bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-261 Thyroid Stimulating Hormone-Secreting Pituitary Macroadenoma and Papillary Thyroid Cancer in a 55-Year-Old Male: A Case Report
Authors: Mislang Francis Xavier Fernandez 
Published: May 2020

Abstract
Background: Thyroid-Stimulating Hormone Secreting Pituitary Adenoma (TSHoma) is a rare Endocrinologic finding occurring in 0.5–3% of all pituitary adenomas, and is even rarer to find it coexisting with differentiated thyroid cancer.
Clinical Case: A 55-year-old male consulted last 2012 for palpitations and resting tachycardia. Initial tests revealed an ECG of sinus tachycardia, normal electrolytes and TSH 3.16 uIU/mL (0.27–4.2) and FT4 66 pmol/mL (12–22). He was referred to an Endocrinologist where thyroid ultrasound was done revealing bilaterally enlarged thyroid lobes with diffuse thyroid parenchymal changes, and a thyroid scan consistent with Graves’ Disease. He was started on methimazole and beta-blockers. Persistently elevated FT4 and a non-suppressed TSH prompted work-up for secondary hyperthyroidism. Pituitary MRI revealed a sellar mass measuring 3.4cm x 2.7cm x 2.6cm, noted to be compressing the left side of the optic chiasm and prechiasmatic left optic nerve laterally. The consideration was pituitary macroadenoma. He underwent trans-sphenoidal surgery but operative technique only involved near total excision of the adenoma due to proximity of the mass to the pre-chiasmatic left optic nerve. The tumor was reduced to 2.8cm x 1.6cm x 1.5cm. Histopathologic diagnosis and immuno-histochemical staining revealed pituitary tumor cells reactive to TSH but non-reactive to FSH, LH and GH. He eventually underwent intensity-modulated radiation therapy (IMRT) which reduced the tumor size, but did not obliterate the tumor. His thyroid function tests persistently revealed elevated TSH and FT4 levels. Last January 2019, he manifested with an enlarged anterior neck mass. An ultrasound revealed thyromegaly with multiple nodules, largest at 1.4cm with multiple sub-centimeter nodules, mostly complex and solid in description. He underwent total thyroidectomy. Histopathology results revealed Papillary Thyroid Cancer with no extracapsular or lymphovascular invasion. He was scheduled for radioactive iodine at 100mci a month after. His I-131 whole body scan revealed foci of residual thyroid tissue but without distant mestastases. He is currently on levothyroxine at 225mcg daily therapy and advised annual cranial MRI readings which mostly showed a stable pituitary tumor.
Conclusion: This is a case of TSHoma, S/P trans-sphenoidal surgery and intensity modulated radiation therapy with significant tumor residuals that eventually led to the development of Papillary Thyroid Cancer and subsequent total thyroidectomy and radioactive iodine administration. He is now on frequent tumor monitoring and levothyroxine suppression dose.
Reference:
P. Beck-Peccoz, A. Lania, A. Beckers, K. Chatterjee d, J.-L. Wemeau. 2013 European Thyroid Association Guidelines for the Diagnosis and Treatment of Thyrotropin-Secreting Pituitary Tumors. Eur Thyroid J 2013;2:76–82.
MON-387 Association Between Vitamin D Level and Bone Mineral Density in Korean Adolescents
Authors: Song Kyungchul , CHOI Han saem , Suh Junghwan , Kwon Ah Reum , Chae Hyun-wook , Kim Ho-Seong 
Published: May 2020

Abstract
Introduction
Fractures are common in pediatric population, and lower bone density increases the risk of fracture. Most bone acquisition happens during youth, so juvenile bone mineral density (BMD) assessment is important. There are many factors associated with low BMD, including vitamin D status, calcium intake, low body weight, and physical activity. Among these, our investigation focused on the association of BMD with vitamin D in adolescents.
Methods
This study investigated data of 1,063 adolescents aged 12-18 years from the fifth and sixth Korea National Health and Nutritional Examination Survey (2009-2011). The association of various factors (vitamin D level, calcium intake, body mass index (BMI), lean mass, fat mass, and physical activity) with BMD Z-scores in whole body, lumbar spine, total femur, and femur neck were analyzed. We defined vitamin D deficiency (≤ 12 ng/mL), vitamin D insufficiency (12-20 ng/mL), and sufficiency (&gt; 20ng/mL) according to the 25-hydroxyvitamin D (25-OHD) level. We analyzed association between BMD and vitamin D levels after adjusting for other factors.
