bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-LB96 Basal Contralateral Aldosterone Suppression Is Rare in Lateralized Primary Aldosteronism and Can Be Useful in Predicting Surgical Outcome
Authors: Desrochers Marie-Josée , St-Jean Matthieu , Nada El Ghorayeb , Bourdeau Isabelle , So Benny , Therasse Éric , Kline Gregory , Lacroix André 
Published: May 2020

Abstract
Background: Adrenal venous sampling (AVS) is performed to distinguish between unilateral or bilateral source of aldosterone in primary aldosteronism (PA). Unilateral aldosteronomas should lead to suppression of renin and contralateral (CL) aldosterone secretion, assessed by the CL suppression ratio. We recently found that CL aldosterone suppression was relatively rare using the ratio of basal aldosterone concentration of the opposite adrenal vein/periphery (AOPP/AP) in contrast to the traditional cortisol-corrected aldosterone ratio ((A/C)OPP(A/C)P). Pathology studies showed frequent zona glomerulosa (ZG) hyperplasia adjacent to a dominant aldosteronoma, which could also indicate probable ZG hyperplasia in the CL adrenal. The ratio of basal CL suppression could be a usefull parameter to predict cure following unilateral adrenalectomy (UA), but controversy remains in the literature.
Objectives:
1. To evaluate the prevalence of basal CL suppression using the AOPP/AP ratio as compared to the (A/C)OPP/(A/C)P ratio at previously established cut-offs.
2. To determine the best cut-off to predict clinical and biochemical surgical cure in two Canadian referral centers.
3. To compare the accuracy of the AOPP/AP ratio to the basal lateralization ratio (LR) and the post-ACTH LR in predicting the surgical outcome.
Methods: 330 patients with PA and successful bilateral simultaneous basal and post-ACTH stimulated AVS (selectivity index &gt;2 basally and &gt;5 post-ACTH) were included; 124 patients found to be lateralized underwent UA. The follow-up data were evaluated for clinical and biochemical cure at 3 and 12 months using the PASO criteria.
Results: Using AOPP/AP and (A/C)OPP/(A/C)P at the cut-off of 1, the prevalence of CL suppression is 6% and 45%, respectively. The median CL suppression ratio is 2.3 (1.3-5.1) in lateralized cases of PA using AOPP/AP. Using ROC curves, the AOPP/AP ratio is associated with clinical cure at 3 and 12 months and biochemical cure at 12 months. (A/C)OPP/(A/C)P is associated with biochemical cure only. The cut-offs for AOPP/AP offering the best sensitivity and specificity for clinical and biochemical cures at 12 months are 2.15 (Se 63% and Sp 71%) and 6.15 (Se 84% and Sp 77%), respectively. Basal LR and post-ACTH LR are associated with clinical cure but only the post-ACTH LR is associated with biochemical cure.
Conclusions: Basal CL suppression defined by the AOPP/AP ratio is rare and incomplete compared to the traditional (A/C)OPP/(A/C)P ratio in lateralized cases of PA. This may reflect the frequent micronodular hyperplasia adjacent to dominant aldosteronomas and possibly in the CL adrenal. Basal CL aldosterone suppression may predict clinical postoperative outcome, but with modest accuracy.
