bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-364 Brown Tumor of the Mandible in Severe Uncontrolled Primary Hyperparathyroidism
Authors: Gupta Suruchi K , Hou Runhua , Rosen Harold 
Published: May 2020

Abstract
Background: Brown tumors are a part of the complex “osteitis fibrosa cystica” which is a diffuse resorptive process of the bone resulting from uncontrolled hyperparathyroidism. Although these brown tumors were fairly common in the past1, the incidence of brown tumors is now extremely rare in the United States due to early diagnosis and treatment of hyperparathyroidism. Here we describe an unusual presentation for osteitis fibrosa cystica.
Clinical Case: A 38 year old woman was admitted to the hospital with rapidly growing facial swelling in June 2019. The swelling initially appeared in January 2019 and had rapidly increased in size since April 2019. The mass was malodorous, painful and interfered with oral intake. The patient smoked 1 pack per day for 13 years. A CT scan of the head and neck with contrast showed a 3.6 x 4.5 x 3.3 cm mass destroying the right mandibular body, involving the right platysma muscle and displacing the central and lateral incisor teeth and was concerning for malignancy. The initial impression was that this was likely a squamous cell carcinoma with local and perhaps distant metastases, complicated by humoral hypercalcemia of malignancy and she was admitted for management.
Upon admission, her calcium level was 14 mg/dL, albumin 4.1 g/dL, phosphorus 1.4 mg/dL PTH level was 890 pg/mL and vitamin D level was 22 ng/mL. Since the high PTH did not fit with hypercalcemia of malignancy, further evaluation was undertaken. A thyroid ultrasound showed a 4.6 x 1.8 x 1.5 cm isoechoic, heterogeneous lesion in the left lower pole, and Tc-99 sestamibi scan suggested parathyroid origin. The biopsy of the mouth lesion showed fibro histiocytic proliferation with multiple giant cells, negative for malignancy and consistent with a brown tumor. CT scan of the chest, abdomen and pelvis did not reveal any other masses or lytic lesions. . A skeletal survey showed another 2 cm lytic lesion in the proximal left humeral metaphysis which was not biopsied.
On parathyroidectomy, the patient was found to have an enlarged left inferior parathyroid gland measuring 3.3 x 3.0 x 0.8 cm weighing 7.093 grams. Intraoperatively PTH level decreased from 890 pg/mL to 69 pg/mL. Her calcium levels returned to normal post-operatively and she was discharged home. Pathologic examination report revealed the mass to be a parathyroid adenoma. The patient reports a reduction in the size of her mandible mass since the surgery.
Conclusion: Although uncommon, brown tumors can be seen in uncontrolled primary hyperparathyroidism. The mandible is a common site, though, as in this case, it is less common for it to be the only site affected
Reference:
1. Rosenberg, E. H. (1962). Hyperparathyroidism. A review of 220 proved cases with special emphasis on findings in the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 15(2), 84–94.
MON-141 Healthcare Services Utilization and Costs Associated with the Management of Patients Living with Acromegaly
Authors: Ribeiro-Oliveira Antonio , Munoz Kathryn A , Brook Richard Alan , Beren Ian A , Whalen John D , Yuen Kevin C j 
Published: May 2020

Abstract
Background: Acromegaly (ACRO) is a rare, chronic growth hormone hypersecretory disorder associated with increased morbidity and mortality. Limited information is available on the utilization and costs of healthcare by patients with ACRO.
Aims: To assess the impact of ACRO healthcare utilization and costs by locations of care (LoC).
Methods: A US database of prescription (Rx) drug and medical claims from Jan 2010 to Apr 2019 was analyzed. Patients with an ACRO diagnosis (Dx) were identified based on claims with ICD-9/-10 codes 253.0x/E22.0. The 12-month study period followed each patient’s first ACRO Dx in the database (the index date). ACRO patients included in the study had ≥ 2 ACRO Dxs &gt; 30 days apart, or 1 ACRO Dx plus either a pituitary adenoma Dx or a pituitary surgery or radiosurgery claim during the study period. Costs were adjusted using the medical and Rx cost Consumer Price Indexes (CPIs). Study subjects were 18–65 yr old and had continuous eligibility during the study period. Eligible ACRO patients were matched with 20 subjects who did not have ACRO. Outcomes by LoC included costs, services, and likelihood of use and were compared using separate two-part regression models (logistic followed by generalized linear) for each outcome, controlling for demographic and job-related variables, region, and Charlson comorbidity index (CCI) scores. The likelihood models only used logistic regression. Data are shown as likelihoods or mean ± standard error. Findings are significant at P &lt; 0.05.