Results
The mean 25-OHD level of subjects was low (16.28 ng/ml). Of all subjects, 21.9% were vitamin D deficient, and 58.5% were vitamin D insufficient. Among the vitamin D groups, the vitamin D sufficient group had significantly higher BMD Z-scores than the vitamin D deficient group in whole body, lumbar spine, and femur neck. The sufficient vitamin D group had higher BMD Z-score than the vitamin D insufficient group in femur neck, and the vitamin D insufficient group had higher BMD Z-score than the vitamin D deficient group in whole body. Among various factors, vitamin D status, calcium intake, BMI, lean mass, fat mass, and physical activity were positively associated with BMD Z-scores. In particular, lean mass was the strongest independent factor. Vitamin D levels were positively associated with the BMD Z-scores even after adjusting for other factors.
Conclusions
Vitamin D deficiency and insufficiency were common among adolescents. This study suggested that vitamin D level was positively associated with BMD, and that sufficient vitamin D level was needed to prevent low BMD. Vitamin D status is an important factor of BMD in adolescents.
SUN-656 Hypoglycemic Effect of Oral Administered Superoxide Dismutase
Authors: Liu Shutao , Liu Hangqi 
Published: May 2020

Abstract
Hypoglycemic Effect of Oral Administered Superoxide Dismutase on Type 2 Diabetes via reduction of glucogan and insulin resistance
Background & Objective: Superoxide dismutase (SOD) is carefully used in food industry for the concern of its easy degradation and difficult adsorption in digestive tract, although it plays central role in antioxidant system. It is previous reported that orally administered SOD was effective in alleviating hyperglycemia, cerebral ischemia-reperfusion and chronic hepatitis. This work aimed to investigate in-depth the hypoglycaemic effect and possible mechanism of orally administered SOD in the model of type 2 diabetic rats.
Methods:The model of type 2 diabetic rats were divided into 6 groups and orally administered with different Cu/Zn-SOD (abbreviated as SOD) samples and negative or positive controls. The 6 groups included SOD, SOD hydrolysate (pepsin-treated SOD), L-SOD (liposome-embedded SOD), model group and metformin positive groups, as well as normal group. Results of the body weight, serum indexes (including blood glucose, glycated albumin, insulin, glucagon, AMPK, MDA), SOD enzymatic activity in organs (liver, heart, kidney, skeletal muscle, spleen, and pancreas) as well as intestinal density and HE staining were measured to evaluate the hypoglycemic effect and possible mechanism.
Results: SOD showed substantial hypoglycemic effect and improved serum indicators. Moreover, L-SOD group exhibited better effect than SOD group, though the effect of SOD hydrolysate was not obvious. Colon density and HE staining showed obvious intestinal injury in the model group, and SOD was beneficial to repair intestinal structural integrity. Furthermore, the reparative effect of SOD was much better than that of the SOD hydrolysate, but not as good as that of the L-SOD. The SOD enzymatic activity of tissues was positively correlated with the curative effect of three kinds of SOD samples. The contents of serum MDA were negatively correlated with the curative effect. Compared with the model group, the insulin resistance index of SOD group, L-SOD group and positive group were significantly reduced; and glucagon significantly decreased by 68.38, 77.50 and 65.01%, respectively.
Conclusion: Oral SOD showed obvious hypoglycemic effect on type 2 diabetic rats, and liposome could improve this effect. The mechanism may be that SOD effectively reduces intestinal injury, so as to reduce glucongen and insulin resistance index.
MON-502 Clinical-Pathological and Molecular Prognostic Markers in Aggressive and Poorly Differentiated Thyroid Cancers; A Tertiary-Center Experience
Authors: Radi Suhaib , Filimon Sabin , Tamilia Michael 
Published: May 2020

Abstract
Background:
Aggressive variants of papillary thyroid cancer (AV-PTC) and poorly differentiated thyroid cancers (PDTC) are 2 malignancies that lie in between the well-differentiated and the undifferentiated anaplastic cancers. While management of those well-differentiated cancers is established in the literature, that of AV-PTC and PDTC is less clear as they behave different to their more benign counterparts. The aim of this study is to describe the clinico-pathologic characteristics and genotypic background of AV-PTC and PDTC and to assess their prognostic value.
Methods:
The charts of all patients with thyroid cancer in our center for the last 10 years were retrospectively reviewed. Those with AV-PTC and PDTC were selected and included in the analysis. Clinical presentation, pathologic characteristics, molecular markers, specific treatments and clinical outcomes were compared among groups.
