bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-163 Status at 10 Years: Long-Term Follow-Up for a Phase 2a Study of High-Specific-Activity (HSA) I 131 Iobenguane in Patients (Pts) with Relapsed/Refractory High-Risk Neuroblastoma
Authors: Villablanca Judith G , Maris John M , Stambler Nancy , Zhou Duo , DiPippo Vincent A , Matthay Katherine K 
Published: May 2020

Abstract
Background: Metaiodobenzylguanidine (MIBG; iobenguane), a guanethidine derivative, is a substrate for norepinephrine reuptake transporter which is highly expressed on the surface of neuroblastoma cells. AZEDRA® (HSA I-131 MIBG) has been approved by the FDA for the treatment of pheochromocytoma and paraganglioma, in pts 12 years and older with MIBG avid, unresectable, locally advanced or metastatic PPGL who require systemic anticancer therapy. The aim of this study was to establish the maximum tolerated dose in children with neuroblastoma, with secondary aims of assessing overall response and tumor and organ dosimetry. Here we report current long-term survival and toxicity data. Methods: Eligible pts were 1-30 years old with resistant neuroblastoma. A diagnostic dose of HSA I-131 MIBG was followed by 3 dosimetry scans to assess radiation dose to critical organs and soft-tissue tumors. To prevent prolonged myelosuppression, autologous hematopoietic stem cells were infused 14 days after therapy. Response and toxicity were evaluated on day 60. Dose-limiting toxicity (DLT) was failure to reconstitute neutrophils to greater than 500/µL within 28 days, or platelets to greater than 20,000/µL within 56 days, or grade 3 or 4 nonhematologic toxicity by Common Terminology Criteria for Adverse Events (version 3.0) except for predefined exclusions. Results: First pt was enrolled in June 2008. 15 pts total were evaluable at 12 (n=5), 15 (n=3), and 18 (n=7) mCi/kg. Mean whole-body radiation was 0.23 mGy/MBq, and mean organ doses were 0.92, 0.82, and 1.2 mGy/MBq of MIBG for the liver, lung, and kidney, respectively. Eight pts had 13 soft-tissue lesions with tumor-absorbed doses of 26-378 Gy. MYC-N amplification was present in two of 11 pts with available results. Of the 15 treated pts, 1 had a complete response, 3 had a partial response, 1 had a mixed response and 6 had stable disease. The remaining 4 had progressive disease. Twelve of the 15 evaluable pts received non-protocol therapy after HSA I-131 MIBG, the remaining 3 died due to tumor without further therapy. At 3.6 years of follow-up the overall survival was 26.7% (95% CI, 8.3%-49.6%). As of March 2018, one remaining pt is in long term follow up with an overall survival of 8.4 years. This pt was previously reported to have a secondary malignancy of myelodysplastic syndrome which has been in remission since receiving an allogenic bone marrow transplant in March 2014. Conclusions: HSA I-131 MIBG contributed to long term median survival of two years and was well tolerated. Treatment showed promising activity in the absence of significant nonhematologic toxicity.
SAT-679 Autoimmune Hypoglycemia: A Treatment Challenge
Authors: Santana Nadyeschka Angelique Rivera , Lopez Zahira Marie Lugo , Diez Andrea del Toro , Sanchez Ernesto Jose Sola , Garcia Michelle Marie Mangual , Ortiz Ivan Laboy 
Published: May 2020

Abstract
Background: Upon evaluation of patients with recurrent hypoglycemia, both exogenous and endogenous causes should be excluded. Among endogenous hyperinsulinemic hypoglycemia (EHH) pathologies, Insulin Autoimmune Syndrome (IAS), even though extremely rare, must be considered. Most cases of IAS have been reported in the Oriental population, mostly Japanese. No gold standard of care for this condition has been established. Clinical Case: This is the case of an 82 year-old obese female patient with dyslipidemia, obstructive sleep apnea, and osteoarthritis that comes to the Endocrinology clinics for evaluation due to recurrent episodes of hypoglycemia. She refers that for the last three years she had been presenting with multiple episodes of symptomatic hypoglycemia, even levels as low as 30 mg/dL, requiring multiple hospitalizations. Consequently, she refers a 15-pound weight gain because of multiple daily snacks. Home medications were simvastatin and diclofenac. She denies using insulin, sulfonylureas, other hypoglycemic agents, alcohol, or illicit substances. Abdominal MRI and PET CT scan were