Results: A total of 60 patients with ACRO and 1200 controls were compared. Compared with controls, patients with ACRO had a higher likelihood of using the physician’s office (100% vs 91%, P &lt; 0.0001), inpatient (22% vs 3%, P &lt; 0.0005), outpatient (89% vs 38%, P &lt; 0.0001), laboratory (62% vs 31%, P &lt; 0.0001), and “other” locations (e.g., ambulance and claims without a specific location code, 55% vs 23%, P &lt; 0.0001). Services performed at each LoC were higher for patients with ACRO (P &lt; 0.01, all except outpatient hospital). Total costs were higher for the ACRO cohort compared with controls ($25,770 vs $4,059, P &lt; 0.05). Costs by LoC were consistently higher (all reported P &lt; 0.001) for patients with ACRO compared to controls, with differences highest in the following settings: outpatient hospital/clinic ($9,611 ± $1,793 vs $1,355 ± $74), inpatient ($8,646 ± $2,388 vs $739 ± $115), physicians’ office ($4,762 ± $678 vs
$1,301 ± $43), other ($2,001 ± $583 vs $367 ± $29), and laboratory ($508 ± $93 vs $66 ± $4). Neither the costs nor likelihoods of treatment in the emergency department were significantly different between cohorts.
Conclusions: Compared with commercially insured people without ACRO, patients with ACRO had greater health care utilization, in all care locations, indicating a greater burden and higher costs of ACRO patients on the healthcare system.
SAT-585 Autoregulation of Adipose Tissue Development
Authors: Feldman Brian , Sayeed Mohd , Nakuluri Krishna 
Published: May 2020

Abstract
White adipose tissue not only serves as a reservoir for energy storage but also secretes a variety of hormonal signals and modulates systemic metabolism. A substantial amount of adipose tissue develops in early postnatal life, providing unique access to the formation of this important tissue. However, while a number of factors have been identified that can modulate the differentiation of progenitor cells into mature adipocytes in cell autonomous assays, it remains unclear which are connected to physiological extracellular inputs and are most relevant to tissue formation in vivo. We elucidated that mature adipocytes themselves signal to adipose depot-resident progenitor cells to direct depot formation in early postnatal life and gate adipogenesis when the tissue matures. Our studies reveal that, as the adipose depot matures, a previously unrecognized signal is generated in mature adipocytes that converges on progenitor cells to regulate the cytoskeleton and attenuate the rate adipogenesis in vivo. This signal toggles the adipose depots from developmental to tissue homeostatic levels of adipogenesis.
MON-646 Novel Use of GLP-1 Receptor Agonist Therapy in MODY-1 (HNF4A Mutation)
Authors: Broome David Tyler , Pantalone Kevin M , Mehta Adi Erach 
Published: May 2020

Abstract
Monogenic Diabetes (MODY) results from mutations or changes in a single gene, and currently account for about 1 to 4% of all cases of diabetes (1). Our group has previously published on the successful use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in three consecutive generations of a family with an HNF1A mutation (MODY-3) (2). Although GLP-1 RA therapy has been studied in patients with HNF1A mutations (MODY-3) (3), it has not been studied in patients with HNF4A mutations (MODY-1). In this father-son cohort, we demonstrate successful use of GLP-1 RA therapy in two patients with c.790:1 bp deletion of G; codon:264 mutations of HNF4A. The son first presented with neonatal hypoglycemia, then later developed diabetes and presented to our clinic at age 20, when genetic testing was performed and confirmatory for an HNF4A mutation. He was prescribed glimepiride and titrated to 4 mg twice daily, and two years later, his hemoglobin A1c (HbA1c) rose to 8.7%. He was switched to semaglutide 0.25 mg once weekly and was titrated to a maximum dose of 1 mg weekly over 8 weeks. The patient reports improvement in his post-prandial blood glucose values at this time, but HbA1c has not yet been repeated. The father had been diagnosed with monogenic diabetes in his early 20s and had been on sulfonylurea therapy until age 40, at which time he was transitioned to a regimen of long- and short-acting insulin therapy. Thereafter, he presented to our clinic in July, 2018 with a HbA1c of 9.6% and was transitioned to long-acting insulin once daily and liraglutide 0.6 mg once daily which was subsequently titrated to 1.8 mg once daily over 3 weeks. The patient tolerated this well and has been off short acting insulin since December 2018, with notable improvement in his HbA1c to 5.9% and marked improvement in his post-prandial glycemic control. To our knowledge this is the first report demonstrating the benefits of GLP-1 RA therapy in patients with the HNF4A mutations (MODY-1). Based on this report, it appears that GLP-1 RA therapy could be an effective therapy in patients with MODY-1.
