bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-246 A Case of Cabergoline Induced Pituitary Apoplexy in a Patient with Prolactinoma
Authors: Ahuja Ashim 
Published: May 2020

Abstract
Objective
To report a case in which Cabergoline led to pituitary apoplexy (PA) in a young female patient with a macroprolactinoma.
Methods
A 28 y/o F presented with 10 months of irregular menses followed by 6 months of amenorrhea. She reported a dull supranasal headache, and nipple crusting without obvious galactorrhea. She denied visual changes, dizziness nausea or vomiting. Her Prolactin (PRL) was elevated at 194ng/mL, and she was started on Cabergoline 0.25mg twice per week and sent for a pituitary MRI.
Four weeks later, the patient presented to the emergency department with an acute worsening of headache after being found to have a pituitary hemorrhage on MRI. On PE there were no obvious neurologic deficits. Neurosurgery recommended no acute intervention and she was managed conservatively.
Results
Labs prior to Cabergoline: bHCG (-), PRL 194 ng/mL; LH 3.1 µIU/mL; FSH 4.9 µIU/mL; Estradiol &lt;11 pg/mL; Cortisol 11.44 ug/dL; TSH 1.080 µIU/mL; Free T4 0.76 ng/dL. Labs after 1 month of Cabergoline treatment: PRL 84.3 ng/mL; FSH 2.2 µIU/mL; LH 2.8 µIU/mL; TSH 1.23 µIU/mL; FT4 0.82 ng/dL; Cortisol 15.43 ug/dL. MRI 1 month after Cabergoline was performed and showed a 1.4 x 1.4 x 1.5cm hemorrhagic mass of pituitary gland.
Discussion
PA is the acute hemorrhage or infarction of the pituitary gland, commonly presenting with sudden onset of severe headache, visual field impairment, vomiting or altered mental status. However, like our patient, 25% of patients may present with subclinical apoplexy.
Bromocriptine and Cabergoline are the two main treatments for prolactinoma. Both have been linked to PA, though the number of reports on Cabergoline is much less. There are now 10 cases of apoplexy reported with Cabergoline.
PA can be spontaneous or precipitated by angiography, surgery, head trauma, hypertension, thrombocytopenia, diabetes, radiotherapy, coagulopathies, and Dopamine Agonists (DA). Most cases occur in older patients (50–60’s) with comorbidities, and incidence in patients &lt;35 is rare.
Moreover, PA is more common in males. Therefore, PA presenting in a young, healthy female suggests that Cabergoline may have been the precipitating factor.
Conclusion
It is important to be aware that Cabergoline can precipitate PA in patients being treated for a Prolactinoma. We recommend a thorough history, physical exam and baseline imaging before starting Cabergoline therapy. We also recommend emergent imaging if there is an acute change in symptoms.
SUN-717 SG-2 a Novel Multi-Target Directed Ligand (MTDL) for the Treatment of Neurodegenerative Diseases (NDDS)
Authors: Sestito Simona , Runfola Massimiliano , Bandini Lavinia , Santucci Filippo , Origlia Nicola , Rapposelli Simona , Chiellini Grazia 
Published: May 2020

Abstract
NDDs are progressive multifactorial disorders that impair memory, cognition, movements, and general functioning. This deterioration is mostly due to inflammation triggered by aberrant protein deposition, oxidative stress and modification in lipid pathways. Because of these multifactorial aspects, the development of multi-target directed ligand (MTDL) could represent a potential strategy for the treatment of NDDs.
Recently, the thyronamine-like analog SG-2, originally developed as a synthetic TAAR1 agonist, has revealed to efficiently reprogram lipid metabolism and to produce memory-enhancement in mice1. Long-term potentiation (LTP) is one of the basic mechanisms of memory. LTP is inhibited by beta-Amyloid oligomers (Aβ), and in the early stage of AD it is selectively impaired in the entorhinal cortex (EC).
In the present study, to further expand our knowledge on the potential of this novel analog to act as a neuroprotective agent, we investigated if administration of SG-2 has any effect on LTP in EC of a transgenic model of AD (hAPP-J20 mouse).
Extracellular in vitro recordings were performed in EC slices from 2 month-old APP-J20 mice: field potentials were evoked in layer II after stimulation of the same layer and LTP was elicited by high frequency stimulation (HFS), consisting of three trains of 100 pulses at 100Hz. SG-2 (1 or 5μM) was administered for 10 minutes, starting 5 minutes before the delivery of HFS.
LTP cannot be elicited by HFS in mhAPP slices perfused with artificial cerebrospinal fluid (ACSF) alone. When we tried to rescue LTP in mhAPP slices using SG2 at the lowest concentration (1µM), 10 min perfusion with SG2 was not effective. In contrast, a higher concentration of SG2 (5 μM), rescued LTP to a level that was significantly higher than that observed in mhAPP slices alone (n=6; p=0.046), as well as in mhAPP slices perfused with SG2 1 μM (n=5; p=0.043). Our results suggest that SG-2 plays a neuroprotective effect, rescuing Aβ-induced neuronal dysfunction and might open new perspective in the study of AD. Metabolic reprogramming and neuroprotective functions for the histone deacetylase SIRT6 are well known, and a reduction of SIRT6 expression has been observed in patients with AD. Exposure of human neuroblastoma (SH-SY5Y) cells to SG-2 (1 or 10 μM) resulted in significant (p=0.044) over-expression of SIRT6, and concomitant activation of AMPK leading to the inhibition of mTOR phosphorylation, further underlying potential for SG-2 as a multi-target neuroprotective ligand.
Reference: (1) Bellusci et al. Frontiers in Pharmacology 2017; 8: 905.
MON-636 The Relationship Between Glucose Control & Cognitive Function in People with Diabetes After a Lacunar Stroke
Authors: Cukierman-Yaffe Tali , McClure Leslie , Risoli Thomas , Bosch Jackie , Gerstein Hertzel C , Benavente Oscar 
Published: May 2020