Results:
Out of 3244 thyroid cancer charts reviewed, 87 patients met the criteria for AV-PTC (n=45) and PDTC (n=42). Mean age at diagnosis was 48.1 years (SD 17.8), with female predominance (64.4% vs 35.6%). Median duration of follow up was 3 years (0.1-30). Out of the 75 patients with follow up for more than a year, 42.7% had either persistent disease or recurrence (52.6% in AV-PTC and 32.4% in PDTC) and 4.1% died. Presence of vascular invasion was associated with higher rates of persistent or recurrent disease (74.1% in positive vascular invasion vs 20.5% in negative vascular invasion, p &lt; 0.001). Recurrence rate was 0% in patients with Ki67 &lt; 10% and 40% in those &gt;= 10%. There was no difference in terms of recurrence based on presence of BRAF mutation (33% in BRAF+ & 29% in BRAF-, p=1), or percentage of aggressive/poorly differentiated tumor involvement (48% in &gt; 30% involvement vs 28% in &lt; 30%, p = 0.132).
Discussion and conclusion:
The prevalence of AV-PTC and PDTC in this cohort was low at 1.3% each, and the rate of patients with persistent or recurrent disease at 1 year after primary therapy was also similar to that reported (42.7%). The mortality rates, however, in our study is surprisingly lower than that expected elsewhere (4.1%), most likely attributed to a shorter follow up period. Patients with absent vascular invasion were less likely to have persistent or recurrent disease. Those with lower Ki67 (&lt;10%) also had lower relapse rate, although, the p value was &gt; 0.05. It is worth mentioning that even though there were higher rates of recurrence among those with &gt; 30% tumor involvement, it did not reach statistical significance, supporting recent studies stating that even tumor involvement of &gt; 10% can have adverse outcomes. In conclusion, AV-PTC and PDTC are relatively rare but aggressive tumors. Possible prognostic markers that can be used to guide therapy and monitoring include: vascular invasion, extra-thyroidal extension, response to primary therapy and the proliferative index Ki67.
SAT-566 Avoiding the Heartache: A Case of Familial Hypercholesterolemia
Authors: Kinaan Mustafa , Rivera Arelys Ramos , Yau Hanford 
Published: May 2020

Abstract
More than 70% of individuals with atherosclerotic cardiovascular disease are believed to have underlying gene-linked mechanisms leading to hyperlipidemia. It is estimated that 1 in 200 individuals in the United States has heterozygous Familial Hypercholesterolemia (FH). We present a case that highlights the importance of comprehensive care for a patient with heterozygous FH, from screening and risk stratification, to therapy. Our patient is a 43-year-old gentleman with history of hyperlipidemia. At age 25, he was diagnosed with hyperlipidemia and was started on statin therapy. He has strong family history of cardiovascular disease. His mother had her first myocardial infarction (MI) at age 40 and required coronary artery bypass. She also suffered from three strokes. His maternal aunt and uncle suffered from MIs at age 38 and 40, respectively. Additionally, his maternal grandfather passed away from MI at age 38. The patient’s daughter was found to have total cholesterol level &gt; 300 mg/dL at age 8. He does not have history of obesity, diabetes, previous cardiovascular events, or hypothyroidism. He is athletic and follows a healthy diet. He did not have any xanthomas, xanthelasmas, nor arcus cornealis. At time of initial evaluation, the patient had low-density lipid (LDL) level of 180 mg/dL despite therapy with rosuvastatin, ezetimibe, and niacin. Based on these findings, we proceeded with genetic testing. Results of testing showed a heterozygous c.6delG (p.Trp4Glyfs*202) pathogenic mutation of the LDL receptor. We also obtained cardiovascular risk stratification studies. On cardiac CT angiogram, he was found to have extensive, four-vessel disease with 80-90% stenosis of the left ascending artery (LAD) with coronary calcium score of 136 and total score of 219 (99th percentile). Exercise, stress myocardial perfusion scan showed small reversible anteroseptal perfusion abnormality suggestive of mild to moderate ischemia. LAD stenosis was confirmed on a left heart catheter, but no intervention was required. We proceeded with aggressive lipid-lowering therapy with rosuvastatin 40mg daily and alirocumab 300mg monthly. He was also started on aspirin and beta-blocker given coronary artery disease. Following initiation of therapy, the patient’s LDL level dropped to 51 mg/dL with total cholesterol level of 153 mg/dL, HDL of 47mg/dL, and triglycerides of 109 mg/dL. The patient was encouraged to seek genetic counseling for his children and first degree relatives. His daughter was started on rosuvastatin 7.5mg daily by her pediatrician. The patient has not suffered any cardiovascular events and continues to follow up for therapy. Without aggressive lipid-lowering therapy, the lifespan of FH patients can be significantly shortened. Therefore, identifying FH patients is imperative to prevent cardiovascular disease in these patients and their afflicted family members.
