bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-745 Lower Serum Estradiol Levels in Assigned Female at Birth Transgender People with Initiation of Testosterone Therapy: Results from the European Network for the Investigation of Gender Incongruence (ENIGI)
Authors: Defreyne Justine , Aers Xavier-Philippe , Collet Sarah M , Wiepjes Chantal , Fisher Alessandra Daphne , Schreiner Thomas , Martin Den Heijer , T’Sjoen Guy G 
Published: May 2020

Abstract
Introduction: Aromatization of exogenous testosterone might result in increased estradiol levels. Concerns have been raised about undesired estrogenic effects in assigned female at birth (AFAB) transgender people. How serum estradiol levels change after initiation of testosterone therapy and if these levels should be monitored, remains unclear. Methods: This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Serum levels of sex steroids were assessed in 746 AFAB transgender people during a three-year follow-up period, starting at the initiation of hormone treatment. Results: Estradiol levels decreased from median [P25-P75] 45.5[24.0-102.2]pg/mL to 36.5[25.0-46.2]pg/mL over three years (P&lt;0.001), a change was already noticeable during the first three months (mean - 17.1 pg/mL, 95% CI -23.8 - -10.6, P&lt;0.001). Serum estradiol levels were lower in people without endogenous estradiol production (contraceptive users or post gonadectomy) at baseline and after three months, compared to people with endogenous estradiol production. Using long acting testosterone undecanoate injections resulted in a more prominent decrease in serum estradiol values over twelve months, compared to short acting mixed testosterone esters (P&lt;0.001) or testosterone gel (P=0.001). Changes in serum estradiol were positively correlated to changes in LH (ρ = 0.107, P&lt;0.001) and negatively correlated to changes in FSH levels (ρ=-0.167, P&lt;0.001) and body mass index (ρ=-0.082, P&lt;0.001). Conclusion: Testosterone administration in AFAB transgender people results in decreasing serum estradiol levels. Although an underlying mechanism for the observed decrease in serum estradiol levels remains difficult to fathom, our results suggest that testosterone administration suppresses endogenous estradiol production. The exception found in people without endogenous estradiol production may be attributed to aromatization of exogenous testosterone.
MON-383 A Study on the Oral Vitamin D Supplementary Treatment of Korean Children and Adolescents
Authors: Yang Seung 
Published: May 2020

Abstract
Purpose: Between 2017 and 2018, the prevalence rate of vitamin D deficiency (VDD) among children and adolescents in Korea (single institution) was 68.4 percent (59.6 percent for males and 72.5 percent for females). However, effective vitamin D supplements are not consistent in literature. We tried to find out about the dosage and the duration of the administration. Methods: The study was conducted on 2,770 children aged 0-18 who tested serum vitamin D concentrations for outpatients and inpatients at our hospitals from August 2017 to July 2019. One group was treated with maintenance doses and the other group was treated with maintenance doses after oral vitamin D 2000 IU/d for six weeks. The maintenance dose was 400 IU/d before puberty and 1000 IU/d after puberty. Results: There was a significant correlation between serum 25(OH) vitamin D concentration and gender, age, season, weight SDS and BMI SDS (p=0.000, p=0.000, p=0.000, p=0.000, p=0.002, respectively). After 6 months of oral Vitamin D treatment, serum 25 (OH) Vitamin D concentration was increased in both groups (p=0.000, p=0.000, respectively). In a group treated with maintenance doses after oral vitamin D 2000 IU/d for six weeks, it was found a higher rate of change to vitamin D sufficiency (p=0.000). Conclusions: The prevalence rate of VDD increases in female, older age, overweight and winter. The serum 25 (OH) vitamin D concentration increased in both groups after 6 months of treatment. In VDD children, It seemed appropriate to take an oral Vitamin D 2000 IU/day for 6 weeks before maintenance treatment according to the current guideline treatment.
SUN-055 Prenatal Exposure to Artificial Sweeteners
Authors: Halasa Brianna C , Sylvetsky Allison , Conway Ellen M , Walter Peter J , Cai Hongyi , Walter Mary F , Schouppe Eileen , Hui Lisa , Rother Kristina I 
Published: May 2020