SUN-737 Induction of the Pro-Diabetic Gene DPP4 by Glucocorticoids: New Evidence of Pro-Inflammatory Effects in Macrophages
Authors: Diaz-Jimenez David , Petrillo Maria-Grazie , Busada Jonathan T , Cidlowski John A 
Published: May 2020

Abstract
Glucocorticoids are potent endogenous anti-inflammatory molecules, with its receptor (GR) expressed in nearly all immune cells. Macrophages are heterogeneous cells having a central role in both tissue homeostasis and inflammation. Paradoxically glucocorticoids have a limited efficacy controlling these processes and inflammation resolution of macrophage-related diseases, such as type 2 diabetes, atherosclerosis and rheumatoid arthritis. To address this issue, we explored new glucocorticoid target genes in macrophages with potential clinical and therapeutic implications for these diseases. Analysis of genomic platforms identified the pro-diabetic exopeptidase dipeptidyl peptidase 4 (DPP4) as a novel glucocorticoid-responsive gene. GR directly induces its expression by binding to two glucocorticoid-responsive elements within the DPP4 promoter. Unexpectedly, DPP4 mediated the glucocorticoid-induced spontaneous macrophage migration. These actions were blocked by both GR and DPP4 siRNA knockdowns. Furthermore, two DPP4 inhibitors, Sitagliptin and Linagliptin, used clinically for the treatment of diabetes inhibited glucocorticoid-induced mobility of macrophages. DPP4 induction by glucocorticoids was also observed in murine peritoneal macrophages and pro-inflammatory M1 polarized macrophages and was associated with an increase in their migratory properties. Provocatively, DPP4 has been shown to be involved in the inflammatory macrophage profile associated with type 2 diabetes, obesity and atherosclerosis. Since macrophages require efficient cell movement for all their functions, such as sensing of Pattern Associated Molecular Patterns (PAMPs), phagocytosis and the antigen presentation, the DPP4 induction by glucocorticoids could potentiate the macrophage infiltration and their activation in chronic inflammatory tissues and diabetes.
MON-LB036 Uncommon Findings in Beckwith-Wiedemann Syndrome
Authors: Martins Jéssica M E S , Garcia Tamires S , Lee Juliana S , Cechinel Edson , Simoni Genoir , Nascimento Marilza Leal , Da Silva Paulo Cesar Alves 
Published: May 2020

Abstract
Introduction: Beckwith-Wiedemann syndrome (BWS) is characterized by variable phenotypes that might include overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, hemihypertrophy and predisposition to embryonal tumours.
Some features are more specific, including adrenal cytomegaly. BWS increases risk for several tumors, including adrenocortical tumor (ACT). Some protocols recommend screening with adrenal ultrasonography and serum DHEAS every 4–6 months.
Case report: A 1-month-old male, preterm (34 weeks 4 days), large for gestational age (weight 3670g), presented with macrosomia, macroglossia, umbilical hernia and auricular pits, with clinical diagnosis of BWS. In newborn screening 17 alpha hydroxyprogesterone (17OHP): 70,15 ng/mL (&lt;15ng/mL) and 66,32 ng/mL in second sample. Presented basal cortisol 11.4 mcg/L (6,70 a 22,60 µg/dL), normal electrolytes, dehydroepiandrosterone sulphate (DHEAS) &gt; 1000 mcg/dL (30,0 - 250,0 mcg/dL), testosterone 637 ng/dL (60-400 ng/dL), leading to ACT suspicion. No suppression of cortisol (2,8 mcg/dL) after dexamethasone 10 mcg/kg. Urinary metanephrines were normal, plasmatic normetanephrine 554 pg/mL (&lt;196 pg/mL) and plasmatic norepinephrine 2094 pg/mL (&lt; 420 pg/mL). Abdominal CT showed increased adrenal glands, with normal contrast uptake. MRI and PET/CT DOTA-68Ga did not identify tumors. Eight months later: 17OHP 0,88 ng/mL (0,8-5ng/mL), DHEAS 37 mcg/dL (&lt;30,0 mcg/dL), testosterone 13 ng/mL (&lt; 30 ng/dL), normal urinary metanephrines and plasmatic catecholamines.
Conclusion: In this case congenital adrenal hyperplasia was ruled out and ACT was suspected. Imaging did not identify tumors and biochemical findings (hypercortisolism and high androgens levels) had progressive improvement. Bilateral adrenal hyperplasia may be present in BWS as a result of fetal adrenal gland delay maturation. Permanent adrenal cortex cytomegaly may be responsible for hypercortisolism. Transient cortex persistence can lead to androgens elevation and produces large amounts of DHEA, that could explain DHEAS elevation similar to that in ACT.
