefore, should not influence development or growth of MTC. Coexistence of the two conditions is likely coincidental rather than causative.
ConclusionThyroid nodules in patients with Graves should be worked up as there is a possibility of co-existing thyroid carcinoma. This patient had hyperthyroidism with cold nodules on nuclear scan corresponding to sonographic nodules. Based on these results, she had biopsy leading to diagnosis of MTC. Follow up surgery lead to diagnosis of MTC at earlier stage and provided treatment for both conditions.
References1. Staniforth, J. U. etal (2016). Thyroid carcinoma in Graves’ disease: a meta-analysis. International Journal of Surgery, 27, 118-125.
2. Sapalidis, K. etal (2019). A Rare Coexistence of Medullary Thyroid Cancer with Graves Disease: A Case Report and Systematic Review of the Literature. The American journal of case reports, 20, 1398
SUN-LB90 Taurine Reverses Protein Malnutrition-Induced Endothelial Dysfunction of Pancreatic Vasculature
Authors: Guizoni Daniele Mendes , Freitas Israelle Netto , Victorio Jamaira Aparecida , Carneiro Everardo Magalhaes , Davel Ana Paula 
Published: May 2020

Abstract
Background: Pancreatic islets are highly vascularized and there is a correlation between endocrine pancreas function and pancreas perfusion. Protein malnutrition during early stages of development predispose to cardiovascular diseases, impaired insulin secretion and, type 2 diabetes. However, it is unknown if there are alterations in the pancreatic vasculature in response to malnutrition. Taurine (TAU) supplementation has been suggested as antihypertensive and improves endothelial function and insulin secretion in cardiometabolic disorders. Here, we investigated the effect of TAU in the vasorelaxation and endothelium-derived factors of the lieno-pancreatic artery from protein malnourished mice. Because lieno-pancreatic artery provides blood supply to pancreatic splenic lobe, a protective effect of TAU may result in cardiometabolic benefits. Methods: Post-weaned male C57Bl/6 mice fed a normal- (14%, NP) or a low-protein (6%, LP) diet for 90 days. Concomitantly, half of LP mice received 2.5% TAU in drinking water. Lieno-pancreatic artery (internal diameter ~ 160 µm) was isolated and concentration-response relaxation curves to acetylcholine (ACh), nitric oxide (NO)-donor (SNP), or hydrogen sulfide (H2S)-donor (NaHS) were performed. The involvement of NO and endothelium-derived hyperpolarization (EDH) in ACh-induced relaxation was assessed using L-NAME (NO synthase inhibitor) or KCl (to attenuate K+ efflux), respectively. Protein expression was evaluated by Western-blot; NO and H2S production by DAF-2A and WSP-1 fluorescence, respectively. Results: Endothelium-dependent relaxation to ACh was reduced in lieno-pancreatic artery from LP compared with NP group. Either KCl or L-NAME reduced ACh-induced relaxation, but only KCl abolished differences between LP and NP, suggesting that EDH rather than NO is involved in the impaired endothelium-dependent relaxation of LP. In accordance, relaxation to SNP, NO production, and endothelial NO synthase (eNOS) expression were not altered in lieno-pancreatic artery of LP group compared to NP. Because H2S has been demonstrated to have EDH activity in several blood vessels we investigated this pathway. H2S production and NaHS-induced relaxation were both reduced in lieno-pancreatic artery of LP group compared with NP. TAU treatment reversed the impaired relaxation to ACh and to NaHS, as well as significantly increased H2S production in lieno-pancreatic artery of LP group. Conclusion: Protein malnutrition resulted in endothelial dysfunction of lieno-pancreatic artery associated with an impaired production and relaxation to H2S, which was restored by TAU. Therefore, beneficial effects of TAU on lieno-pancreatic artery vasodilatory function may result in improved pancreatic islet blood flow highlighting the potential of TAU for vasculo-metabolic protection.Funding: FAPESP, CAPES.