1). Pihoker C, Gilliam LK, Ellard S, et al. Prevalence, characteristics and clinical diagnosis of maturity onset diabetes of the young due to mutations in HNF1A, HNF4A, and glucokinase: results from the SEARCH for Diabetes in Youth. The Journal of Clinical Endocrinology and Metabolism. 2013;98(10):4055–4062.
2). Maricor Docena, Charles Faiman, Christine Stanley, and Kevin Pantalone (2014) Mody-3: Novel HNF1A Mutation and the Utility of Glucagon-Like Peptide (GLP)-1 Receptor Agonist Therapy. Endocrine Practice: February 2014, Vol. 20, No. 2, pp. 107–111.
3). Ostoft SH, Bagger JI, Hansen T, et al. Glucose-lowering effects and low risk of hypoglycemia in patients with maturity-onset diabetes of the young when treated with a GLP-1 receptor agonist: a double-blind, randomized, crossover trial. Diabetes Care. 2014;37(7):1797–17805.
OR21-06 Physician Management of Thyroid Cancer Patients’ Worry: Is It “Good” Enough?
Authors: Papaleontiou Maria , Zebrack Bradley , Reyes-Gastelum David , Hawley Sarah T , Hamilton Ann S , Ward Kevin C , Haymart Megan R 
Published: May 2020

Abstract
Introduction: Despite the excellent prognosis of most thyroid cancer patients, cancer-related worry is common. Additionally, patients report that being told by physicians that they have a “good cancer” invalidates their fears of having cancer and creates mixed and confusing emotions. However, it is not known what proportion of physicians try to reassure patients with the description “good cancer”.
Methods: Patients diagnosed with differentiated thyroid cancer in 2014–2015 from the Surveillance, Epidemiology and End Results Program (SEER) registries of Georgia and Los Angeles County were asked to identify endocrinologists and surgeons involved in managing their thyroid cancer. Physicians were surveyed using the modified Diliman method. They were asked to describe their thyroid cancer patients’ worry at time of diagnosis and what they tell them if worried. A multivariable logistic regression was conducted to identify physician characteristics associated with reporting thyroid cancer as a “good cancer”.
Results: Response rate was 69% (448/654). Overall, 40% were endocrinologists, 30% were general surgeons and 30% were otolaryngologists. A total of 8% of physicians reported that their patients are not worried or are a little worried at diagnosis, 27% that they are somewhat worried and 65% that they are quite or very worried. Ninety-one percent of physicians reported providing details on prognosis including information on death and recurrence to worried patients, 61% tell them their physicians are experienced in managing thyroid cancer, and 50% tell them that thyroid cancer is a “good cancer”. Factors associated with report of telling patients they have a “good cancer” included otolaryngology specialty [odds ratio (OR) 1.84, 95% confidence interval (CI) 1.07–3.17, compared to endocrinology), private practice setting (OR 2.57, 95% CI 1.42–4.75, compared to academic setting) and Los Angeles site (OR 2.23, 95% CI 1.46–3.45, compared to Georgia site). Physicians who perceived that their patients were quite or very worried at time of diagnosis were less likely to use this terminology (OR 0.55, 95% CI 0.35–0.84) and more likely to encourage patients to seek help outside of the physician-patient relationship (OR1.82, 95% CI 0.35–0.84), compared to patients not to somewhat worried.