Abstract
Background & Objective Both lacunar strokes and diabetes are risk factors for dementia and cognitive dysfunction. Thus, elucidating modifiable risk factors for cognitive dysfunction in people with type 2 diabetes who experienced a lacunar infarct has large public health implications. One such factor may be glycemic status, as measured by glycosylated hemoglobin (A1C). Thus, the aim of this study was to assess the relationship between A1C and cognitive function in people with diabetes after a lacunar stroke. Research Design & Methods The effect of baseline and follow-up A1C on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range 1-5) was examined in of 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov number, NCT00059306). Results Every 1 % higher baseline A1C was associated with a 0.06 lower standardized CASI z-score (95% CI -0.101, -0.018). Higher baseline A1C values were associated with lower CASI z-score over time (p for interaction=0.037). A 1% increase in A1C over time, corresponded with a CASI score decrease of 0.021 (95% CI -0.0043, -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, BMI, CVD, OSA, diabetic retinopathy, nephropathy insulin use and White Matter Abnormalities. Conclusion This analysis of 942 individuals with diabetes after a lacunar stroke demonstrates a relationship between A1C and change in cognitive scores over time. Intervention studies are needed in order to delineate if better glucose control could slow the rate of cognitive decline in this high risk population.
SAT-624 Predictive Ability of Lipoprotein Insulin Resistance (LPIR) Score in South Asians: A Comparison of Surrogate Indices of Insulin Sensitivity/Resistance
Authors: Fosam Andin , Grewal Shivraj , Armiyaw Abdul-Latif , Sarcone Camila , Rabel Antoinette , Auh Sungyoung , Muniyappa Ranganath 
Published: May 2020

Abstract
South Asians (SA) are at higher risk for developing insulin resistance (IR) and type 2 diabetes. Consequently, identifying IR in this population is important. Lack of standardization and harmonization of insulin assays limit the clinical use of insulin-based surrogate indexes of insulin resistance. The lipoprotein insulin resistance (LPIR) score, a metabolomic marker, reflects the lipoprotein abnormalities observed in insulin-resistant states. The reliability of the LPIR score to predict IR in South Asians is currently unknown. In this study, we aimed to evaluate the predictive accuracy of LPIR compared to other fasting-based surrogate indices in SA.
In a cross-sectional study of 59 non-diabetic SA subjects (age 36 ± 8 years, BMI 26.5 ± 5.2 kg/m2), we used calibration model analysis to assess the ability of the LPIR score and other simple surrogate indices [homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and Adipose tissue insulin sensitivity (Adipo-SI)] to predict insulin sensitivity derived from the reference frequently sampled intravenous glucose tolerance test (FSIVGTT) and Minimal Model analysis (SiMM). LPIR scores were calculated using six lipoprotein particle concentrations and sizes measured by nuclear magnetic resonance (NMR) spectroscopy. Further, quantitative predictive accuracy and index comparisons were determined by root mean squared error (RMSE) of prediction and leave-one-out cross-validation-type RMSE of prediction (CVPE). Receiver operating characteristic (ROC) curve analysis was performed to determine how well LPIR distinguished insulin resistant individuals, categorized as an SiMM &lt; 3.
As determined by calibration model analysis, Adipo-SI, HOMA-IR, and QUICKI showed moderate correlations with for SiMM (Adipo-SI: r = 0.66; HOMA-IR: r = 0.60; QUICKI: r = 0.57, p = &lt;0.0001). No significant differences were noted among CVPE or RMSE from any of the routinely used surrogate indices when compared with LPIR. The ROC area under the curve was 0.76 (95% CI 0.64–0.87) suggesting that LPIR performed well in identifying insulin resistant subjects. The optimal cut-off in IR individuals was LPIR &gt;46 (sensitivity: 75.9 %, specificity: 70.0%). We conclude that NMR-derived LPIR may be an appropriate index to assess insulin resistance in South Asians.
MON-659 Course of Puberty and Growth Spurt in Boys with Type 1 Diabetes
Authors: Shpitzer Hana , Lazar Liora , Shalitin Shlomit , Phillip Moshe , Vries Liat de 
Published: May 2020