remarkable only for an atrophic pancreas without focal masses. Patient was hospitalized for a supervised 72-hour fast, resulting in severe hypoglycemia within 14 hours with elevated insulin levels at 46.3 uIU/mL (1.7-31.0 uIU/mL), elevated C-peptide levels at 5.79 ng/mL (0.9-4.3 ng/mL) and elevated insulin antibodies 53µU/mL (&lt;5µU/mL). Patient showed sufficient hepatic reserve after glucagon administration as well as intact cortisol and growth hormone axis upon severe hypoglycemia. With these results, a diagnosis of IAS was made; not associated with other autoimmune diseases, or with medications with sulfhydryl groups, such as the cases already reported on literature. This condition represents a therapeutic challenge because there is no gold standard of care. Literature recognizes diverse treatment options that range from diet modification to more aggressive therapies, including plasmapheresis and immunosupressants. Our patient was managed with diet modification including frequent snacks and Diazoxide with the goal of decreasing insulin levels and inducing hyperglycemia. Diazoxide therapy achieved a steady euglycemic state and decreased insulin antibodies. Patient developed intolerable bilateral lower extremity edema and treatment was modified to complex carbohydrates, frequent snacks in the daytime and Diazoxide only at bedtime, which is the longer fasting period. Patient has remained without episodes of hypoglycemia and diabetes has not been diagnosed since starting treatment two years ago. Conclusion: Early recognition of IAS is essential in order to avoid unnecessary studies and procedures which could delay management. Although no gold standard therapy has been identified for this condition, our case report identifies Diazoxide as a compelling medical treatment.
SAT-342 Humerus Fracture & Dislocation of Right Shoulder Following a Seizure in Non-Epileptic Patient Due to Hypoparathyroidism
Authors: Doub Najah Younes , Hashem Waleed Abdulgafour , alhamdan ali 
Published: May 2020

Abstract
Introduction: Hypoparathyroidism is a rare disease. The most common etiology of hypoparathyroidism is the surgical resection of the parathyroids.
Primary hypoparathyroidism can cause a wide spectrum of manifestations, mainly due to low serum calcium effect on internal organs, and directly correlates with the rate of development of hypocalcemia.Parathyroid Hormone (PTH) is one of the key regulators of the rate of bone remodeling. A reduction or absence of circulating PTH leads initially to a decrease in bone resorption then to a coupled reduction in bone formation.
Case Presentation A 36-year-old male nurse in primary health care, not known to have any medical illness, presented to the emergency department with generalized tonic-clonic seizures associated with right shoulder dislocation and communicated fracture of the humerus. However, the day before his presentation, he has had two episodes of convulsion, but he did not seek medical attention.He had developmental delay in walking and teeth eruption as well as frequent generalized tonic-clonic which were treated by traditional healer. This information could point out to the possibility of congenital origin.Upon arrival to the emergency department, he has teeth decay all over his oral cavity with right shoulder dislocation and right humerus fracture. Chvostek sign and trousseau sign were positive.The patient was treated initially with calcium gluconate intravenously followed by oral treatment of calcium carbonate 1.2 g three times daily and alfacalcidiol 1 mcg twice daily and upon discharge teriparatide 20 mcg subcutaneously daily was given.
Conclusion
Treatment of hypoparathyroidism with recombinant parathyroid hormone may reduce bone mineral density (BMD) but concomitantly strengthen bone.
This is a treatable disorder that may have catastrophic results if overlooked but also its symptoms may be completely reversed with prompt treatment.
It is of utmost importance routine vitamin D, phosphorous, and calcium monitoring, as well as renal calcium excretion evaluation to prevent complications of overtreatment with CA and active Vit D.
References
• Bilezikian JP, Khan A, Potts JT Jr, Brandi ML, Clarke BL, Shoback D, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target- organ involvement, treatment, and challenges for future research. J Bone Miner Res. 2011;26(10):2317-37.