Bilateral adrenal hyperplasia is described as a feature of BWS, but, to our knowledge, there is no similar case in literature with these biochemical findings.
References:
1)
Beckwith JB. Extreme cytomegaly of the adrenal fetal cortex, omphalocele, hyperplasia of kidneys and pancreas, and Leydig-cell hyperplasia: Another syndrome. West Soc Pediatr Res. 1963; 11
2)
Carney JA, Ho J, Kitsuda K, et al. Massive neonatal adrenal enlargement due to cytomegaly, persistence of the transient cortex, and hyperplasia of the permanent cortex: findings in Cushing syndrome associated with hemihypertrophy. Am J Surg Pathol. 2012
SAT-226 Lifestyle Modifications or Adrenalectomy? Pheochromocytoma Presenting with New Onset Diabetes Mellitus
Authors: Sosa-Pagan Max , Sarmiento-Ramon Juan Camilo , Panunti Brandy Ann 
Published: May 2020

Abstract
Introduction
When clinicians think of pheochromocytomas, diabetes might not be the first thing that comes to mind. Pheochromocytomas elicit deterioration in glucose tolerance in 20% to 40% of affected individuals. Size of the pheochromocytoma could be an independent risk factor for developing diabetes, as larger pheochromocytomas often present with diabetes mellitus in 23% to 33% of patients with symptomatic pheochromocytomas. Evidence suggests that pheochromocytoma proposes a risk for development of diabetes. There is no consensus or recommendations on which patients with new onset diabetes should be screened for pheochromocytoma or how to manage hyperglycemia in these patients.
Clinical Case
42 YO F with PMH of HTN presented to primary care clinic c/o polyuria, fatigue, 25-pound weight loss, epigastric pain and worsening hypertension over 3 months. Initial work up showed a HbA1C of 9%. The patient was diagnosed with type 2 diabetes mellitus and started on Metformin 1g BID with no improvement of glucose levels or symptoms. As part of initial work up for suspicion of pancreatic malignancy patient had an abdominal CT scan showing a 5.6 x 4.8 cm well-circumscribed left adrenal mass. Patient was referred for endocrine evaluation. Initial workup showed negative GAD Ab, normal 1mg Dexamethasone suppression test, normal aldosterone/renin ratio, elevated Free Normetanephrine of 17,921 pg/mL and elevated chromogranin A of 3,427 ng/mL. Based on biochemical evidence of catecholamine excess and left adrenal mass on imaging, patient was diagnosed with Pheochromocytoma. MIBG showed no evidence of metastatic disease. She was started on insulin therapy, Doxazosin 1mg BID which was titrated to 2mg BID and Amlodipine 5mg was increased to 10mg daily. Pt was referred to surgery for adrenalectomy. On pre-op evaluation patient had significant improvement of glucose levels and symptoms. Propranolol 20mg BID was started for BP optimization. A laparoscopic left adrenalectomy was performed without complications. Patient did not require anti-hypertensive medications or insulin during hospitalization and was discharged on metformin 500mg daily with no anti-hypertensive medications. At one-month Post-adrenalectomy follow up patient had normal BP of 116/72 mmHg and A1C of 5.4% with normal glucose logs indicating resolution of diabetes and HTN post adrenalectomy.
Conclusion
Diabetes is a multifactorial disease that has direct impact on patient’s quality of life, morbidity and mortality. It is important to consider pheochromocytoma as a risk factor for development of diabetes, especially in young patients with atypical presentation, uncontrolled hypertension or without evidence of antibodies or insulin resistance. Screening and early diagnosis of pheochromocytoma could mean significant reduction on long term diabetes complications as diabetes seems to improve or even resolve after adrenalectomy.