Abstract
Introduction: In adults, epidemiologic studies consistently show negative health outcomes (e.g. insulin resistance, stroke) related to artificial (or non-nutritive) sweetener (NNS) intake. In children, NNS sweetened beverage consumption is associated with higher total energy and sugar intake. In infants, we documented the immediate appearance of NNS in breast milk after mothers consume diet soda. A positive association between prenatal NNS exposure and higher BMI at 1 year of life has been observed in infants whose mothers routinely consumed NNS during pregnancy. In mice, we recently reported marked changes in intestinal microbiome and hepatic detoxification pathways of pups that had been exposed to NNS via their mothers’ intake during pregnancy and lactation. Thus, we conducted a pilot project to determine whether there is direct evidence for prenatal NNS exposure in humans. In future studies, we will investigate effects on health outcomes.
Methods: Concentrations of 3 NNS (acesulfame-potassium (ace-K), sucralose and saccharin) were measured with liquid chromatography-mass spectrometry in cord blood samples (n=15) and amniotic fluid samples (n=13). Aspartame cannot be measured because of its prompt metabolism into aspartic acid and phenylalanine. The cord blood samples were obtained from offspring of women enrolled in a sickle cell clinical trial at the NIH, while the amniotic fluid samples had been obtained for clinical purposes during the 3rd trimester. No dietary information was available other than 2 of 13 women were not in the fasting state when undergoing amniocentesis.
Results: In the cord blood samples, ace-K and saccharin were present in 12/15 (80%) samples. None of the samples contained sucralose. In the 13 amniotic fluid samples, 10 (77%) samples contained at least one sweetener. One sample was positive for all 3 sweeteners. Maximum concentrations in cord blood were 6.5 ng/mL for ace-K and 2.7 ng/mL for saccharin, while maximum concentrations in amniotic fluid were 78.9 ng/mL for ace-K, 55.9 ng/mL for saccharin, and 30.6 ng/mL for sucralose (non-fasting sample). Most women were in the fasting state before undergoing amniocentesis or giving birth, thus NNS peak concentrations could not be determined in this pilot study.
Discussion and Conclusion: 80% of cord blood samples (babies’ blood) and 77% of amniotic fluid samples (reflecting babies’ direct gastrointestinal/lung exposure) contained ace-K, saccharin and/or sucralose. We speculate that NNS exposure may influence in utero growth and development, e.g. sweet taste preference and metabolic pathways. Prospective studies are necessary to test these hypotheses. Results will determine whether current recommendations (or lack thereof) regarding NNS intake during pregnancy and lactation need to be revised.
MON-591 Effect of Liraglutide Treatment on Proglucagon-Derived Peptides
Authors: Kim Sun , Abbasi Fahim , Nachmanoff Clara , Kumar Ajay , Kalra Bhanu , Savjani Gopal , Mantzoros Christos 
Published: May 2020

Abstract
Liraglutide is a glucagon-like peptide 1 receptor agonist (GLP-1ra) and has 97% homology to native GLP-1. Native GLP-1 derives from proglucagon, which is also a prohormone for other peptides including GLP-2, glucagon, oxytomodulin, glicentin, and major proglucagon fragment. Aside from GLP-1 and glucagon, the actions and roles of the other proglucagon-derived peptides remain unclear. In addition, the effect of liraglutide treatment on these peptides are unknown. The aim of this study was to evaluate the effect of treatment with liraglutide compared with placebo on proglucagon-derived peptides. Adults who were overweight/obese (BMI 27-40 kg/m2) with prediabetes were randomized to liraglutide 1.8mg daily vs placebo for 14 weeks. All participants met regularly with a registered dietitian and were advised to decrease calorie intake by 500 kcal/day. Proglucagon-derived peptides were measured during mixed-meal tolerance test (MMTT) at baseline and after 14 weeks in a subset of individuals with saved samples (n=16 on liraglutide, n=19 on placebo). The MMTT involved eating breakfast at 08:00 (20% of daily energy intake) and lunch at 12:00 (40% of daily energy intake). Blood was collected before breakfast and hourly from 08:00 to 16:00. The area-under-the curve (AUC) was calculated for all proglucagon-derived peptides using the trapezoidal method. Individuals treated with liraglutide lost twice as much weight as those assigned to placebo injections (mean ± SD, 6.1 ± 1.9 vs 3.2 ± 2.2 kg, p&lt;0.002). Treatment with liraglutide also was associated with a significant (p &lt; 0.01) decrease in all proglucagon-derived peptides. In the placebo group, only glucagon AUC significantly decreased after 14-weeks (P=0.002). Our study demonstrates for the first time that liraglutide treatment is associated with decrease in proglucagon-derived peptides, suggesting downregulation of endogenous proglucagon. The effects of this downregulation are unknown and need further study.
MON-505 Quantitative Characteristics and Sonographic Patterns Before and After Thyroid Radiofrequency Ablation
Authors: Wu Ming-Hsun 
Published: May 2020

