bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-297 Pituitary Hormonal Levels and Gonadal Histology in the Pubertal Period of the Ames Mice
Authors: Silva Juliana M , Viscardi Bruna A , Mendonca Berenice Bilharinho , Carvalho Luciani Renata Silveira 
Published: May 2020

Abstract
Introduction: The pituitary gland controls several mechanisms as metabolism, growth, and reproduction, in response to hypothalamic stimuli. The adequate temporal/ spatial expression of transcription factors is mandatory for a normal pituitary development. PROP1 transcription factor is widely known as a key pituitary regulator. The Ames mice is a model of congenital hypopituitarism due to a pathogenic variant in the Prop1 gene, leading to growth retardation, infertility, and hypothyroidism. Aim: To characterize the peripheral levels of pituitary hormones and correlate with gonadal histology during the pubertal period of the Ames mice. Methods: Weight and naso-anal length were measured. Peripheral blood samples were collected from 5 wild type (WT) and 5 Prop1 mutants (Mut) animals with 30 (P30), 40, (P40), and 60 (P60) days after birth. Pituitary hormone levels were measured using the kit Milliplex Map® - Mouse Pituitary Bead Panel (Merck Millipore, Massachusetts, USA). Ovaries and testis from 3 WT and 3 Mut animals from each sex were collected and fixed in 4% paraformaldehyde and embedded in paraffin. Gonadal sections of 3 μm were obtained and the slices were stained with hematoxylin and eosin. Follicles were counted and classified according to the size and cellular composition as small follicle (17μm to 28μm), developing follicle (100μm), and antral follicle (&gt;550μm). Testis were classified using the Johnsen score, ranging from 1 to 10 according to cellular composition and spermatogenesis state. Results: All mutant mice presented decreased weight and naso-anal length at the three analyzed periods. At P30, the female mutants presented GH, LH, and TSH levels similar to wild type and decreased FSH and PRL levels, as well as the males that only differed from GH reduced levels. At P40, females and males presented GH, LH, FSH, and TSH levels similar to wild type with reduced PRL levels. At P60, it was observed decreased GH, FSH, and PRL levels for both sexes and TSH levels with no difference from WT, LH secretion was decreased in mutant females and normal in males compared to WT. There was no significant difference in follicular number and classification between mutants and wild type in all analyzed periods, despite the observation of ovarian hypoplasia in the mutants. Johnsen score was in the average of 7.5 in mutant males and 8.8 in WT, with no significant difference between periods. Conclusion: Despite the absence of PROP1 and the hypopituitary phenotype, mutant females and males were able to secrete some pituitary hormones, mainly during puberty, a pituitary high demand period. Although the ovaries and testis from mutant mice are hypoplastic, cellular morphology and classification are similar to WT.
SUN-367 Changes in Bone and Glucose Metabolism in Patients Post Solid Organ Transplant
Authors: Lo Keswick , Tarar Omer H , Yaturu Subhashini 
Published: May 2020

Abstract
Introduction:
Solid organ transplantation has emerged as a pivotal therapeutic option for various organ failures and has gained more popularity with newer technologies and better immunosuppressive options.
However, immunosuppressive therapies for survival of solid organ transplant is also associated with various metabolic complications with changes in bone and glucose metabolism.
The aim of our study is to review the changes in bone and glucose metabolism in post solid organ transplant recipient Veterans.
Methods:
Single center, retrospective study with subjects who had solid organ transplant conducted at William Jennings Bryan Dorn Veteran Hospital in Columbia, South Carolina. All available subjects who had solid organ transplant between January 1, 2008 till December 31st, 2017 and had at least one post-transplant followed up visit were included. Data was collected from computerized patient record system after approval by Institutional Review board (IRB) and Research and development. Collected data included age, sex, BMI, Laboratory data, Medications, Bone mineral density (BMD) by DXA, Diabetes status and medications pre and post operatively.
Results:
Data collected include 227 patients with solid organ transplants. Out of those, only 88 had BMD evaluation and only 45 had follow up BMD. Out of 88 with baseline BMD, 16 had osteoporosis, 36 had osteopenia and 36 had normal BMD. Although 51 were on Bisphosphonates, many of them did not have follow up DXA scans. 157 were receiving Vitamin D supplementation but very few had levels checked.
A total of 158 patients had Diabetes, with 95 having pre-existing diabetes and 52 were diagnosed post transplantation. The time of onset was unknown in 11 patients. Majority of patients with pre-existing diabetes required intensification of their medications for diabetes to achieve optimal glycemic control.