Abstract
Background: Data on the course of puberty and pubertal growth in boys with Type 1 diabetes (T1D) are sparse.
Objectives: To study the course of puberty, pubertal growth and final height in boys with T1D as well as possible factors affecting these.
Methods: In this retrospective longitudinal study, 68 boys diagnosed with T1D between 1996-2009 who were pre-pubertal at diagnosis and had completed puberty served as the cohort. Collected were data on anthropometric measurements, Tanner stage, and HbA1c levels from diagnosis to final height (F-Ht). F-Ht was compared to parental height and to the data of the national health survey
Results – In the study cohort final height-SDS was lower than that at diagnosis. It was similar to parental Ht-SDS as well as to that of the national health survey (p=0.126). F-Ht was inversely related to average HbA1c during puberty (R=-0.27, p=0.045). Boys who presented with diabetic ketoacidosis at diagnosis were shorter than those who did not throughout the entire follow-up. Age at onset of puberty was significantly related to the age of maternal menarche (R=0.44, p=0.01) and to HbA1c levels in the year preceding puberty onset (R=0.36, p=0.01). Total pubertal growth was inversely related to HbA1c levels in the year preceding onset of puberty (average R=-0.3, p=0.03)
Conclusions: Boys with T1D diagnosed before puberty achieve final height similar to that of their parents and that of the general population. Diabetic ketoacidosis at the diagnosis is associated with diminished F-Ht. Age of pubertal onset and F-Ht are affected by genetic factors as well as by glycemic control before and during puberty.
These results emphasize the importance of tight metabolic control in adolescents, to enable growth within the genetic target.
OR15-05 Gain in Near Adult Height Using the Combination of an LHRH Analogue and an Aromatase Inhibitor in Early Maturing Girls with Compromised Growth. The “Gail” Study ISRCTN11469487
Authors: Papadimitriou Dimitrios T , Dermitzaki Eleni , Papagianni Maria , Kleanthous Kleanthis , Mastorakos George 
Published: May 2020

Abstract
Background. Third generation aromatase inhibitors (AI), as monotherapy, have never been used to increase predicted adult height in girls. Our previously published GAIL study has shown that the combination of anastrozole to an LHRH analogue for 24 months is safe and effective in ameliorating PAH in girls with early puberty +1.21 SDS (+7.51 cm) compared to inhibition of puberty alone +0.31 SDS (+1.92 cm), p=0.001 (1).
Objective and Hypotheses. We assessed the final height of the girls who participated in the GAIL study compared to the predicted after 24 months of combined treatment and additionally the efficacy of anastrozole monotherapy after completion of the combined treatment in further improving final height.
Methods. We measured adult (i.e. age 16.5 yrs) or near adult height (i.e. at bone age 14 yrs) of the 40 girls who participated in the GAIL study and were divided in two groups Group A (20 girls on anastrozole + leuprorelin) and Group B (20 girls on Leuprorelin alone). Group A was further randomized into two subgroups. Group A1 (10 girls), after completion of the combined therapy, received anastrozole 1 mg/day as monotherapy until bone age of 14 yrs with a 6-month follow-up. Group A2 (10 girls) had stopped the combined therapy at 24 months or 11 yrs of age and were recalled for adult (or near) height evaluation.
Results. Adult or near adult height (NAH) exceeded the predicted at the completion of the initial phase of the GAIL study in all three groups but the result was statistically significant only in Group A1: NAH-PAH = Group A1: +3.85 cm (+0,62 SDS) p=0.001, Group A2: +1,6 cm (+0,26 SDS) p=0.26, Group B: +1,7 cm (+0,3 SDS) p = 0.09. Gain in Group A1 was significantly greater to that of Group A2 (p=0.046) and Group B (p=0.035).
Conclusion. In early maturing girls with compromised growth, treatment for 2 yrs or until the age of 11 yrs with LHRH analogue plus anastrozole 1mg/day, the gain is +9.7cm in total when treated with anastrozole monotherapy until they reach NAH, whereas it is +7.4 cm if they do not continue with the monotherapy and only +3.6 cm when treated with an LHRHa only. As a result, the combination therapy continued with anastrozole monotherapy, ends in the shortest distance from target height. This implies that the addition of the anastrozole to an LHRHa apart from being safe, is effective in ameliorating substantially Near Adult Height making the intervention meaningful.
Reference:
(1) Papadimitriou DT, Dermitzaki E, Papagianni M, Papaioannou G, Papaevangelou V, Papadimitriou A. Anastrozole plus leuprorelin in early maturing girls with compromised growth: the “GAIL” study. Endocrinol Invest. 2016 Apr;39(4):439-46]
MON-193 Glucocorticoid Excess and Its Association with Metabolic and Cardiovascular Complications in Primary Aldosteronism
Authors: zhu Ke ying , chen huan , mengsi Liu , Feng Wen-huan huan , zhu da long , li ping 
Published: May 2020