Abstract
Although most thyroid nodules (TNs) are benign and require only serial observation, some may need treatment for symptoms. Radiofrequency ablation (RFA) has been used and shown to be a promising and well-tolerated new approach. The efficacy of RFA is evaluated by using parameters such as volume reduction ratio (VRR), and cosmetic or symptomatic improvement. However, no index is now available to predict the therapeutic success before RFA. And apart from size reduction, little is known about their ultrasonography (US) appearances after RFA. The purpose of this study was to 1) assess the effectiveness of single session RFA treatment on volume reduction 2) determine if quantitative US characteristics are correlated to the VRR 3) demonstrate the US characteristics from the baseline and during the follow-up. Quantification of characteristics was performed using commercial software. The CAD software classified nodules into the 2015 ATA sonographic patterns and TIRADS categories. All patients underwent a single treatment session and with significant improvement in cosmetic and pressure symptoms. It shows that there is a direct correlation between the initial tumor size/cyst component percentage and VRR. The US characteristics are significant different after RFA, and the tumors were categorized to more suspicious ATA patterns and had higher TIRAD scores. In conclusion, RFA is effective on volume reduction and US characteristics correlated with therapeutic success. Post RFA US features may potentially mislead and clinicians should always keep in mind.
SUN-510 Prolonged RAIA Induced Thyroiditis After 131 I Therapy for Graves’ Hyperthyroidism
Authors: Aljaberi Asma Khaled , Boharoon Hessa 
Published: May 2020

Abstract
Radioactive iodine ablation (RAI) has been used for the treatment of Graves’ hyperthyroidism since 1946 and it is the primary recommended modality for Graves’ disease treatment in many countries. Acute painful radiation thyroiditis after radioiodine treatment for hyperthyroidism of Graves’ disease is considered uncommon. The prevalence is 1-5% in patients treated with 131I therapy for hyperthyroidism. Dose of RAI and thyroid volume can be precipitating factors for post radiation thyroiditis. The higher RAI dose increases the chance of RAI thyroiditis while the larger goiter size decreases the absorbed radiation dose in the thyroid gland. We present a 25-year-old Emirati male previously healthy, who was referred to our service for hyperthyroidism management. He presented with thyrotoxicosis in absence of goiter. All investigations revealed that graves’ disease is the primary cause of his hyperthyroidism. He was treated with RAI ablation 18.3 mCi. Day four after RAI, he presented with severe pain in the anterior neck associated with fatigue, tremor, palpitation and weight loss. Symptoms lasted for 6 weeks post RAI. There was laboratory evidence of thyrotoxicosis presented with further suppression of TSH and higher fT4 than the baseline. Acute radiation thyroiditis was diagnosed and has been commenced on propranolol 10mg BID. Symptoms completely resolved after 6 weeks of treatment and thyroid function returned to normal level. The patient has remained asymptomatic on continued follow up care till eventually became hypothyroid clinically and biochemically. Our case reflects that radioiodine thyroiditis can last for longer period and occur after larger doses of 131I treatment in absence of goiter. Our patient has RAIA induced thyroiditis lasted for 6 weeks post 18.3mCi of 131I, and has no goiter, which were both contributing factors for RAIA induced thyroiditis
SAT-676 Pembrolizumab Induced Worsening Glycemic Control and DKA in Type 2 Diabetes Mellitus
Authors: Goud Sarita , Thar Yu Yu 
Published: May 2020