Discussion
A multitude of factors including type of transplant, individual pre-operative metabolic profiles, choice of immunosuppressive agents and certain infections increase the risk of these metabolic complications. Given the complex post-operative care, issues with immunosuppressive agents and other comorbidities, metabolic bone disease and other complications may go unnoticed and under recognized which may later lead to higher risk of fractures, morbidity and mortality.
Conclusion
This study highlights the importance of monitoring prudently for metabolic changes after solid organ transplantation. Early identification and aggressive management of these complications may help decrease morbidity and mortality related to fractures and sub-optimal glycemic control.
SUN-005 Hirsutism Due to Bilateral Leydig Cell Tumors
Authors: Shakir Mohamed K M , Sherin Rinsha P V , Weaver Travis , LaChance David , Hoang Thanh Duc 
Published: May 2020

Abstract
Severe hyperandrogenism in post-menopausal women is rare. It may be caused by either benign or malignant neoplasms of the adrenal or ovary. We report a rare case of a post-menopausal woman with hirsutism associated with virilization due to Leydig cell tumors (LCT) of both ovaries. Case report 61 yo female presented for evaluation of hirsutism. She had also been experiencing increased facial hair growth, deepening of voice, clitoromegaly, alopecia, and acne. Physical examination: normal vital signs. Patient had signs of virilization, including coarse hair along her upper lip, chin, lower abdomen and inner thigh with Ferriman-Gallwey score of 8, acne, and clitoromegaly. She had no signs of acanthosis nigricans or Cushing syndrome. Base line labs: Hemoglobin 16.2 gm/dL (ref 12.0 to 15.5), total testosterone 803 ng/dL (ref 3–41), free testosterone 20.2 pg/mL (ref 0.0–4.2), estradiol 77 pg/mL (&lt;6.0−54.7), estrone 148 pg/mL (ref 7–40), FSH 11.5 mIU/mL (ref 25.8 - 134.8), LH 6.90 mIU/mL (ref 7.7 - 58.5), androstenedione 28 ng/dL (ref 17–99), DHEAS 99.9 mcg/dL (ref 19–205), dehydroepiandrosterone 512 ng/dL (ref 31–701), inhibin A 2.3 pg/mL (ref &lt;5), inhibin B &lt;7.0 pg/mL (ref 00-16.9), 17-alpha hydroxyprogesterone 187 ng/dl (ref &lt;51). Her other serum markers such as anti -Mullerian hormone, alpha-fetoprotein, and hCG were normal. A CT scan of adrenals: normal. Similarly a transvaginal US did not show any ovarian pathology, however MRI of the pelvis showed homogeneous ovarian enhancement bilaterally and based on this information a diagnosis of ovarian hyperthecosis was considered and patient underwent laparoscopic bilateral oophorectomy. Pathology confirmed: LCT in both ovaries. Laboratory values performed 3 months later showed the following values: hemoglobin 14.2 gm/dL, total testosterone 13 ng/dL, free testosterone 1.4 pg/mL, LH 124 mIU/mL, FSH 99mIU/mL, estradiol &lt;5.0 pg/mL. In 6 months she had significant improvement in hirsutism and virilization. Discussion Hyperandrogenism, especially serum testosterone in the male range with rapidly progressive hirsutism or virilization signs in a female indicates tumor etiology. Androgen-secreting ovarian tumors are usually small and often embedded in the ovary. Transvaginal US is useful in the diagnosis of ovarian tumors. However, in our case, transvaginal US failed while MRI scan showed bilaterally enlarged ovaries and with this information patient underwent bilateral oophorectomy. Although 5 cases of bilateral LCT are reported in the literature, LCT is unilateral 95% of the time, the pathogenesis of Leydig cell proliferation and LCT is unclear. In conclusion, androgen secreting tumors should be considered in women (especially in post-menopausal state) with hyperandrogenism and hirsutism. In fact, diffuse stromal Leydig cell hyperplasia and small Leydig cell tumors may be missed on imaging and in some cases only pathology can confirm the result.