SUN-LB92 The Importance of Early Diagnosis and Treatment of Primary Aldosteronism on the Progression of Chronic Kidney Disease, Compared With Essential Hypertension: A Retrospective Cohort Study
Authors: Lim Jayoung 
Published: May 2020

Abstract
&lt;META NAME=“author” CONTENT=“Windows 사용자”&gt;Introduction: Primary aldosteronism(PA) has few clinical phenotypes and features, compared with other endocrine hypertension(HTN). Even though hypokalemia is a typical sign of PA, most of PA reveals normal potassium concentration. For that reason, PA is likely to undetected and underestimated and it may account for larger proportion of total HTN than we expected. However, it has known that PA has higher risk of renal complications than essential hypertension(EH) and has been controversy which treatment between medication and operation is better for renal protection of PA. Methods: We retrospectively reviewed the medial records of patients with PA and EH of a single medical center from January, 2009 to December, 2019. PA patients were divided into medical and surgical treatment groups. EH patients were distinguished from one that satisfied with case detection test, called non-confirmed PA. We excluded cases with other secondary HTN and baseline eGFR &lt; 60 mL/min/1.73m2. Results: Patients with PA(N=66) and patients with EH(N=514) were selected for analysis. Each baseline mean eGFR of patients with PA and EH indicated 91.2 ± 74.5 and 87.1 ± 19.7 mL/min/1.73m2 and statistically insignificant differences(P = 0.1688) as well as baseline SBP(P = 0.5403) and DBP(P = 0.8691). However, in spite of treatment of PA and controlled BP, mean eGFR of PA patients was lower than one of EH patients and its difference was statistically significant showing 66.5 ± 14.2 and 94.6 ± 195.9 mL/min/1.73m2 (P &lt; .0001) at 2~ 5 years, 52.4 ± 17.9 and 77.6 ± 20.6 mL/min/1.73m2 (P &lt; 0.0004) at 6~10 years. Baseline mean eGFR of PA with normokalemia and hypokalemia respectively were 77.7 ± 11.6 and 98.9 ± 92.5 mL/min/1.73m2 (P = 0.0269). Baseline mean eGFR of non-confirmed PA and EH were 82.5 ± 13.2 and 88.4 ± 21.1 mL/min/1.73m2 (P = 0.0240). Although baseline mean eGFR of PA with surgical treatment was better than one with medical treatment, it was reversal after 2~5 years indicating mean eGFR of PA patients treated with operation, 62.9 ± 16.1 mL/min/1.73m2 and one treated with spironolactone, 70.5 ± 12.6 mL/min/1.73m2 (P = 0.0010). Conclusions: This study support PA has worse effects on renal function than EH. PA is frequently unsuspected and undiagnosed because it hardly shows symptoms and signs. Many cases do not reveal main characteristics such as uncontrolled HTN and hypokalemia, so that patients with PA maybe have longstanding exposure to risk of CKD. Therefore it is necessary to do case detection test and rule out PA in initial hypertensive patients. In addition, more longitudinal study and research should be performed to decide personalized and adequate treatments for PA patients.
SUN-LB116 Improved Family Medicine Resident Diabetes Care Through Participation in a Diabetes Clinic
Authors: Douthitt Key , Taylor Wanda , Jonathan Piercy , Fletcher-Jones Crystal , Hughes Juanita , Slone Melissa , Feltner Frances , Atkins Robert 
Published: May 2020

Abstract
As the population ages and the prevalence of diabetes increases, the demand for endocrinology services, especially in underserved areas, will continue to exceed availability. Primary care residency training programs must prepare residents to care for high risk patients with diabetes who cannot access specialists. We hypothesized that resident participation in an inter-professional diabetes clinic run by primary care physicians would lead to improved diabetes care in resident patient panels.