Conclusion: Most physicians in our sample from two diverse geographic areas report perceiving patient worry as common at time of thyroid cancer diagnosis. They report addressing this worry with different strategies, including telling patients they have a “good cancer”. The benefit of such strategies on patient outcomes still needs further investigation.
SUN-578 Role of Linagliptin on CD34+ Endothelial Progenitor Cells and Arterial Stiffness in Renal Function Impaired Type 2 Diabetes Subjects
Authors: Awal Hassan , Domingues Cleyton , Dore Fiona , Kundu Nabanita , Ahmadi Neeki , Magan Fosso , Witkin Linda , Batistich Bethany , Safai Shauna , Amdur Richard , Sen Sabyasachi 
Published: May 2020

Abstract
Introduction: Endothelial Progenitor cells (EPCs) has been shown to be dysfunctional in both Type 2 Diabetes and Chronic Kidney Disease (CKD) leading to poor regeneration of endothelium and renal tubules. EPCs have been shown to be a robust cardiovascular disease (CVD) risk indicator. DPP4 inhibitor increase endogenous SDF1a which has been shown to increase CD34+ cells migration and thereby improve CVD risk. However, cellular mechanisms of DPP4i mediated improvement of CVD in patients with Type 2 Diabetes with established CKD is not established. Hypothesis: Linagliptin, a DPP4 inhibitor when added to insulin, metformin or both may recover endothelial function in a diabetic kidney disease (DKD) population. Methods: 31 subjects taking 1–2 grams of metformin and/or Insulin were enrolled in this 12 weeks, double blind, two-arm, randomized placebo matched trial, with 5 mg Linagliptin compared to placebo. Type 2 diabetes subjects (30–70 years old), HbA1c of 6.5–10%, and all stages of CKD were included. CD34+ cell number, migratory function, gene expression along with vascular parameters such as Arterial stiffness, biochemistry, resting energy expenditure and body composition were measured. Data were collected at week 0, 6 and 12. During trial HbA1C was maintained between 7–8% for all subjects. Every subject was used as their own control. A mixed model regression analysis was done with p value &lt;0.05 considered significant. Results: A double positive CD34/CD184 cell count had a statistically significant increase (p&lt;0.02) as determined by flow cytometry in treatment group though there was no statistically significant increase in CD34+ cell number, or colony formation units. Gene expression analysis on CD34+ cells showed reduced expression of TP53 (p&lt;0.04). Arterial stiffness measures such as augmentation Index (p&lt;0.04) along with augmentation pressure (p&lt;0.02) were significantly reduced in the treatment group. A reduction in LDL: HDL ratio was noted in treatment group (p &lt;0.04). No change in renal function was noted during the 12 week period.. We are currently analyzing urinary exosome based data to enquire further into renal function Conclusions: In DKD subjects, Linagliptin promotes an increase in CXCR4 expression on CD34+ progenitor cells with a concomitant improvement in arterial stiffness and LDL parameters within 12 weeks of intervention.
SAT-355 Severe Symptomatic Hypocalcemia Related to Cinacalcet Administration Introduction
Authors: Weaver Travis , Hoang Thanh Duc , Shakir Mohamed K M 
Published: May 2020

Abstract
BACKGROUND: Cinacalcet, a class of drug used to treat secondary hyperparathyroidism due to end-stage renal disease, is also indicated for the treatment of hypercalcemia in patients with parathyroid carcinoma. This drug acts as a calcimimetic agent by allosteric activation of the calcium-sensing receptor that is expressed in various tissues. Common side effects of cinacalcet include nausea, vomiting, diarrhea and weakness. Although mild hypocalcemia is a common side effect, severe hypocalcemia is rare.