SUN-310 Growth Hormone Deficiency and Replacement Therapy: Association with Health-Related Physical Fitness
Authors: Carvalho-Furtado Adriana Claudia Lopes , Ramari Cintia , Soares Edgard , Saint-Martin Daniel R F , Porto Luiz Guilhemme Grossi , Nogueira Montenegro Maria Luiza Ricardo , Ferro André Metzker , Rodrigues Marcelo Palmeira , Naves Luciana Ansaneli 
Published: May 2020

Abstract
Objective: To compare health-related physical fitness (HRPF) in patients with severe adult growth hormone deficiency (AGHD) according to the deficiency onset phase, and to evaluate the effects of a six-months human growth hormone (rhGH) replacement therapy on HRPF, in a subgroup of patients. Methods: First arm: cross-sectional observational study at baseline of naive rhGH multiple pituitary hormonal deficiency (MPHD) hypopituitarism patients - adult-onset growth hormone deficiency (AO-GHD) versus child onset growth hormone deficiency (CO-GHD). Second arm: a 6-month intervention clinical trial in a selected group of a non-randomized, non-controlled cohort. HRPF was evaluated by measuring isokinetic and isometric torque stensor strength at the knee using an isokinetic dynamometer, handgrip strength and six-minute walk test. Body composition was assessed by DXA. Results: Patients who presented AO-GHD had higher BMI than CO-GHD (28.1±3.5 x 22.4±4.8; p=0.017), but body composition (lean body mass%:57.9±7.9 x 58.9±8.6;p=0.816/fatty body mass%:39.3±6.8 x 36.0±9.1;p=0.434), stensor peak torque/body weight at 60, 90 and 180deg/s (2.18±0.6 x 2.18±0.6; p=0.580/1.99±0.5 x 2.14±0.5;p=0.546/1.52±0.4 x 1.64±0.4;p=0.547), isometric torque/body weight at the knee (2.62±0.7 x 2.91±0.6;p=0.357) and six-minute walk test (570.2±76.0cm x 554.1±91.0cm;p= 0.703) did not differ between groups. Handgrip strength test also showed significant reduction in scores for age and gender in both groups of GHD patients. After six months of rhGH, no improvement in muscular strength tests was found. There was a significant worsening in the six-minute walk test (575.1±84cm x 545.4±90.6cm; p=0.033) despite the improvement in body composition (lean body mass%:59.7±8.6 x 63.6±11.1;p=0.005/fatty body mass%:35.7±9.2 x 32.9±10.0;p=0.003). Conclusion: Despite differences in BMI, there were no other differences in HRPF between AO-GHD and CO-GHD patients. The decrease of the six-minute walking test performance after rhGH replacement therapy supports the clinical evidence that the GH regulates bioenergetics in human skeletal muscle fibers. Although the treatment had a short period, GH might have stimulated the anaerobic and suppressed the aerobic energy system.
SAT-457 The Association Between Thyroid Stimulating Hormone and Severe Depression: A Historical Cohort Study
Authors: Sundaresh Vishnu , Newman Mike , Bakian Amanda V , Abraham Devaprabu , Singh Balwinder 
Published: May 2020

Abstract
Introduction: Hypothyroidism is implicated in the pathophysiology and clinical course of mood disorders. This study aimed to investigate the association between TSH and severe depression.
Methods: The historical cohort included all consecutive adult patients (≥ 18 years) who had a TSH and PHQ-9 questionnaire data within 6 months of index visit, between October 2016 and July 2019, at the University of Utah Health. Data on demographics, hypothyroidism, TSH, PHQ-9, thyroid hormone replacement (THR), and antidepressant medications were extracted electronically. T-test and chi-square were used to compare continuous and categorical variables respectively. Logistic regression and one-way ANOVA were used to evaluate the association between TSH and depression severity. A sub-group analysis was performed among mood disorder patients without a diagnosis of overt hypothyroidism, comparing euthyroid patients (TSH 0.3-4) and patients with sub-clinical hypothyroidism based on TSH 4-10.
Results: The cohort included 26,722 patients, mean age 46.3 years, 79.5% Caucasian, 68% females, and mean BMI 30. Mean PHQ-9 score was 8.2, 10% patients had severe depression (PHQ-9 ≥20), and 51% were on antidepressants and 26% on mood stabilizers. Mean TSH was 2.85, 19% patients had a diagnosis of hypothyroidism, and 20% patients were on THR. Patients with severe depression were more likely to have a higher mean TSH (p=0.06), be on antidepressants (p= &lt;0.0001), and have a higher BMI (p=0.0003). There was a positive correlation between TSH and PHQ-9 score (p= 0.04). TSH was associated with severe depression, odds ratio 1.006 (1.003-1.009), after adjusting for potential co-variates. Hypothyroid patients who were on THR had a lower mean PHQ-9 score (p= &lt;0.0001) as compared to hypothyroid patients not on THR. Patients with TSH from 7-10 had a higher PHQ-9 score as compared to those who had a TSH from 4-7 (p= &lt;0.003).