A diabetes clinic was created in an existing primary care practice at a Federally Qualified Health Center in Eastern Kentucky. All non-pregnant, adult, Type II diabetes patients with a HgbA1C of 8.0% or greater were invited to participate in the clinic. Initial visits included evaluations by a dentist, mental health counselor, social worker, nutritionist, primary care provider, and pharmacist. Four first-year and four second-year family medicine residents rotated through the diabetes clinic and followed the patients as they saw each member of the health care team. On follow-up visits, a resident served as the primary care provider for each patient and participated in post-clinic meetings of the entire healthcare team. Resident patient charts were reviewed 3 months prior to the year-long intervention and data collected was compared to resident patient charts 3 months following the intervention.
Ninety patients served as the pre-intervention sample and 108 were in the post-intervention sample. Chi-square analysis showed a statistically significant increase in patients with A1C less than 8.0% pre (57.7%) to post (71.3%) p=0.0468. Overall, there were significant increases in all health-associated behaviors. Patients receiving eye exams increased from pre (29%) to post (66%) intervention significantly; z=-5.2, P&lt;.001. Patients receiving a urine microalbumin test increased from pre (61%) to post (82%) intervention; z=-3.2, P&lt;.001. Patients receiving dietary counseling increased from pre (54%) to post (79%) intervention; z=-3.6, P&lt;.001. Patients receiving foot exams increased from pre (34%) to post (48%) intervention, z=-1.9; p=.03.
Resident involvement in a multidisciplinary diabetes clinic led by primary care physicians resulted in a statistically significant increase in HgbA1Cs &lt; 8 among patients in their regular clinic and resulted in a statistically significant increase in their diabetic patients receiving eye exams, dietary counseling, foot exams, and urine microalbumin tests. This study suggests that teaching family medicine residents important diabetes care skills with an inter-professional team approach through the use of a diabetes clinic may be superior to standard educational practices.
SUN-LB47 Extended Release Octreotide Pharmacokinetics in Healthy Subjects After Subcutaneous Injection of MTD201
Authors: Seaman Paul , Damment Stephen J P , Kalinov Krassimir , Cook Craig , Kolev Emil 
Published: May 2020

Abstract
An open-label, randomised, single-dose Phase I study in healthy subjects evaluated octreotide pharmacokinetics after deep-intramuscular (IM) or subcutaneous (SC) injection of MTD201 (30mg). All subjects received Sandostatin® (100μg immediate release; SIR) by deep SC injection 24h before MTD201. MTD201 is manufactured by Q-Sphera™ printing technology to minimize particle size variation and afford simpler reconstitution and less painful injection via a 21G needle. Plasma octreotide concentrations were measured over 63 days to ascertain the potential for a 6- to 8-week dosing interval. MTD201 is being developed as a next generation long-acting somatostatin analogue for maintenance management of acromegaly and neuroendocrine cancer patients. Methods: 28 healthy subjects were randomised to two groups. The reference product SIR (100μg) was injected SC, followed 24 hours later by MTD201 administered by either IM (n=14, 38mm 21G needle) or SC (n=14, 16mm 21G needle) injection. MTD201 was resuspended in WFI to give a final injection volume of 1.5mL. Plasma samples for determination of octreotide and serum samples for IGF-1 and GH levels were drawn pre-dose and over the 63-days post-dosing. Injection site reactions and AEs were recorded, scored and compared across groups. Results: MTD201 was very well tolerated by both groups with 3 mild TEAEs observed per group. Transient and mild injection site reactions were similar after all treatments. Upon MTD201 injection, a low initial burst of octreotide (&lt;1ng/mL) was followed by a sustained period of release that extended beyond the final sampling point at Day 63. Cmax values of 5.42ng/mL (SC) and 3.68ng/mL (IM) were within the plasma exposure range reported for marketed octreotide products. Octreotide bioavailability was 47% (IM) and 62% (SC) relative to SIR. Sustained suppression of IGF-1 concentration was achieved throughout the study period to similar levels for both groups. Octreotide PK profiles and overall exposures were similar between groups, indicating that these routes may be interchangeable in clinical use.Conclusions: MTD201 (30mg) by either IM or SC injection produced continuous octreotide release over a period of at least 63 days at levels predicted to maintain efficacious plasma concentrations at steady state with a dosing interval of up to 8 weeks. Reduced plasma IGF-1 concentrations were maintained throughout the study period. Unlike marketed octreotide depot products, MTD201 can be simply and rapidly reconstituted in WFI to give a stable suspension injectable via 21G needle in a 1.5mL volume. MTD201 can be developed as an easy to inject SC or IM depot for acromegaly and NETs, with an expected dose interval of 8 weeks, and confirmed patient-centric advantages.