Abstract
INTRODUCTION Pembrolizumab(Keytruda) is a humanized IgG4 anti-programmed cell death-1 (PD-1) antibody serving as an immune-checkpoint inhibitor, now approved by FDA to treat several types of cancer.
Although there are few reported cases of pembrolizumab induced new onset DKA in a non diabetic patients due to its autoimmune nature, its association in worsening glycemic control and DKA in pre-existing type 2 Diabetes mellitus is not well established.
CASE 79 years old female with past medical hx of DM type 2 (Hba1c 7.4 was started on metformin), COPD(on chronic steroids and trilogy machine at home), recently diagnosed with poorly differentiated adenocarcinoma of the left lung, metastasis to liver, PDL 1 positive at 99%, started on palliative chemotherapy with Keytruda, 2 weeks after the third cycle of keytruda presented to the ED for AMS. Patient noted to be very dehydrated, somnolescent and tachypnea. Labs consistent with sugars &gt; 600, potassium 6.8, Bicarb 5, Anion gap 33, beta hydroxybutyrate 11.5 (on 7/15/19 0.6), HbA1c 9.7,(On 12/15/16 7.3, 9/25/18 6.7, 1/22/19 7.4). PH 7.31, lactate 2.4. WBC count 21.5- no infectious source identified (CXR, CT brain, UA clean). Patient was admitted for DKA and treated with IV insulin and IV fluids. After medically stable patient was discharged with Insulin regimen. Within 5 days after being discharged, patient presented to ED again with DKA with PH 7.27, Bicarb 8, anion gap 22, sugars&gt;600, beta hydroxybuterate 13.70. Patient was Rx for DKA- after a week of hospitalization was discharged to Hospice(due to metastatic cancer) and few weeks later expired.To summarize, pt with well controlled type 2 DM on metformin presented with frequent DKA 2 weeks after treatment with third cycle of keytruda leading to worsening glycemic control in-turn making patient Insulin dependent.
CONCLUSION Incidence of Type 1 DM with pembrolizumab treatment is being increasingly recognized and reported, and DKA is a common initial presentation. However we need further studies to establish the mechanism of worsening glycemic control leading to Insulin dependent and DKA in patients with pre-existing type 2 diabetes.
Also, physicians should counsel patients about this potential immune related adverse effect and educate them about the symptoms of hyperglycemia and DKA.
REFERENCES Immune checkpoint inhibitors and type 1 diabetes mellitus: a case report and systematic review Jeroen M K de Filette1, Joeri J Pen2, Lore Decoster3, Thomas Vissers4, Bert Bravenboer1, Bart J Van der Auwera5, Frans K Gorus5, Bart O Roep6,7, Sandrine Aspeslagh3, Bart Neyns3, Brigitte Velkeniers1 and Aan V Kharagjitsingh1,2,5,8
Immune checkpoint inhibitors: an emerging cause of insulin-dependent diabetes. Anupam Kotwal1, Candace Haddox2, Matthew Block3, Yogish C Kudva1. BMJ open Diabetes and research, Vol 7, issue1.
OR07-03 Continuous Subcutaneous Delivery of RhPTH(1-84) by Pump in Adults with Hypoparathyroidism
Authors: Bove-Fenderson Erin , Wong Daniel , Cusano Natalie Elissa , Mannstadt Michael 
Published: May 2020