Conclusion: Severe depression was associated with higher TSH. Subclinical hypothyroidism with TSH above 50th percentile was associated with higher PHQ-9 scores. Future RCTs should evaluate the effect of THR in (a) patients with severe depression and (b) patients with mood disorders who have subclinical hypothyroidism.
SUN-414 Tyrosine Kinase Inhibitors Induced Thyroid Dysfunction: An Experience from a Tertiary Care Hospital
Authors: Wangnoo Subhash Kumar , Siddiqui Mohammad Asim , Pamnani Harsha , Usman Khwaja Mohammed 
Published: May 2020

Abstract
Tyrosine kinase inhibitors (TKI) belong to a new class of molecular multi-targeted anticancer therapy which targets different growth factor receptors and hence attenuates cancer cell survival and growth. TKI-induced thyroid dysfunction is recognized as a common adverse effect of treatment., but the onset of thyroid dysfunction is variable. This study analysed correlation between initiation of TKIs and the onset of thyroid dysfunction in non-thyroid cancers patients without any background thyroid dysfunction.
METHODS:
This was a retrospective cohort study to evaluate thyroid dysfunction in adult patients (n=227, M:F=153:74) with non-thyroidal cancers treated with TKIs. Patients having pre-existing thyroid disease including euthyroid goitres were excluded. Demographic, clinical, and cancer treatment data were collected. Thyroid function tests (TFTs) were done prior to initiation, at 2 months, 6 months and at 1 year. TFTs were classified as euthyroid (thyrotropin [TSH] normal), subclinical (SCH; TSH 5-10 mIU/L, or higher TSH if free thyroxine normal), or overt hypothyroidism (OH; TSH &gt;10 mIU/L, low free thyroxine, or requiring replacement).
RESULTS:
Of the 227 patients in the study, OH occurred in 57 patients (25.1%)(M:F = 19:38) and SCH occurred in 89 patients (39.2%) (M:F=39:50) with TKI therapy at the end of 12 months. 37 patients (M:F=13:24) developed OH in first 6 months after initiation of TKIs. Female patients were more likely to have OH in the first 6-month period following TKIs irrespective of type of TKI or the cancers. SCH was also more common after 2 months in female patients (n=23) (M:F=6:17) but the conversion of SCH to OH was more common in male patients at the end of 12 months. The symptoms were variable and most the patients did have any thyroid specific symptoms. After adjustment for age, sex, cancer type, cancer stage, performance status, and type of TKI, OH remained significantly associated with survival at 1-year (hazard ratio=0.461; p&lt;0.0001), whereas SCH did not (hazard ratio=0.591; p=0.165). Analysis of hypothyroid patients (SCH and OH) with TSH &gt;5 and &lt;10 mIU/L stratified by hormone replacement status showed improved survival associated with hormone replacement, although 1 year follow-up is too short to comment on overall survival rates.
CONCLUSIONS:
New onset hypothyroidism, both OH and SCH is common in non-thyroidal cancer patients treated with TKI. SCH is more common after 2 months and OH after 6 months following TKI initiation. Female sex is more predisposed to develop thyroid dysfunction irrespective of underlying cancer or type of TKI used but male patients progressed to OH at the end of 12 months.
SAT-158 New Data on High Prevalence and Time of Occurrence of New Onset Hypothyroidism Associated with Mitotane Therapy in a Cohort of Adrenocortical Cancer
Authors: Poirier Jonathan , Lacroix André , Olney Harold J , Bourdeau Isabelle 
Published: May 2020

Abstract
Context. Mitotane is a steroidogenesis inhibitor and an adrenocorticolytic drug used to treat adrenocortical cancer (ACC). Central hypothyroidism is recognized in mitotane-treated patients and recent data suggested that mitotane could have an inhibitory effect on TSH-secreting cells in the pituitary gland. Moreover, mitotane may lead to induction of thyroid hormone metabolism. Clinical data on hypothyroidism related to mitotane such as prevalence and time of occurrence was described in a limited number of patients.
Objective. To better characterize clinically secondary hypothyroidism in patients with ACC treated with mitotane therapy.