OR11-01 Using Kisspeptin to Predict Pubertal Outcomes for Youth With Pubertal Delay
Authors: Chan Yee-Ming , Lippincott Margaret Flynn , Barroso Priscila Sales , Alleyn Cielo , Brodsky Jill , Granados Hector , Roberts Stephanie , Sandler Courtney Nagel , Srivatsa Abhinash , Seminara Stephanie Beth 
Published: May 2020

Abstract
Background: The management of youth presenting with delayed puberty is challenging because it can be difficult to predict which children will eventually progress through puberty and which children will not. We have previously shown that exogenous administration of the neuropeptide kisspeptin, which stimulates GnRH release, can be used to probe the integrity of the reproductive endocrine axis. We hypothesized that responses to kisspeptin could predict outcomes for individuals with pubertal delay. Methods: We conducted a longitudinal study of 16 children (3 girls and 13 boys) with delayed or stalled puberty who had undergone stimulation testing with kisspeptin and GnRH. Participants were followed with serial physical examinations and laboratory studies every six months for evidence of progression through puberty. Inhibin B was measured in boys. A subset of participants underwent exome sequencing. Results: “Kisspeptin responders” who had responded to kisspeptin with a rise in LH of 0.8 mIU/mL or greater all subsequently progressed through puberty (n = 8). In contrast, “kisspeptin nonresponders” who had exhibited LH responses to kisspeptin ≤0.4 mIU/mL all reached age 18 years without developing physical signs of puberty (n = 8). Thus, responses to kisspeptin accurately predicted later pubertal outcomes (p = 0.0002), with sensitivity and specificity of 100% (95% CI 74-100%). Moreover, the kisspeptin-stimulation test outperformed overnight LH measurements, GnRH-stimulated LH, inhibin B, and genetic testing in predicting pubertal outcomes. Conclusion: The kisspeptin-stimulation test can be used to reveal future reproductive endocrine potential in prepubertal children and is a promising novel tool for predicting pubertal outcomes for children with delayed puberty. Trial registration: ClinicalTrials.gov NCT01438034
SUN-LB95 Developing a Highly Equivalent Non-Competitive Chemiluminescence Immunoassay Aldosterone Measurement to LC/MS
Authors: Satoh Fumitoshi , Ono Yoshikiyo , Omata Kei , Tezuka Yuta , Yamanami Hiroaki , Morimoto Ryo , Kojima Satoshi , Sasano Hironobu 
Published: May 2020

Abstract
Background Measurement of plasma aldosterone and renin concentration, or activity, is useful for selecting antihypertensive agents anddetecting hyperaldosteronism in hypertensive patients. However, it takes several days to get results even if measured by inaccurateradioimmunoassay, or we must accept high-cost LC/MS, and development of a more rapid and accurate substitute has been long hoped. We havedeveloped a novel, fully-automated, high-quantitative noncompetitive chemiluminescence immunoassay (NC-CLEIA) for detecting aldosterone inserum and plasma, and its performance is evaluated as compared to LC/MS measurement. Methods Recently a unique anti-metatype antibody,which recognizes the immunocomplex of aldosterone and its monoclonal antibody, was established. Using this antibody for sensing permittedthe construction of non-competitive assay for the detection of aldosterone. The reaction protocol of novel aldosterone assay is the following. Inthe 1st reaction, aldosterone in patient’s sample is captured on anti-body coated magnetic particles. Alkaline phosphatase-conjugated antimetatypeantibody is added and incubated as 2nd reaction following a wash. Then substrate solution is added after washing immunocomplex.The resulting reaction signals are proportional to the amount of aldosterone in the sample allowing quantitative determination of in serum orplasma sample. The overall reaction is completed within 30 min. Results Limit of blank (LoB), limit of detection (LoD) and limit of quantitation(LoQ) of our NC-CLEIA aldosterone assay were 0.09 ng/dL, 0.21 ng/dL and 0.57 ng/dL, respectively. NC-CLEIA aldosterone measurements werelinearly well correlated with LC/MS aldosterone measurements (N = 130, y = 1.027x - 0.23 ng/dL, Spearman’s ρ = 0.996, P&lt; 0.0001). Bland-Altmanplot analysis between NC-CLEIA and LC-MS/MS of aldosterone revealed a bias of 0.40 ng/dL with the limits of agreement of -4.60 and 5.41 ng/dLwith 95% confidence interval. Conclusion Our novel NC-CLEIA aldosterone assay was well-correlated and had only a very low bias with LC-MS/MSmethod and also was able to accurately quantify low level samples even in essential hypertension patients. This aldosterone assay can be a most equivalent to LC-MS/MS measurement with a low cost of 12 $ and a short measuring time of 30 minutes.
