bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-351 Early Diagnosis and Management of Bilateral Transient Osteoporosis of the Hip in Pregnancy
Authors: Kha Christine K , Simon Nicole 
Published: May 2020

Abstract
Introduction: Transient osteoporosis of the hip (TOH) in pregnancy is a rare and under-reported condition. It is clinically characterized by a sudden onset of hip pain in young females without any history of systemic disorders or traumatic injuries (1). Bilateral involvement of the hips, such as in this case report, is less common than unilateral involvement.
Clinical Case: A 33 year old G2P1 female presented to the hospital at 30 weeks gestation for described sharp, bilateral inguinal pain, greater on the left than right, worse with movement, and with progressive difficulty ambulating, of three weeks duration. She had no significant PMH, notably denying thyroid or calcium disorder, nephrolithiasis, osteoporosis, or steroid treatment. She denied tobacco, alcohol, or illicit substance usage. She only took prenatal vitamins. On physical examination, she had reduced active and passive range of motion of both hips, but normal muscle strength and no signs of infection or neurological deficits. Labs including CMP, LFTs, and TFTs were within normal range. 24 hour urine free cortisol was 54 mcg/24h (normal 3.5-45mcg/24h); repeat post-partum was 21 mcg/24h. 25OH-D was 18.3 ng/mL. MRI without contrast demonstrated “extensive abnormal marrow edema within the left femoral head and neck and small effusion, suspicious for transient osteoporosis of the hip. A subtle small focus of edema on the right was also noted. No discrete fracture line or subchondral collapse was noted.”
The patient was managed conservatively with analgesics, thromboprophylaxis, and education regarding reduction of weight bearing activities, rest, and mobility aids with crutches. She was started on vitamin D. Her bilateral hip pain resolved by the 38th week. She had an uncomplicated cesarean delivery at 39 weeks to a healthy male neonate. At the one-month postpartum visit, she was ambulating independently without difficulty. She denied further pain, and passive and active ROM were intact without tenderness.
Conclusion: TOH in pregnancy is usually a self-limiting disorder with no obvious etiology (2). It can present unexpectedly in the third trimester or early postpartum period in a healthy female with an otherwise uneventful pregnancy. In rare instances where fractures of the affected hip occur, surgical intervention may be necessary. MRI has become the diagnostic tool of choice for early diagnosis of TOH. Early diagnosis and optimal management are essential to prevent major complications such as traumatic fractures and deep vein thrombosis, as well as to prevent stress for the mother during the course of pregnancy.
References:
1. Xyda, A. et al., (2008) Postpartum bilateral transient osteoporosis of the hip: MRI findings in three cases. La Radiologia Medica, 113(5),689–694.
2. Asadipooya, K., et al., (2017). Transient osteoporosis of the hip: Review of the literature. Osteoporosis International, 28(6),1805–1816.
SAT-726 Estrogen Receptor Alpha as a Potential Target for Bisphenol A-Mediated Epigenetic Reprogramming: An in Vitro Analysis
Authors: Gallo Morgan , Treviño Lindsey S , Katz Tiffany A 
Published: May 2020

Abstract
Perinatal exposure to bisphenol A (BPA) has been shown to reprogram the hepatic epigenome of rodents and may promote the development of various metabolic diseases later in life, such as nonalcoholic fatty liver disease (NAFLD). This developmental reprogramming is characterized by the creation of “super promoters” at target genes implicated in metabolic pathways. While it is unclear how these “super promoters” are created, their creation is potentially mediated through BPA and estrogen receptor (ER) interaction. In order to test this potential mechanism, in vitro methods were used to examine ER target gene expression via RT-qPCR in 2 human hepatic cell lines transiently transfected with the ER isoform, ER alpha, prior to BPA exposure for various lengths of time. Within individual time points, there were no significant differences in target gene expression levels between cells that had been transfected with ER alpha and the vector control. Gene expression levels in the target genes were visibly increased at the 24-hour exposure mark in both transfection groups in comparison to the 0- and 6-hour time points, however only a fraction of these increases were found to be statistically significant. These gene expression patterns are not only consistent with previous studies examining target gene expression in BPA-treated hepatic cell lines, but more importantly, suggest BPA does not act via ER alpha to orchestrate the epigenetic changes seen in vitro. BPA may interact with a different ER isoform or an unknown target to create the observed “super promoters” at target genes, reinforcing the promiscuity of BPA and other xenoestrogens in facilitating epigenetic modifications, and ultimately, disease phenotypes.