Methods. We reviewed retrospectively paper charts and electronic records from patients with histologically confirmed diagnosis of ACC evaluated at our center from 1995-2019. We analysed the pattern of TSH and thyroid function, but also mitotane timing and levels at baseline and during treatment of patients under mitotane therapy. Thyroid hormone assessment including TSH, FT4 and FT3 was performed at least every 3 months during follow-up.
Results. Our cohort of 104 patients with ACC includes 84 patients that received mitotane therapy. Among them, thyroid function data was incomplete for 39 cases. Complete data was retrieved from 45 patients. Ten out of 45 (22.2%) patients were already known for primary hypothyroidism and were receiving L-T4 replacement before the initiation of mitotane. Two of 45 (4.4%) patients maintained a normal thyroid function during complete follow up (4.5 years) and 33/45 (73.3%) had new onset hypothyroidism requiring levothyroxine treatment. Of these 33 patients, 22 were females and 11 were males, ranging from 22-74 yo with a median of 46 yo. The number of patients with ENSAT stage I, II, III and IV of disease were 1, 8, 11 and 13 respectively. Thyroid profiles were compatible with central hypothyroidism (low T4 with low or inappropriately normal TSH) in 22/33 patients (66.7%). Interestingly, 6/33 patients (18.2%) developed a TSH elevation with a normal lower-limit or low T4 level. The timeline distribution of the occurrence of hypothyroidism was 21.2% (n:7) at &lt;3 months, 15.2% (n:5) between 3-6 months, 21.2% (n:7) between 6-9 months and 15.2% (n:5) between 9-12 months. 9.1% (n:3) occurred within the second year of treatment (between 12-24 months). However, in 5/33 (15.2%) cases, the exact time of new hypothyroidism onset was undetermined.
Conclusion. Mitotane therapy is frequently associated with new onset hypothyroidism with a prevalence of 73% in our cohort of exposed patients and is most likely of central etiology. 72.7% of cases occur in the first year of treatment while 9.1% occur in the second year. This study supports the importance of monitoring thyroid function (including a free T4 level) during the complete course of mitotane therapy.
SUN-692 Comprehensive and Structured Care Program for Patients with Type 2 Diabetes Mellitus: A Preliminary Report from Raipur, Chhattisgarh State of India
Authors: Dash Kalpana , Tippisetty Surekha , Rao Samba Siva , Kolukula Vamsi Krishna 
Published: May 2020

Abstract
Aim: To assess the glycemic outcomes of T2DM patients enrolled in comprehensive structured care program at the outpatient clinic of Apollo Sugar at Raipur, India. Methods: This is a preliminary, prospective, single-center, observational study on T2DM patients from Jan 2018 to December 2018. Uncontrolled diabetes or patients with comorbid conditions with the duration of disease for more than one year and age ≥18 years and who gave consent to enroll in the program were included in the study. The structured care program is a 6 months program where patients were continuously engaged by counseling them on diabetes management- diet and exercise, self-monitoring of blood glucose, health interactions with the remote health coach through a mobile app. Baseline demographics and clinical data were collected at the time of enrollment and were followed up for 6 months. HbA1c reduction is the target measurement of this program. Descriptive statistics were used to analyze and report the data. A paired t-test is used to check the significant reduction in HbA1c from baseline to follow up Results: Total 102 patients were included in this study. Mean (SD) age was 50.7 (10.5) years, males were 78 (76%) and females were 24 (24%). The mean (SD) duration of diabetes and BMI were 7.9 (7.0) years and 27.5 (4.5) kg/m2 respectively. At the time of enrollment, patients were at mean HbA1c of 9.0(2.1)%, fasting (F) and post-prandial (PP) blood (BG) glucose was 194(68) mg/dL and 247(94) mg/dL respectively. Among these patients 38% had neuropathy and 15% had retinopathy as their complications. These patients were regularly followed up over the phone call to counsel on diabetes management with a healthy diet, exercise, self-monitoring of blood glucose, and medication compliance. After 6 months followup the HbA1c, FBG, and PPBG were 7.6 (1.5) %, 139 (50) mg/dL, and 196 (75) mg/dL, respectively with a significant mean reduction of 1.4%, 56 mg/dL, and 51 mg/dL (p &lt;0.001). Further analysis of glycemic outcomes between these patients on oral hypoglycemic agents (OHAs) and OHAs+insulin, the reduction in HbA1c (1.5%) was not significant. Conclusion: Our study demonstrates that a structured care program might bring a clinically significant glycemic control through tight adherence to SMBG, diet, exercise, and medication. To establish these results a study in large sample is in progress.