SAT-410 Long Term Evaluation of TSH Receptor Antibodies and Thyroid Stimulating Immunoglobulin After Radioiodine Therapy for Thyrotoxicosis
Authors: Marui Suemi , Irigoitia Bruna , Lenczuk Aline , Rocha Nelisa Helena , Brito Luciana Pinto , Watanabe Tomoco 
Published: May 2020

Abstract
Background Radioioactive iodine therapy (RAI) is an excellent choice to treat thyrotoxicosis, particularly Graves′ disease (GD) patients. After RAI therapy, it is well known that TSH receptor antibodies (TRAb) rise in GD patients and autoimmunity can eventually surge in patients with toxic multinodular or uninodular goiter (TNG). Recently, biological assay distinguishes stimulating TRAb, called thyroid stimulating immunoglobulin (TSI) bringing a new perspective on follow-up, as TSI is involved in Graves′ pathogenesis of persistent thyrotoxicosis and ophthalmopathy after RAI therapy. Objective Analyze TRAb and TSI levels after 6 and 12 months of RAI therapy for thyrotoxicosis. Patients and Methods Patients were evaluated prospectively immediately before and 6 to 12 months after RAI therapy for thyrotoxicosis. Thyroid hormones were all measured using immunoassays (Roche Diagnostics Ltd). TRAb was analyzed by Elecsys Anti-TSHR assay (Roche Diagnostics, Germany) and was considered negative if &lt; 1.75 IU/L (analytical range: 0.3 to 40 IU/L). TSI was measured by Immulite TSI assay (Siemens Healthcare, UK) and was considered negative if &lt; 0.55 IU/L (analytical range: 0.1 to 40 IU/L). Clinical data and comparison of assays were analyzed by SPSS and MedCalc softwares. Results From 2017 to 2019, 54 patients (44 females) were prospectively evaluated after 6 months of RAI therapy, mostly because of GD (40 patients). A high degree correlation was observed between TRAb and TSI (Spearman correlation coefficient =0.875; p &lt; 0.0001, 95% CI 0.784 to 0.929). After 6 months, among patients with GD, 5/40 patients had negative TRAb levels and 2/40 had negative TSI levels, whereas all TNG patients had both negative TRAb and TSI levels. In GD group, 4 patients showed subclinical hyperthyroidism and relapse occurred in 1 case. All patients with TNG showed euthyroidism status with or without thyroid medications. One year after RAI therapy, we evaluated 32 patients (23 GD) and 4/23 of GD had negative TRAb levels and only 1/23 had negative TSI level. All patients with TNG had negative TRAb and TSI levels after one year fo treatment. Subclinical hyperthyroidism was diagnosed in 5 patients with GD but none with TNG. Along follow-up, 4 patients with clinical diagnosis of GD with TRAb negative before RAI therapy became positive after RAI therapy and 3 patients became TSI positive. Conclusions Long term after RAI therapy for thyrotoxicosis treatment, TRAb and TSI are still positive in most GD patients and few cases can even turned to positive levels. Nevertheless, in TNG patients, RAI therapy is safe as TRAb and TSI maintained at negative concentrations and thyrotoxicosis is properly resolved.
MON-388 Total and Free 1,25dihydroxyvitamin D Levels in Postmenopausal Patients with Primary Hyperparathyroidism
Authors: Meng Lingqiong , Shapses Sue A , Wang Xiangbing 
Published: May 2020

Abstract
Background: Vitamin D3 is metabolized to 25-hydroxyvitamin D [25(OH)D] in liver, and only after it goes to kidney is it converted to its biologically active form, 1,25-dihydroxyvitamin D [1,25(OH)2D]. Also, the majority of both total 25(OH)D and 1,25(OH)2D are tightly bound to vitamin D bind protein (DBP) and only a small portion remains in free form. In certain patient populations, like primary hyperparathyroidism (PHPT), concentrations of free vitamin D metabolites may be affected by altered levels of binding protein.
Objective: To evaluate total and free 1,25(OH)2D levels in PHPT patients and healthy controls.
Methods: Thirty female patients with PHPT and 30 healthy age and body mass index (BMI) matched controls were enrolled (57.1 ± 9.8 years and BMI of 32.2 ± 7.2 kg/m2). Serum levels of calcium, intact parathyroid hormone (iPTH), DBP, total 25(OH)D and 1,25(OH)2D levels were examined. Serum free 25(OH)D and 1,25(OH)2D levels were calculated using equations adapted from Bikle et al.
Results: There were no significant differences in age and BMI between groups. Compared to controls, patients with PHPT had lower total 25(OH)D (25.2 ± 7.5 vs. 19.3 ± 6.4 ng/mL; p &lt;0.001) and DBP levels (40.7± 3.1 vs. 36.5 ± 5.7 mg/dL; p &lt;0.001). There were no significant differences in total 1,25(OH)2D levels or calculated free 25(OH)D levels between PHPT patients and controls; but the calculated free 1,25(OH)2D levels were 27% higher in the PHPT patients compared to controls (p&lt;0.001). The calculated free (but not total) 1,25(OH)2D level was inversely correlated with DBP (r=-0.35, p&lt;0.01) and positively correlated with iPTH levels (r=0.33, p&lt;0.01).