SAT-238 Congenital Nephrogenic Diabetes Insipidus with First Presentation as an Adult: A Case Report
Authors: Liu Yuan-yuan , Sargious Peter , Kline Gregory A , Leung Alexander A 
Published: May 2020

Abstract
Congenital Nephrogenic Diabetes Insipidus with First Presentation as an Adult: A Case Report
Background:
Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited condition, usually presenting during the first year of life. It is characterized by a renal insensitivity to arginine vasopressin. About 90% of patients are males with X-linked NDI who have mutations in the vasopressin V2 receptor (AVPR2) gene encoding the vasopressin V2 receptor. Females are typically asymptomatic. Here, we report female case of NDI initially presenting and diagnosed in an adult woman.
Clinical Case:
A previously well 47-year-old woman of Italian descent underwent an elective laparoscopic repair of an abdominal hernia. Her medical history included obesity and migraine headaches. She was not taking any medications prior to admission. She had a bowel perforation 6 days after surgery, necessitating an emergency right hemicolectomy and small bowel resection. Upon instituting bowel rest with nil per os (NPO), she developed severe hypernatremia (Na+ 163 mmol/L) with polyuria (&gt;6 L/day) and dilute urine (osmolality 174 mmol/kg). Further inquiry revealed that the patient routinely drank at least 10 L/day of fluids throughout her entire adult life. Her family history was remarkable for polydipsia affecting at least additional six people across three generations (including her son, her mother, 3 maternal uncles and 1 nephew). Following administration of desmopressin 1 ug subcutaneously, her urine remained inappropriately dilute (osmolality 160 mmol/kg) with no significant change in urine output (rate 350 mL/h for 3 hours). Her arginine vasopressin level was detectable (3.2 pmol/L, reference range 0.8–3.5 pmol/L), consistent with nephrogenic diabetes insipidus. Subsequent molecular analysis of the AVPR2 gene, located on chromosome Xq28, confirmed a pathogenic mutation (c.253G&gt;A), consistent with a p.Asp85Asn substitution resulting in decreased binding affinity between the V2 receptor and arginine vasopressin. Thus, X-linked NDI was diagnosed according to the patient’s presentation, compatible family history, and genetic analysis. When she was able to eat and drink ad lib again, a low-salt, low-protein diet along with a trial of a thiazide diuretic were recommended. The patient remained well with 3 years of follow-up.
Conclusion:
The diagnosis of congenital NDI may be delayed until adulthood because of a relatively mild phenotype and compensatory drinking behavior, so that the disorder will not be clinically apparent until a person is deprived of free water. Men and women alike can be affected by this X-linked dominant condition which should be considered in any polyuric, hypernatremic hospitalized patient.