SUN-LB62 Differential Regulation of 22 kDa and 20 kDa Growth Hormone Isoforms in Response to Acute Glucose Load and Moderate Intensity Exercise
Authors: Haenelt Michael , Schilbach Katharina , Gar Christina , Longo Schweizer Junia Ribeiro de Oliveira , Nicolay Shiva Sophia , Andreas Lechner , Bidlingmaier Martin 
Published: May 2020

Abstract
Background: Among growth hormone (GH) isoforms, the 22kDa (22kD) is the most abundant (~90%), followed by 20 kDa GH ((20kD) ~10%). 22kD has known diabetogenic potential by increasing insulin resistance. Although of equal somatotropic activity, 20kD has been suggested to be less diabetogenic. Under physiological conditions, both isoforms are largely secreted in parallel, but data on regulation of both isoforms in the context of glucose load and utilization are scarce.
Methods: We measured 20- and 22kD GH in fasted healthy adult females during two scenarios: (A) Premenopausal females (n = 25; age (mean (range)) 27.8 (22-52), body mass index (BMI) (kg/m2) 21.8 (18.2-27.3), insulin sensitivity index (ISI) 7.9 (3.2-19.7) underwent an oral glucose tolerance test (OGTT, 75g, sampling at baseline, 30, 60, 90, 120 and 180 minutes (min); (B) Premenopausal females within 1 year postpartum (n=28, age 36 (29-44), BMI 23.7 (19.4-41.3), ISI (7.2- (2.4-13.2)) performed moderate intensity exercise (fixed workload 60% VO2max, sampling at -15, -10, -5, 0, 3, 6, 10, 15, 20, 30 and 45 min and after 5, 10 and 15 min of resting). 20- and 22kD were measured by specific immunoassays (22kD: IDS-iSYS GH CLIA, limit of quantification (LoQ) 0.05 ng/mL; 20kD: in-house immunofluorometric assay (IFMA), LoQ 0.025 ng/mL), and the 20/22kD ratio was calculated.
Results: As expected, both, 22kD and 20kD concentrations decreased after glucose load. However, the 20/22kD ratio increased significantly (Friedman test, P = 0.04, Kendall’s W 0.69, Conover’s post test: 0 vs. 60, 90 and 120 min; P = 0.018, 0.032 and 0.018, respectively. After 120 min, 20/22kD returned to baseline.
With exercise, both, 20- and 22kD increased. In contrast to glucose load, the 20/22kD ratio significantly decreased (Friedman test, P = 0.025, Kendall’s W 0.59, Conover’s post test: -10 vs. 10 and 20 min; P = 0.015 and 0.022, respectively), reaching a nadir at 10 min and returning to the baseline after cessation of exercise (20 vs. 50, 55 and 60 min; P = 0.02, 0.005 and 0.016, respectively.
Conclusion: Glucose load and exercise lead to opposite changes in the 20/22kD ratio, suggesting a tight regulation by glucose demands. We speculate that the putative less diabetogenic isoform (20kD) is preferentially secreted during situations of glucose excess, while the opposite happens during exercise, when increased energy demands are associated with predominant upregulation of the more diabetogenic 22kD GH.