Case Presentation: A 61-year-old man was evaluated for treatment of type I diabetes mellitus. He reported several months of progressive fatigue, muscle weakness, and paresthesia of his hands and feet. He was prescribed cinacalcet for a parathyroid disorder since 2014 and his previous physician increased the dose of cinacalcet about 2 months ago from 60mg daily to 120mg daily. Since that time his paresthesias have been more severe. Physical examination: normal vital signs, Chvostek’s and Trousseau’s signs were positive. Rest of the examination was normal. Laboratory: corrected serum calcium (Ca) of 6.7 mg/dL (ref 8.6–10.0), down from 7.6 mg/dL 2 months earlier. Additional laboratory: Ionized Ca 3.4 mg/dL (ref 4.5–5.6), PTH 68 pg/mL (ref 15–65), 25-OH vitamin D 37 ng/mL (ref 29–100), phosphorus 4.9 mg/dL (ref 2.5–4.5) and calculated GFR 97 mL/min. Cinacalcet was stopped. The patient was treated with calcium intravenously in the ICU resulting in normal serum calcium levels after 36 hours of treatment and complete resolution of symptoms. He was discharged on oral calcitriol and calcium supplementation, which was discontinued within 1 week of discharge.
Discussion:
In vast majority of cases hypocalcemia associated with cinacalcet therapy are mild and self-limited. Generally hypocalcemia develops within 16 weeks of starting therapy and resolves spontaneously within 2 weeks. This case is unusual in that the hypocalcemia occurred years after starting therapy and the patient experienced severe symptoms, undiagnosed for a prolonged period of time and required admission for close monitoring. Additionally, this patient was without the most common risk factor for cinacalcet-associated hypocalcemia which was secondary hyperparathyroidism, and he had normal renal function. The marked decrease in serum Ca levels may be related to his low baseline serum Ca levels and due to the recent increase in cinacalcet dose. However this has not always verified based on retrospective studies. Interestingly the cinacalcet dose was increased in up to 14% of patients with severe hypocalcemia (&lt;7.5 mg/dL) and even in this population severe symptomatic hypocalcemia symptoms were rare. In conclusion, clinicians should closely monitor patients on calcimimetic drugs for hypocalcemic symptoms although mild asymptomatic hypocalcemia may resolve without intervention.
SAT-027 Comparison of Estradiol by Mass Spectrometry Versus Immunoassay in Women Undergoing Menopause: Study of Womens Health Across the Nation (SWAN)
Authors: Santoro Nanette F , Auchus Richard Joseph , Greendale Gail , Lasley Bill L , McConnell Daniel S , Randolph John F , Martin Deborah , Crawford Sybil 
Published: May 2020

Abstract
Serum estradiol (E2) concentrations in midreproductive women are easily measured using a variety of conventional immunoassays (IA). However, when women approach and traverse menopause, E2 eventually drops below levels where IA lacks sufficient sensitivity to accurately measure E2. Liquid chromatography and tandem mass spectrometry (LC/MS/MS) has become the standard method for assessing steroid hormones, especially when circulating concentrations are low. We evaluated the relationship between IA and LC/MS/MS E2 measurements in a cohort of women taken from the Study of Womens Health Across the Nation (SWAN) to assess the degree of agreement between the two methods and to determine the level of E2 at which IA becomes unreliable.
Methods: 315 serum samples that had been previously measured for E2 using IA were re-analyzed using LC/MS/MS performed by one of the authors (RA). In this original set, E2 levels that were below the limit of assay detection (LLD, 6 pg/ml) were interpolated as a random number between 0 and the LLD. Agreement between all 315 samples was assessed using both Pearson and Spearman correlation. The analysis was repeated excluding the subset of specimens that were below the lower limit of detection (LLD) for the IA E2 assay (6 pg/ml; N=176), and a third set of correlations was obtained for specimens that measured &lt;15 pg/ml by IA but were above the 6 pg/ml LLD (N=82).
Results: The overall dataset (N=315) demonstrated excellent agreement between IA and LC/MS/MS with a Pearson’s r and Spearmans r of 0.98 AND 0.60, respectively. When the subset of 176 samples above the LLD were assessed, Pearson’s r was 0.98 and Spearman’s r was 0.81. In contrast, when specimens measuring 6–15 pg/ml by IA were compared to LC/MS/MS, Pearson’s r was -0.03 and Spearman’s r was 0.09, indicating a complete loss of relationship between the two methods.
Conclusions: The IA used by SWAN (England, Clin Chem 2002; 48: 1584) and LC/MS/MS demonstrate excellent correlation for E2 measurements above 15 pg/ml. However, circulating concentrations of E2 below 15 pg/ml were not accurately measured using IA.