Conclusion: Postmenopausal patients with PHPT had lower serum total 25(OH)D, but similar free 25(OH)D levels. In contrast, total 1,25(OH)2D levels did not differ between patients and controls; however, patients had higher free 1,25(OH)2D. Because total 25(OH)D and 1,25(OH)2D levels do not reflect free levels, standard clinical measures of circulating vitamin D may not be an accurate estimate of true vitamin D status in patients with PHPT.
References: Bikle et al. Serum Protein Binding of 1,25-Dihydroxyvitamin D: A Reevaluation by Direct Measurement of Free Metabolite Levels. JCEM 1985;61:969-75.
OR05-04 Steroid Receptor Co-Activators Complexes Cooperate with Progesterone Receptors (PR) to Reprogram Metabolic Pathways that Drive Therapy Resistant Populations in ER+ Breast Cancer
Authors: Truong Thu H , Benner Elizabeth , Ostrander Julie Hanson , Lange Carol A 
Published: May 2020

Abstract
Late recurrence of metastatic disease stemming from acquired therapy resistance remains a significant health burden for women with ER+ breast cancer. Disseminated ER+ tumor cell populations can remain quiescent for years to decades, and contributing factors include breast cancer stem cells (CSCs), which are non-proliferative and frequently exist as a minority population in recurrent therapy-resistant tumors. Progesterone receptors (PR) are known drivers of normal stem and breast CSCs. Our objective was to define novel signaling pathways governing cell fate transitions involved in driving therapy resistance in ER+ breast cancer. We reported that cytoplasmic complexes composed of steroid receptor (SR) co-activators, PELP1 and SRC-3, drive breast CSC outgrowth. SRC-3 knockdown abrogated PELP1-induced CSC expansion and target genes required for cell survival, suggesting an essential role for PELP1/SRC-3 complexes. PELP1 also forms a signaling and transcriptional complex with ER and PR-B. Phospho-PR species are key mediators of stemness in ER+ breast cancer models. Accordingly, PR knockdown and antiprogestins disrupted PELP1/SRC-3 complexes and blocked PELP1-induced breast CSC outgrowth. Mammary stem cell (MaSC) populations were increased in vivo in MMTV-tTA;TRE-cyto-PELP1 transgenic mice as well as in MMTV-tTA;TRE-hPR-B mice. To better understand PELP1-mediated pathways, we performed RNA-seq on MCF-7 PELP1+ models grown in tumorsphere conditions to enrich for CSC populations (ALDH+, CD44+/CD24-). Cytoplasmic PELP1-expressing cells had a different global gene profile relative to WT PELP1 (i.e. nuclear). Gene sets associated with stem cell biology, hypoxic stress, and cancer metabolism were differentially regulated, including members of the glycolytic bi-functional kinase/phosphatase PFKFB family. Seahorse metabolic phenotyping demonstrated cytoplasmic PELP1 influences metabolism by increasing both glycolysis and mitochondrial respiration. Cytoplasmic PELP1 interacted strongly with PFKFB3 and PFKFB4, and inhibition of PFKFB3 or PFKFB4 kinase activity blocked PELP1-induced tumorspheres and protein-protein interactions with SRC-3. Additionally, antiprogestin and PFKFB inhibitors were synergistic when combined with ER+ targeted therapies. These aspects of PELP1/SRC-3 biology were phenocopied in therapy resistant models (tamoxifen resistant [TamR], paclitaxel resistant [TaxR]). Together, our data suggest that PELP1, SRC-3, PR, and PFKFBs form complexes that reprogram cellular metabolism to drive breast CSC expansion. Identifying the mechanisms that regulate recurrent ER+ tumor cell populations will enable specific targeting within heterogeneous breast tumors and may lead to the development of non-ER targets that can be used in combination with endocrine treatments to overcome therapy resistance.