SAT-LB96 Chronic Kidney Disease Incidence and Cardiorespiratory Fitness Association in Patients With Diabetes And/Or Hypertension
Authors: Powell Joseph , Nylen Eric S , Myers Jonathan , Karasik Pamela , Moore Hans , Faselis Charles , Patel Samir , Samuel Imannuel , Kokkinos Peter 
Published: May 2020

Abstract
Introduction: Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are considered strong risk factors for developing chronic kidney disease (CKD). Increased cardiorespiratory fitness (CRF) is associated with lower CKD risk. However, the CRF-CKD association in patients with T2DM and/or HTN has not been assessed.Methods: We identified 9,751 patients (age 58.6 + 10.1 years) with T2DM (N=1,444) or HTN (n=5,031) or both (n=3,276) prior to a maximal standardized exercise treadmill test (ETT) and no evidence of ischemia as indicated by the ETT. We established four CRF categories based on age-adjusted peak metabolic equivalents (METs) achieved: Least-Fit (4.6±1.2 METs; n=2,231); Low-Fit Fit (6.4±1.1 METs; n=2,693); Moderate-Fit (8.0±1.0 METs; n=2,432); and High-Fit (10.8±2.1 METs; n=2,395). We performed multivariable Cox Regression analyses to access the risk of CKD according to fitness. The models were adjusted for age, body mass index (BMI), traditional risk factors and medications. Results: During the median follow-up of 12.4 years, 1,118 patients developed CKD, accounting for 9.1 events/ 1,000 person-years of observation. The association between CRF and CKD was inverse and graded. The risk of CKD was 21% lower (Hazard Ratio [HR] 0.79; 95% confidence interval [CI] 0.77-0.81). When CRF categories were considered, the CKD risk was 44% lower for Moderate-Fit patients (HR 0.56; 95% CI 0.48-0.67) and 80% lower for High-Fit (HR 0.20; 95% CI 0.15-0.25). Similar findings were noted in patients with both T2DM and HTN. Conclusions: We noted an inverse and dose-response association between CRF and CKD incidence. The risk was attenuated significantly beyond a mean peak MET level of 8.0±1.0, suggesting that moderate increases in exercise capacity confers favorable health benefits in patients at high risk of developing CKD.