SUN-389 Trends in Osteoporosis Treatment Uptake and Persistence Among Postmenopausal Women in the U.S., 2010–2015
Authors: Kim Min , Park Andrew , McGrath Leah , Wiener Catie , Balasubramanian Akhila , McDermott Michele , Deignan Cynthia , Brookhart Alan 
Published: May 2020

Abstract
Background: Over the last several years, the approval of new pharmacotherapies, changes to health plan formularies limiting treatment access, the emergence of new evidence related to medication safety and effectiveness, and updates to clinical practice guidelines may have influenced osteoporosis treatment patterns. Sankey visualizations were used to depict postmenopausal (PM) women’s osteoporosis treatment journeys, from treatment uptake, patterns of transition, to persistence. Methods: We conducted a retrospective analysis of all PM women (aged 55+) who newly initiated five antiresorptive treatments between October 1, 2010 and September 30, 2015 using patient and prescription data from the Truven Health Analytics MarketScan Commercial Claims and Encounters and Medicare Supplemental databases. We identified women who were continuously enrolled in the health plan for one year prior to the date of treatment initiation (index date) and were treatment-free during this period. Treatment states were evaluated cross-sectionally at six-month time points; treatment switches and gaps in therapy between time points were not captured. Persistence was defined as a patient being on the same treatment at a given follow-up time point as compared to the treatment they were on at the index date. Results: Among women newly initiating any of the five antiresorptive therapies, alendronate (53%) remained the most commonly prescribed therapy, followed by ibandronate (13 %), zoledronic acid-ZA (12%), risedronate (11 %), and denosumab (11%). New initiation of alendronate was high across all age, prior fracture history, and osteoporosis diagnosis subgroups (range: 45–68%). From 2010 to 2015, new uptake of denosumab increased by 13%, while ZA uptake declined by 10%. A higher proportion of denosumab users were ≥ 65 years (denosumab: 59%; ZA: 54%; alendronate: 46%) and had a prior history of fracture (denosumab: 30%, ZA: 25%; alendronate: 19%) compared to bisphosphonate users. Two-year persistence was highest among women initiating denosumab (58%), followed by ZA (48%), alendronate (32%), ibandronate (30%), and risedronate (25%). Persistence was lowest for oral bisphosphonate users (alendronate range: 30–33%), irregular among ZA users (range: 29–49%) and higher for denosumab users across all subgroups (range: 46–59%). From 2010 to 2014, persistence improved for all therapies, except among ZA users, which declined by 9%. Conclusions: Little has changed in the prescribing patterns and patient profiles of PM women newly initiating antiresorptive therapies over five years from 2010–2015. Alendronate remained the most commonly prescribed therapy despite lower rates of persistence, with similarly high uptake regardless of risk for fracture. Denosumab was primarily prescribed to women at higher risk for fracture, and persistence was higher compared to other therapies across all subgroups.
SAT-612 Features of the Severity of Cardiovascular Remodeling and Metabolic Disorders in Hypertensive Patients with Obesity in the Presence of Two Unfavorable Genotypes of the ADIPOQ and IRS-1 Genes
Authors: Shalimova Anna , Psarova Valentyna , Kyrychenko Nataliia , Kochuieva Maryna 
Published: May 2020

Abstract
The results of a number of studies have shown that in arterial hypertension (AH), G/T and T/T genotypes of the adiponectin gene (ADIPOQ) and Gly/Arg and Arg/Arg genotypes of the insulin receptor substrate 1 gene (IRS-1) are associated with a greater severity of metabolic disorders and hemodynamic parameters compared with G/G and Gly/Gly genotypes of these genes.
The aim of the study: to evaluate the severity of cardiovascular remodeling and metabolic disorders in hypertensive obese patients in the simultaneous presence of two unfavorable genotypes of the ADIPOQ and IRS-1 genes.
Methods: We examined 300 AH patients: 200 patients with AH and obesity, 50 patients with AH and normal body weight, 50 patients with AH and overweight, 40 patients with AH, obesity and type 2 diabetes mellitus (DM2), 30 healthy individuals. The polymorphisms of the ADIPOQ and IRS-1 was assessed by molecular genetic method.
Results: It was found that in all groups of hypertensive patients, regardless of body weight and the presence of DM2, the simultaneous presence of two unfavorable genotypes of the ADIPOQ and IRS-1 genes occurred significantly more often than in healthy individuals: in 41% of AH patients with obesity, 30% of AH patients with normal weight, 40% of AH with overweight, 57.5% of AH with obesity and DM2 vs. 13.3% of healthy individuals. In hypertensive patients, in the presence of overweight and obesity, the frequency of combination of the two unfavorable genotypes of these genes was significantly higher than in AH patients with normal body weight.