Abstract
Objective: To investigate autonomous cortisol secretion in patients with primary aldosteronism and its effect on metabolism and cardiovascular events (CVE) in patients with primary aldosteronism (PA).
Methods: This study included 163 patients with PA and 105 sex- and age-matched patients with essential hypertension (EH). Clinical and laboratory data were collected. The expression of cortisol synthase (CYP11B1) and aldosterone synthase (CYP11B2) was investigated in adenoma tissues from 44 patients with aldosterone-producing adenoma (APA) by employing immunohistochemistry.
Results: 1) CYP11B2 was expressed in 36 patients with APA and was absent in 8 patients, while CYP11B1 immunoreactivity was detected in all tested patients with APA; 2) Compared with patients with EH, midnight cortisol concentration (104.81±90.86 vs 76.87±65.86), 24-h urine free cortisol level (726.04±309.87 vs 630.65±168.2), and cortisol level after 1mg-DST [35.6(27.6,75.73)vs 27.6(27.60,29.27)]were all significantly increased in patients with PA(all P&lt;0.01); 3) Midnight cortisol concentration is positively associated with systolic blood pressure (SBP) (r=0.147 P&lt;0.05), LDL-C (r=0.194 P&lt;0.05), HOMA-IR (r=0.262 P&lt;0.05), HOMA-β (r=0.313 P&lt;0.05) and fasting insulin level (r=0.329 P&lt;0.05) in patients with PA. In multiple linear regression analysis, midnight cortisol concentration was a postitive predictor for SBP (β=0.185 P&lt;0.05), HOMA-IR (β=0.331 P&lt;0.05) and HOMA-β (β=0.390 P&lt;0.05); 4) Of the 163 patients with PA, 35 had a history of CVE, including 22 with stroke, eight with myocardial infarction, three with atrial fibrillation, and two with heart failure. The multivariate logistic-regression analyses revealed older age (OR 1.160 95%CI 1.041-1.294 P &lt;0.001) and higher serum aldosterone level (OR 1.013 95%CI 1.000-1.026 P &lt;0.05) were independent risk factors of CVE, serum cortisol level was not associated with the increased risk of CVE in patients with PA (OR 0.997 95%CI 0.985-1.009 P =0.570).
Conclusion: Excess cortisol secretion was common in PA. Cortisol excretion is correlated with metabolic disorders, but not associated with increased risk of CVE in patients with PA.
SAT-156 Shorter Hospital Stays Are Not Associated with Increased Readmission or Complication Rates in Patients Undergoing Laparoscopic Adrenalectomies
Authors: Sharma Rahul K , Huang Bernice , Lee James A , Kuo Jennifer H 
Published: May 2020