MON-605 Serum CD163, but Not Gal-3, Predicts Response to Liraglutide Therapy in Obese Patients
Authors: Mat Arimin , Tobin Laura , Hogan Andrew , O’Shea Donal Brendan 
Published: May 2020

Abstract
Liraglutide is a GLP-1 Receptor Agonist licensed to treat T2DM and obesity. Soluble CD163 (sCD163) is a marker of macrophage activation, the integral immunological component in inflammation associated with obesity. Gal-3 is a β-galactoside-binding lectin that has been implicated in the development of cardiovascular diseases and insulin resistance. Recent studies have suggested that Gal-3 is raised in obesity with levels correlating with markers of inflammation.
In this study, we aim to elucidate if the levels of sCD163 and Gal-3 can be used to predict treatment outcomes of Liraglutide in obese patients.
Thirty-four obese patients (58.8% female; 44.1% diabetic) were enrolled for 12-week Liraglutide therapy. Anthropometric parameters were assessed before and after. Serum levels for sCD163 and Gal-3 were measured using ELISA.
Pre-treatment age (mean ± SD) was 52.41 ± 10.74y, BMI was 44.97±7.71 kg/m2, HbA1c was 47.18±15.96 mmol/mol, sCD163 was 284059.20 ± 71859.88 pg/ml and Gal-3 was 6584.83 ± 3477.59 pg/ml. Post-treatment, BMI reduced to 43.19±7.92 kg/m2 (p &lt; 0.001), HbA1c to 43.59±16.00 mmol/mol (p&lt;0.001), sCD163 to 249130.45 ± 57972.85 pg/ml (p&lt;0.001) and Gal-3 to to 6254.23 ± 3282.66 pg/ml (p&lt;0.03). We found that pre-treatment sCD163 levels correlate weakly with BMI and HbA1c (r=0.3 & 0.4) while Gal-3 correlates moderately with age only (r=0.36). Percentage of changes in HbA1c (∆HbA1c) correlates strongly with ∆sCD163 (r=0.6). Levels of pre-treatment sCD163 correlates strongly with higher ∆sCD163 (r=0.7). Changes in BMI post-treatment (∆BMI) is negatively correlated with initial sCD163 levels (r=-0.3) and is not correlated with ∆sCD163.
Liraglutide treatment leads to significant improvement in sCD163 and Gal-3 levels in obese patients. Patients with high HbA1c have high levels of sCD163. Reduction in sCD163 predicts reduction in HbA1c. Higher initial sCD163 levels predicts poor weight improvement. Patients most likely to have reduction in sCD163 are the ones with higher initial sCD163 levels. We conclude that sCD163 but not Gal-3 levels can predict response to liraglutide in obese patients.
MON-587 A Case of Pseudoglucagonoma Syndrome Post Bariatric Surgery
Authors: Raghunathan Sapna , Akkireddy Padmaja 
Published: May 2020

Abstract
Introduction
Necrotizing migratory erythema (NME) is hallmark clinical finding of Glucagonoma, an islet cell tumor of the pancreas. NME can sometimes be seen in the absence of Glucagonoma, a condition referred to as Pseudo-glucagonoma syndrome(PGS). We report a case of NME associated with severe nutritional deficiency.
Case
48 y/o female presented to dermatology clinic with diffuse itchy rash of 6 months duration. The rash started on the arms and spread to involve lower abdomen, legs and perioral area. It was unresponsive to both topical and high dose PO steroids. Biopsy of the rash showed confluent parakeratosis and mild spongiosis secondary to nutritional deficiencies vs NME. Her medical history was significant for Nissen fundoplication 20 years ago with a revision to Roux-en Y gastric by-pass, 6 years ago. She did not have a history of Diabetes or Inflammatory Bowel Disease. She was not on any vitamin supplementation, as she did not follow up for post bariatric care. On admission to the hospital for sepsis from secondary infection of the rash, diffuse erythematous, eczematous papules and plaques were noted on bilateral forearms, thighs, calves, buttocks and ankles. She also had perioral erythema and fissuring. Laboratory evaluation showed low prealbumin and multiple nutritional deficiencies including copper, zinc, vitamin B6, Vitamin D, ferritin. Her HbA1c was 5.8 % and fasting glucagon levels were normal. Her liver function was initially normal but later developed transaminitis from septic shock. She was started on enteral feeds with nutritional supplementation. This resulted in significant improvement of her rash with correction of underlying nutritional deficiencies.