SUN-933 Lactic Acidosis as a Rare and Unusual Presentation of Pheochromocytoma
Authors: Mohammad Nazar , Frith Margaret , Wilhelm Olayinka Olawale 
Published: May 2020

Abstract
Background: Pheochromocytoma is a rare catecholamine-producing tumor of chromaffin cells in the adrenal medulla or of a paraganglion. Typically it presents with sustained or paroxysmal hypertension, severe headaches, palpitations and sweating due to hormone excess. However, the presentation can be variable and can mimic many other diseases. If left undiagnosed or untreated, it can lead to life-threatening consequences.
Case Presentation:A 35 year old female with significant past medical history of migraine headaches, poorly controlled hypertension and a recent new onset seizure, presented with progressive worsening shortness of breath and persistent abdominal pain following a gastrointestinal illness. She also reported diaphoresis, cold fingers and toes, abnormal weight gain, and orthostatic symptoms that gradually worsened for two months prior to presentation. Laboratory evaluation revealed lactic acidosis, leukocytosis, and hypokalemia. Subsequently, a CT scan of the abdomen was performed that revealed an adrenal mass with significant elevation in urine metanephrines. As a result, the patient was diagnosed with pheochromocytoma and successfully treated with laparoscopic left adrenalectomy.
Conclusion: Pheochromocytoma is a rare but can be life threatening if left undiagnosed. It is of utmost importance for clinicians to keep in mind such unusual presentation of a potentially life threatening tumor. To the best of our knowledge, this is an unusual presentation of Pheochromocytoma with severe lactic acidosis.
SAT-LB90 Angiotensin II and ACTH Receptor Expression in Aldosterone-Producing Adenomas
Authors: Lim Jung Soo , Plaska Samuel , Rege Juilee , Turcu Adina F , Rainey William E 
Published: May 2020

Abstract
Background: The mechanisms leading to elevated aldosterone synthesis in aldosterone-producing adenomas (APAs) remain an area of active research. Aldosterone-driver somatic gene mutations that allow inappropriate intracellular calcium entrance have been identified in most APAs. Cell-based studies of such mutations indicate that responses to physiologic stimuli, such as angiotensin II or ACTH, are increased. Little is known, however, regarding possible variations in response to hormonal stimuli between APAs with different aldosterone-driver mutations. Herein, we analyzed the transcript expression of the ACTH receptor (MC2R), the melanocortin 2 receptor accessory protein (MRAP) and the type 1 angiotensin II receptor (AGTR1) in APAs with known aldosterone-driver somatic mutations. Methods: RNA was isolated from normal adrenal glands (n=8), and from APAs with mutations in: KCNJ5 (n=14), ATP1A1 (n=14), CACNA1D (n=14), and ATP2B3 (n=5). The gene expressions of MC2R, MRAP, AGTR1 and aldosterone synthase (CYP11B2) were quantified using qPCR and normalized to β-actin. Results: All APA mutation groups had significantly higher transcript levels of CYP11B2, MC2R and AGTR1 as compared to whole normal adrenals. While MRAP and AGTR1 transcripts were comparable between tumor mutation groups, MC2R expression was significantly lower in KCNJ5-mutated APAs compared to other APAs. Overall, CYP11B2 expression demonstrated positive correlations with MC2R (R=0.728, p&lt;0.0001) and AGTR1 (R=0.397, p=0.006) in APAs. These correlations were strongest in APAs harboring ATP1A1 mutations, and weakest in KCNJ5-mutated APAs. Conversely, CYP11B2 did not correlate with MC2R and AGTR1 in the normal adrenals. Conclusions: ACTH and angiotensin II receptors are expressed in all APAs, regardless of the underlying aldosterone-driver somatic mutations. Further research to clarify the effects of ACTH and posture on aldosterone production from APAs could provide additional insight into developing diagnostic and subtyping tools for primary aldosteronism.