Conducting comparative evaluation of AH patients with obesity depending on the presence of two unfavorable genotypes or two protective genotypes of the ADIPOQ and IRS-1 genes showed that carriers of the combination of the G/T + T/T genotype of the ADIPOQ and the Gly/Arg + Arg/Arg genotype of the IRS-1 had a higher body mass index, more pronounced insulin resistance, cardiovascular remodeling, adipokine imbalance, impaired carbohydrate and lipid metabolism.
Conclusions: In AH patients, the frequency of the simultaneous presence of two unfavorable polymorphisms of ADIPOQ and IRS-1 genes was higher than in healthy individuals. In AH patients with overweight and obesity, the frequency of combination of the two unfavorable genotypes of the ADIPOQ and IRS-1 genes was significantly higher than in normal body weight. The presence of a combination of two unfavorable genotypes of the ADIPOQ and IRS-1 genes in patients with AH and obesity was associated with a greater severity of cardiovascular remodeling and metabolic disorders compared with the combination of two protective genotypes of these genes.
SAT-372 A Case of Hypercalcemia Secondary to Rhabdomyolysis Induced by Heroin Use
Authors: Zuniga Gabriela , Garay Paola Andrea Sanchez , Rios Paola , Lichtenberg Robert 
Published: May 2020

Abstract
Background: Rhabdomyolysis is a potential life threatening condition defined as injury of the skeletal muscle, which results in the release of intracellular contents into the circulation. This muscle injury is often associated with the development of myoglobinuria, electrolyte abnormalities, and often ARF; it can be caused by diverse mechanisms including drugs and toxins. We present a case of rhabdomyolysis complicated by hypercalcemia and ARF in a patient with a history of polysubstance abuse after using intravenous heroin.
Case: A 28 y/o male with h/o polysubstance comes to the ED with c/o fatigue, nausea, vomiting and decreased urine output for about 5 days; patient acknowledged using heroin and afterwards he developed weakness and tenderness in upper and lower extremities. Additionally he admitted cocaine and marijuana abuse. On physical exam vital signs were unremarkable and he had some mild tenderness to palpation mostly of the quadriceps bilaterally. Laboratory data was significant for acute kidney injury (cr 11.33 mg/dl, n: 0.7–1.5 mg/dl) and CPK 171920 u/l (n: 22–269 u/l). He received 2 L of NS in the ED and was started on NS at 100cc/hour.
He underwent hemodialysis on day 2; initially he was treated for hypocalcemia with calcium and vitamin D supplementation until day 11 were hypercalcemia (calcium 12.7 mg/dl, n: 8.7–10.3 mg/dl; ionized calcium 1.7 mmol/l, n: 1.12–1.32) was noted; this was associated with concomitant suppression of PTH (5 pg/ml, n: 10–65 pg/ml). He remained asymptomatic from calcium abnormalities during his hospitalization, his urine output recovered progressively, hemodialysis was discontinued on day 13. Upon discharge was recommended to f/u with nephrology.
Discussion: Various neurological and neuromuscular complications of heroin abuse have been described; one of these is rhabdomyolysis; its pathophysiology in heroin abuse is thought to be multifactorial; including acidosis, hypoxia, muscle compression and adulterants found in heroin. Narcotics may also have direct cell toxicity and alter membrane transport. Usually upon initial presentation hypocalcemia is one of the most common electrolyte imbalances seen with rhabdomyolysis. The proposed mechanism is precipitation of serum calcium salts in necrotic muscle. This may be followed by hypercalcemia during the diuretic phase of ARF which appears to be a relatively unusual complication associated with the presence of severe muscle damage due to metastatic calcium salts that are liberated from the necrotic muscle and the return to the serum.
Conclusion: This case report highlights the importance of recognizing potential electrolyte imbalances in patients with rhabdomyolysis; it appears, that concomitant rhabdomyolysis and ARF are needed for a patient to develop hypercalcemia.
Serum calcium should always be routinely measured and the appropriate treatment should be implemented to improve outcomes.