Discussion
NME in the absence of Glucagonoma is extremely rare and is seen in hepatic cirrhosis, malabsorption disorders, inflammatory bowel disease and nutritional deficiencies including zinc deficiency, Pellagra, Kwashiorkor. Though the exact mechanism for NME in these conditions is unclear. It is postulated that unabsorbed nutrients in the gut lumen are potent stimulators of enteroglucagon which in turn mediates the development of NME. The treatment of NME associated with PGS is to correct the underlying cause. Our patient had history of gastric bypass surgery and did not get routine post bariatric care. She presented with multiple nutritional deficiencies which likely caused NME. It is important to recognize that post bariatric surgery, patients are at risk for both macro and micronutrient deficiencies and hence need frequent nutrition assessment, supplementation and monitoring.
References
Tierney EP, Badger J. Etiology and pathogenesis of necrolytic migratory erythema: review of the literature. MedGenMed 2004
SUN-307 Partial Secondary Adrenal Insufficiency and Growth Hormone Deficiency in Fibromyalgia
Authors: Gruber Lucinda , Nanda Sanjeev , Nippoldt Todd B , Chang Alice Y , Bancos Irina 
Published: May 2020

Abstract
Introduction: Low or borderline cortisol concentrations and impaired response to dynamic testing have been reported in patients with fibromyalgia, potentially related to hypothalamus-pituitary dysfunction.1,2 Superimposed adrenal insufficiency (AI) may contribute to some fibromyalgia symptoms or delay improvement in patients enrolled in fibromyalgia treatment programs. We hypothesized that a subset of patients with fibromyalgia have: 1) partial secondary AI and concomitant growth hormone (GH) deficiency 2) a discordance in Cosyntropin stimulation test and 3) improvement in fibromyalgia symptoms with initiation of glucocorticoid and/or GH replacement.
Design: This was a retrospective study of patients with fibromyalgia diagnosed with partial secondary AI based on abnormal insulin tolerance test (peak cortisol &lt; 18 mcg/dL) at our institution from June 2002 to August 2019. Patients were excluded if they had other reasons for adrenal insufficiency, including steroid exposure and opioid use.
Results: We identified 22 patients (18 women, 82%) diagnosed with partial AI at a median age of 38 years (range 19-65). The fibromyalgia symptoms included fatigue (n=22, 100%), pain (n=22, 100%), sleep disturbance (n=15, 68%), and bowel changes (n=13, 59%). The median morning cortisol concentration was 8.6 mcg/dL (range 1.1-11); 9 patients (41%) had a morning cortisol concentration below the normal range (7 mcg/dL). The median ACTH level was 15.5 pg/mL (range 7.7-54). Nineteen patients had baseline IGF1 levels, with a median z-score of -0.94 (range -1.96 to 1.70). MRI pituitary imaging was performed in 20 patients and showed no significant pituitary pathology.
All patients achieved hypoglycemia &lt;=40 mg/dL during the insulin tolerance test. Peak median cortisol level was 11 mcg/dL (range 5.4-17). Nineteen patients (86%) also had partial GH deficiency (defined as a peak GH &lt; 4 ng/mL) with a median GH level of 0.36 ng/mL (range 0.03-3.83). Cosyntropin stimulation test was performed in 13 patients (59%) with a 1 mcg dose in 2 patients and 250 mcg dose in 11 patients. The peak cortisol was &gt;=18 mcg/dL in 10 (77%) patients. All patients were started on physiologic glucocorticoid replacement, and 12 patients were started on GH replacement. Endocrinology follow-up information was available for 13 patients, and 8 (62%) reported symptom improvement after starting treatment.
Conclusions: Patients with fibromyalgia can have co-existing partial secondary AI and GH deficiency as defined by insulin-induced hypoglycemia. Cosyntropin stimulation test can be used in patients with fibromyalgia, but a normal test does not rule out partial secondary AI. Replacing the underlying deficiency improved symptoms in some patients demonstrating certain fibromyalgia symptoms may overlap with AI and GH deficiency.
1Gur et al. Ann Rheum Dis. 2004. 63(11):1504-1506.
2Kirnap et al. Clin Endocrinol (Oxf). 2001. 55(4):455-459.