Abstract
More than 80,000 people in the United States have hypoparathyroidism, a disease of low or absent parathyroid hormone (PTH) leading to hypocalcemia and hyperphosphatemia. Conventional treatment with oral calcium and active vitamin D increases serum calcium concentrations but does not replace the physiologic functions of PTH. Once-daily subcutaneous injections of recombinant human (rh) PTH(1-84) were recently approved for the treatment of hypoparathyroidism, but are not consistent in correcting biochemical abnormalities and alleviating symptoms for all patients. In cases in which single or multiple daily injections of rhPTH(1-84) are insufficient for controlling symptoms, continuous subcutaneous infusion via insulin pump is used as a therapeutic alternative. Pump therapy with PTH(1-34) has some support in the literature as an effective form of treatment for hypoparathyroidism.1However, the effects of pump therapy with rhPTH(1-84) in patients with hypoparathyroidism have not been reported. Five women with chronic postsurgical hypoparathyroidism who received treatment at three different endocrine outpatient clinics in the United States were transitioned from multiple daily injections of rhPTH(1-84) to continuous delivery of rhPTH(1-84) using the Omnipod insulin pump. The patients’ ages ranged from 27 to 60 years old and all had had hypoparathyroidism for at least 5 years. All of the patients were transitioned from conventional therapy with oral calcium and calcitriol to subcutaneous injections of rhPTH(1-84), and then switched to continuous subcutaneous administration using an insulin pump. In all five patients, increased serum calcium concentrations and decreased serum phosphate concentrations were observed with increased frequency of PTH administration. Serum calcium concentrations were within the normal to high-normal range and serum phosphate concentrations were in the normal range on pump therapy. Urinary calcium was well-controlled (&lt;250 mg/day) in four of the five patients. All of the women reported a decrease in symptoms while receiving pump-administered rhPTH(1-84), including a lower incidence of fatigue, brain fog, tingling, and muscle cramps compared to standard therapy and daily injections. This is the first report of patients with hypoparathyroidism on long-term therapy with continuously infused subcutaneous rhPTH(1-84) using a pump. Pump therapy improved key parameters of mineral metabolism; normalizing serum calcium in all patients and urinary calcium in four out of five patients. Clinical trials with larger cohorts are needed to confirm the efficacy of this promising mode of administration of rhPTH(1-84). Reference: 1. Winer KK. Advances in the treatment of hypoparathyroidism with PTH 1-34. Bone. 2019;120:535-541.
SUN-174 Giant Bilateral Myelolipomas in a Patient with Congenital Adrenal Hyperplasia
Authors: Duro Teodor , Palinka Bethany , Gomez Nephtali , Codorniz Kevin Anthony 
Published: May 2020

Abstract
INTRODUCTION Adrenal myelolipomas are rare, benign adrenal tumors composed of adipose and hematopoietic tissue. The first mass was identified by Gierke in 1905 and named by Oberling in 1929. Myelolipomas often coexist with CAH and other hormonal disorders although this relationship is still unclear. We present a rare case of giant bilateral myelolipomas in a patient with CAH. CASE REPORT A 28-year-old female with a history of CAH due to 21-hydroxylase deficiency diagnosed at birth presented to our endocrinology clinic after being lost to follow up for 4 years and a history of poor follow up for several years before that. She reported being on varying doses of hydrocortisone throughout her life with the most recent being 10mg TID with poor adherence. Over the past 4 years, the patient noticed increased hair growth on her face, abdomen, inner thighs and back, abdominal striae, and weight gain of 80-100lbs. She also reported a history of bilateral flank pain for the last several years, requiring several ER visits where she was told she had adrenal nodules based on scans that were done. A few months prior to her first visit to our clinic she developed increasing flank pain, which prompted a visit to a local ER. A CT of the abdomen revealed bilateral adrenal septated complex cystic masses measuring 19x12x20 cm on the left and 12x11x11 cm on the right. Initial biochemical workup was consistent with poorly managed CAH: ACTH 45.2 pg/mL (n 7.2 - 63.3), total testosterone 401 ng/dl (n 8-48), androstenedione 2085 ng/dl (n 41-262), 17-OH progesterone 18880 ng/dl, (n 15-290), DHEA-sulfate 423.5 ug/dl, (n 84.8-378), and estradiol 72.0 pg/dl, (n 12.5-498). Plasma renin activity was 13.904 ng/mL/hr (n 0.167-5.380 ng/mL/hr). Based on laboratory results hydrocortisone was decreased to 10mg BID and dexamethasone was added. Due to severe recurrent pain the patient underwent bilateral adrenalectomy. On pathology the bilateral masses were found to be myelolipomas with the left diameter measuring 22.3 cm and the right measuring 16.5 cm. Post-operatively her lab values showed significant improvement compared to her initial workup: ACTH 4.1 pg/mL, total testosterone 6.7 ng/dl, androstenedione 73 ng/dl, 17-OH progesterone 29 ng/dl, DHEA sulfate 7.2 ug/dl, and estradiol 228.3 pg/dl. Plasma renin was also within normal range at 1.776 ng/mL/hr. On follow up, the patient had recovered well and reported improvement in her flank pain. CONCLUSION This is a rare case of giant bilateral adrenal myelolipomas. Despite these tumors being benign and often asymptomatic, they are clinically relevant due to their role in the differential diagnosis of an adrenal mass. The presence of megakaryocytes in a biopsy specimen of a fatty adrenal mass is pathognomonic for myelolipoma. Treatment is guided by the tumor size and patient presentation; masses &gt;7 cm, hormonally active, or causing abdominal pain should be surgically removed as demonstrated in this case