MON-032 Excessive Ovarian Sympathetic Activity Impairs Embryonic Development and Causes Reproductive and Metabolic Dysfunction
Authors: Manti Maria , Pui Han-Pin , Edström Sonja , Risal Sanjiv , Lu Haojiang , Lindgren Eva , Jerlhag Elisabeth , Benrick Anna , Deng Qiaolin , Stener-Victorin Elisabet 
Published: May 2020

Abstract
Nerve growth factor is a member of the neurotrophin family and within the ovary, it plays an important role in sympathetic innervation and in the development and maintenance of folliculogenesis. Despite its critical role, excessive levels of ovarian NGF may lead to ovarian pathology and to the development of features of polycystic ovary syndrome (PCOS), which is the most common endocrine disorder among women of reproductive age. Here, using a transgenic mouse model overexpressing NGF selectively in the ovary (17NF mice), we studied how ovarian sympathetic hyperactivity affects embryonic development and reproductive and metabolic function in adulthood. Firstly, we showed that ovarian NGF excess caused growth restriction in the developing female fetuses, which was driven by defects in the placenta function. Moreover, the 17NF fetuses experienced a reduction of germ cell number along with delayed gonocyte and primary oocyte maturation. The adult 17NF mice displayed irregular cyclicity and aberrant ovarian expression of steroidogenic genes and epigenetic markers. The ovarian sympathetic hyperactivity also led to increased systemic sympathetic outflow, indicated by increased circulating dopamine levels, and to metabolic dysfunction in adulthood. The 17NF mice had increased adiposity, impaired glucose metabolism and decreased energy expenditure. The subcutaneous and parametrial fat depots displayed impaired function due to ovarian NGF excess, wherein the subcutaneous fat increased mass by enhanced preadipocyte differentiation and enlarged adipocyte size, while the parametrial fat had smaller adipocyte size and a modest increase in stimulated lipolysis. These defects also led to hepatic steatosis. Overall, our findings indicate that ovarian sympathetic hyperactivity has deleterious effects on whole-body homeostasis and leads to impaired embryonic development and to reproductive and metabolic defects in adult life.
MON-211 Prevalence, Characteristics and Outcomes of Primary Aldosteronism in Newly Diagnosed Hypertensives in China (Pa China)
Authors: Xu Zhixin , Yang Jun , Hu Jinbo , Song Ying , Luo Ting , He Wenwen , Cheng Qingfeng , Ma Linqiang , Luo Rong , Fuller Peter J , Cai Jun , Yang Shumin , Li Qifu 
Published: May 2020

Abstract
Abstract
Background 44.7% adults in China have hypertension but the prevalence of primary aldosteronism (PA) in Chinese hypertensives is unknown. Objective We prospectively investigated the prevalence of PA in newly diagnosed hypertensives and tested the hypothesis that these PA patients have less severe cardiovascular complications and better outcomes when compared to those diagnosed after established (or prolonged) hypertension. Method In a community health center, consecutive hypertensive patients with an aldosterone-renin ratio≥2 (ng∙dL−1/mIU∙L−1) and plasma aldosterone concentration &gt;10ng/dL underwent captopril challenge test and/or saline infusion test for confirmation. Adrenal CT scan and adrenal vein sampling were used for subtyping. PA patients were followed up for one year and clinical outcomes were compared with PA patients from an established hypertensive cohort. Results 1020 newly diagnosed hypertensive patients were screened over 16 months. Forty were diagnosed with PA, 948 with non-PA, resulting in a prevalence of 4.0%. Thirty-two patients were diagnosed as “possible PA” due to positive screening but failure to complete the confirmatory test. Compared to non-PA, PA patients more frequently displayed microalbuminuria (P=0.031), but the incidence of cardiovascular events was not different (P=0.927). For patients treated with surgery, complete clinical success rate was 85.7%, 28% higher than that of PA patients diagnosed after prolonged hypertension. For patients treated with medication, blood pressure control rate was 79.3%, 30% higher than that of PA patients diagnosed after prolonged hypertension. Conclusions The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4.0%. PA screening in newly diagnosed hypertensive patients can lead to better clinical outcomes.