SAT-559 Patients with Hyperaldosteronism Have Higher Prevalence of Obstructive Sleep Apnea. From the National Inpatient Sample
Authors: Ahmed Fatima , Abugroun Ashraf , Patel Pragnesh , Elhassan Manar , Msallaty Zaher , Seyoum Berhane 
Published: May 2020

Abstract
Introduction: Previous studies suggested that aldosterone excess may worsen obstructive sleep apnea (OSA) through causing peri-pharyngeal edema. Objective: In this study we sought to examine if hyperaldosteronism is associated with OSA. Methods: The National Inpatient Sample (NIS) data was queried for adults with diagnosis of primary and secondary hyperaldosteronism during the years 2012 - 2015. Patients with hyperaldosteronism were identified using the international classification of disease (ICD-9). Each patient who was diagnosed with hyperaldosteronism was matched to randomly selected controls at a 1:4 ratio by age, gender and year of hospitalization. A multivariable logistic regression model was used to estimate the adjusted odds ratio (aOR) of OSA among patients with hyperaldosternoism. We adjusted for patient demographics, socioeconomic factors, hospital factors and clinical comorbidities. Subgroup analysis was performed based on gender, race and age groups; young adults (aged 18–35 years), middle aged (&gt; 35-&lt;55 years) and older adults (aged &gt; 55 years). Results: There were 23,465 patients diagnosed with hyperaldosteronism identified. The mean age was 59 (standard error of the mean (SEM): 0.1. Females represented 48.5%. Compared to control, patients with hyperaldosteronism had higher prevalence of hypertension, CHF, stroke, obesity, diabetes, renal failure and lower prevalence of tobacco use and COPD. The proportions of African Americans were higher among patients with hyperaldosteronism compared to the control 30.1 vs 15.5, p&lt;0.001. Patients with hyperaldosteronism had higher prevalence of OSA 16.4 vs 8.3, p&lt;0.001. On multivariate analysis, hyperaldosteronism was independently associated with higher odds for OSA with aOR 2.01 (95%CI: 1.81–2.23) p&lt;0.001. On subgroup analysis, similar findings were observed irrespective of gender, age group or race. Conclusion: Prevalence of OSA is higher among patients with hyperaldosteronism. Physicians may need to consider a case detection of hyperaldosteronism in patients with OSA and hypertension. Similarly we suggest to evaluate patients with hyperaldosteronism for OSA.
SUN-245 Sensory Neuron Metabolism Mediates Changes in Ovarian Function via LKB1
Authors: Lenert Melissa E , Burton Michael D 
Published: May 2020

Abstract
Bi-directional communication between sensory neurons to peripheral tissue to mediate physiology has become an area of interest. Previous research on peripheral neuron control of ovarian function shows that lesioning the superior ovarian nerve resulted in decreased estradiol release from the ovary; but there has been little research on how sensory neurons affect ovarian physiology. Interestingly, the metabolic activity of sensory neurons that control ovarian and follicular function may have profound effects on tissues they innervate. LKB1 (Liver Kinase B1) is a metabolic kinase that regulates cell growth and polarity. When downregulated in cortical neurons in vitro, leads to shorter axons with less branching. Female mice with LKB1 removed from their peripheral sensory neurons have litters more often and increased litter sizes compared to wild-type mice, which led to the investigation into the mechanisms into the role of LKB1 in sensory neurons in ovarian function. Nav1.8cre-LKB1fl/fl mice were used to assess the removal of LKB1 from Nav1.8-expressing neurons on the mechanisms behind reproductive viability. The estrus cycle was tracked by using vaginal lavage to collect cells from the vagina twice per day for ten days, and cytology was assessed to determine phase. Ovaries were collected from mice in all phases of the estrus cycle, sectioned at 8 micron thickness, stained with H&E. Follicle sizes and numbers were measured on 8 sections per ovary. Sensory innervation was measured by clearing whole ovary using ScaleS1 and using confocal microscopy to image through the whole tissue for sensory neurons tagged with tdTomato and DAPI. Our data indicate that Nav1.8-expressing neurons innervate the ovary from celiac ganglia, upper lumbar, and lower thoracic dorsal root ganglia. Nav1.8cre-LKB1fl/fl mice have larger litters and breed more frequently compared to cre-negative litter mates (WT). Nav1.8cre-LKB1fl/fl mice have larger ovaries, spend less time in proestrus, and have greater follicular turnover compared to WT mice. Phase-matched ovaries from Nav1.8cre-LKB1fl/fl mice in proestrus show greater numbers of antral and degenerating follicles than WT mice, but similar numbers of immature follicles; however, the size of all follicles from Nav1.8cre-LKB1fl/fl mice are smaller than follicles from WT mice. Nav1.8cre-LKB1fl/fl mice have improved reproductive viability by increased follicular turnover rate, more mature follicles, and shortened estrus cycle length.