MON-LB59 Radiofrequency Ablation as a Primary Therapy for Benign Functioning Insulinoma
Authors: Alyusuf Ebtihal Y , Ekhzaimy Aishah Ali , Alomair Basil 
Published: May 2020

Abstract
Background Insulinomas are rare life-threatening pancreatic neuroendocrine tumors. Surgical removal continues to be the treatment of choice for such benign cases with a high cure rate. However, surgery is associated with a considerable risk of morbidity and mortality.Here we describe a case of benign solitary insulinoma successfully treated with RFA in a patient who strongly refused surgery. Case Description A 56-year- old non- diabetic, male is known to have hypertension and lymphoma diagnosed at age of 20 years, in remission. He presented with recurrent episodes of transient ischemic attack and stroke over the last three years. A change in his cognitive function, behavior, and memory was noticed. During his hospital stay for the second episode of stroke, he was found to have hypoglycemia which was asymptomatic. Insulinoma was confirmed based on the followings: low plasma glucose level of 2.04 mmol/l (4.0- 5.6), inappropriately elevated plasma f insulin and C-peptide 68.9 mU/l (3-13) and 4.08 ug/l (1.0-3.1); respectively. Sulfonylurea screening test was negative. MRI of the abdomen showed a 3.2x2.5 cm, well-circumscribed hypervascular lesion at the uncinate process of the pancreas, which is compatible with neuroendocrine tumor. Treatment modalities have been explained to the patient who was fully informed about the risk and benefit of each treatment option. However, he strongly refused surgery. Meanwhile, he was admitted with a third attack of stroke with concurrent hypoglycemia. In view of his refusal of the surgical treatment and due to his recent stroke and high-risk status for surgery, the option of radiofrequency ablation was decided. RFA of the pancreatic tumor using 40.75 GY fractions was carried out with a favorable outcome. The patient achieved biochemical normalization and remains euglycemic during his follow up. Reversal of his cognitive, behavioral, and memory changes was recognized. CT abdomen during a follow-up of 2 months after radiation showed a mild regression of the size of the tumor with no evidence of new lesions or distance metastasis. He remained under close follow up at the neuroendocrine clinic.
Conclusion This case shows a treatment challenge which required the use of an alternative treatment option other than the standard of care in managing a case of benign insulinoma. Successful treatment was achieved in our case with the use of RFA rather than surgery. This report highlights the evolving evidence of nonsurgical RFA being a potential safe, feasible therapeutic modality option or even an alternative to surgery in selected cases of benign insulinoma. Because of the rarity of this tumor and low rate of therapeutic application of RFA in similar cases, the role of RFA had not been extensively studied. Large studies are needed to evaluate the long-term outcomes of RFA in this setting.
MON-LB52 Evaluation of Arterial Stiffness in Acromegaly Patients
Authors: alagüney sevil , Yorulmaz Goknur , Kalkan Toygar Ahmet , Mert Kadir Ugur , Dural Muhammet , Akalin Aysen , Efe Belgin , Kebapci Nur 
Published: May 2020

Abstract
Acromegaly is associated with increased morbidity and mortality primarily attributed to cardiovascular and cerebrovascular diseases, thus demonstrating the negative arterial impact of chronic GH and IGF-1 excess. There are limited and conflicting data regarding coronary artery disease (CAD) in acromegaly that consists mainly of heterogeneous cohorts and pathological reviews of old case series. Increased arterial stiffness is associated with an increased risk of cardiovascular events such as myocardial infarction. Arterial stiffness may measured from pulse wave velocity(PWV). In this study we aimed to evaluate the association between pulse wave velocity and aortic augmentation index in acromegalic patients. Methods: Our study population consists of a consecutive subset of 32 acromegalic patients and 19 control. Acromegalic patients IGF 1 levels were noted. All patients BMI, age, blood pressure, gender also were noted. Also pulse pressure, central blood pressures were measured by non-invasive central blood pressure measurement device (SphygmoCor). Pulse wave velocity and aortic augmentation index were measured by the same device. Results: A total of 32 acromegalic patients and 19 control were enrolled in the study. Body mass index and gender were not significantly different between the groups. Aortic augmentation index (5 vs. 6, p =0,685) variables weren’t significantly different in the study. Systolic and diastolic blood pressures were significantly high in the acromegalic group. (130/82 vs. 120/70) PWV was significantly high in the acromegalic group. (13 vs 11,5 p=0,002)Conclusions: Our study results suggest that acromegaly patients have worse arterial stiffness due to increased pulse wave velocity. Acromegaly is associated with increased morbidity and mortality primarily attributed to cardiovascular problems. We thought that it may be a guiding method in disease management since it can be an early marker of cardiovascular risk.Keywords: acromegaly, pulse wave velocity, aortic augmentation index