Abstract
Background : Traditionally, elective adrenalectomies have been performed as an inpatient procedure. However, the adoption of laparoscopic adrenalectomy as the gold standard has allowed for shorter postoperative stays. Our objective was to assess the safety of same-day discharge for patients undergoing laparoscopic adrenalectomy.
Methods : A retrospective cohort study of patients who underwent laparoscopic adrenalectomy from 2011-2017 was conducted using The American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. Demographic data was obtained. Multivariable logistic regression models to assess the association between length of stay and both postoperative complication rates and 30-day readmission rates were regressed on age, sex, race, comorbidities, functional status, postoperative diagnosis, and operative time. Statistical significance was defined as p&lt;.05.
Results : 5,611 unique patients who underwent a laparoscopic adrenalectomy were identified. 1,564 patients had a postoperative diagnosis of a pheochromocytoma (27.9%), 162 with Cushing’s syndrome (2.9%) and 210 (3.7%) had metastatic disease to the adrenal glands. The average postoperative length of stay was 2.4 days (SD=3.9). 93 patients (1.7%) were discharged on the same day as their surgery (POD0). 2,509 (44.7%) were discharged on postoperative day 1 (POD1), 1,558 (27.8%) on postoperative day 2 (POD2), and 1,451 (25.9%) after POD2. Longer hospital stays were predicted by male sex, non-white race, longer operating time, and postoperative complications in regression models.
351 patients (6.26%) experienced a complication postoperatively. Complication rates were 3.23% for patients discharged on POD0, 1.67% for those discharged on POD1, 3.27% for those discharged on POD2, and 17.57% for those discharged after POD2 (p&lt;.01). An increased risk of postoperative complications was also associated with male sex, impaired functional status and the presence of multiple comorbidities in regression models.
290 patients (5.17%) experienced a readmission. Readmission rates were 4.30% for patients discharged on POD0, 3.67% for those discharged on POD1, 4.49% for those discharged on POD2, and 8.55% for those discharged after POD2 (p&lt;.01). Multiple comorbidities, African American race, and post-operative complications were associated with higher readmission rates. Length of hospital stay was not associated with readmission rates in regression models.
Conclusions : Readmission rates were not significantly different for patients discharged on POD0 than POD1 after a laparoscopic adrenalectomy. Readmission rates were higher for patients who had complications or multiple comorbidities. Therefore, low-risk patients with uncomplicated laparoscopic adrenalectomies can be considered for same day discharge to potentially reduce hospital spending and resource utilization.
SAT-020 Fluoxetine Administration Influences Serotonin-Driven Bone Remodeling During Lactation and Pregnancy Outcome in Mice
Authors: Fricke Hannah P , Sheftel Celeste M , Hernandez Laura L 
Published: May 2020

Abstract
Selective serotonin reuptake inhibitors (SSRI) are the most commonly prescribed class of antidepressants during pregnancy and lactation. SSRI decrease bone mineral density (BMD) across all ages and sexes. Lactation is also characterized by increased bone resorption to mobilize calcium due to the demands of lactation and achieves this via a serotonin-induced hormonal cascade. This serotonin-mediated bone loss is normally restored after weaning but is persistent when an SSRI is administered during the peripartum period. We hypothesize that the long-term BMD loss associated with fluoxetine administration during lactation will be seen in two sequential lactations and will have a more dramatic effect on maternal bone loss after the second lactation at both weaning and 3 months post-weaning. Female C57BL/6 mice were randomized to receive the SSRI fluoxetine hydrochloride (20 mg/kg) or saline daily from the beginning of pregnancy (E0), determined by the presence of a vaginal mucous plug, through the end of lactation (D21). They were then given a 3-week rest period before undergoing a second lactation with the same study design. Each group is paired to an age-matched virgin cohort to provide a non-lactating control. This created the following treatments: saline dam (S), fluoxetine dam (F), saline virgin pair (SV), and fluoxetine virgin pair (FV). Dual-energy X-ray absorptiometry (DEXA) was used to measure BMD of all groups throughout the peripartum period. At the end of gestation (E17.5), BMD was decreased in both the F and FV groups, and the BMD of the FV group remained persistently lower than the SV group across all timepoints. Both the F and S groups exhibited a dramatic decrease in BMD between E17.5 and the beginning of lactation (D2), then a slight increase between mid-lactation (D10) and at weaning (D21). There was an overall interaction between treatment and time for all groups across the peripartum period (p&lt;0.0001). During the first peripartum period, the F dams that were mated had significantly increased pregnancy loss (p=0.0041) and pup mortality post-parturition compared to S mice. Of the dams that were inseminated, determined by the presence of a mucus plug, 63% of successfully mated S dams (n=19) resulted in a full-term pregnancy. Of those S dams (n=12), 25% lost their entire litter at the beginning of lactation, and 75% maintained their litter until weaning. In the F dams that were successfully mated (n=37), only 35% resulted in a full-term pregnancy. We conclude that fluoxetine administration during the peripartum period decreases long-term maternal BMD and that fluoxetine exhibits a drug-specific effect on the dam resulting in a notably decreased incidence of a successful pregnancy.