bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-011 Beyond PCOS - Ovarian Neoplasms Presenting with Hirsutism and Virilization
Authors: Chakravorty Shourjo , Hoard Brandon , Cosentino Gina , Friday Karen E , Uwaifo Gabriel Ikponmosa 
Published: May 2020

Abstract
BACKGROUND: PCOS is the most common cause of hirsutism in women of reproductive age. The presence of virilization in addition to hirsutism should alert to the possibility of less common causes of hyper-androgenization (HA) in this population including otherwise uncommon functional ovarian neoplasms (FON). We present 3 cases of women initially thought to have PCOS in whom virilization was the prime clue to the correct diagnosis of FON. Clinical Case series: Case 1 is a 40yr old woman with obesity and dysmetabolic syndrome referred for hirsutism presumed due to PCOS. She had noted symptoms over 2–3 yrs with amenorrhea and associated infertility. Examination revealed marked hirsutism and virilization with Ferriman-Galleway score (FGS) of 20. Lab tests confirmed marked male range HA. Multiple imaging tests revealed no adrenal or ovarian mass lesions. FDG-PET scan finally revealed a left ovarian focus for which she has left oophorectomy that revealed a 1cm Leydig cell tumor, Her HA resolved post-op and spontaneous periods resumed. Case 2 is a 45yr old woman referred with possible PCOS who had 5 mth history of progressive hirsutism and generalized hypertrichosis, dull lower abdominal pain and amenorrhea. Examination revealed marked hirsutism with generalized hypertrichosis and virilization. FGS was 25 and clitoral index was 935mm2. Lab tests confirmed marked male range HA and abdominopelvic imaging show no adrenal lesions but a 5.2cm left ovarian mass. Left salpingo-oophorectomy revealed a steroid cell tumor and postoperatively her androgen levels normalized. Case 3 is 37 yr old woman with SLE and obesity with prior gastric bypass referred with presumed PCOS but presenting with 1 yr history of progressive hirsutism. She was initially thought to have non classical CAH and treated with oral glucocorticoids with no symptom improvement. Examination revealed marked hirsutism, virilization with elevated FGS and clitoromegaly. Lab tests showed marked male range HA but multiple imaging studies revealed no apparent adrenal or ovarian lesions. Patient had no fertility interests and so had elective total hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 2.5cm left ovarian Leydig cell tumor not apparent at surgery and post op her androgen levels normalized. Conclusion: The distinction between PCOS which is ubiquitous and FON which is rare hinges on careful history and examination. Rapid onset hirsutism with virilization should prompt suspicion of FON. Marked male range HA (total serum testosterone &gt;250ng/dl) is another “red flag” finding. Persistent radiologic search for such lesions should continue as they may not be immediately apparent on routine abdominopelvic imaging.
SUN-613 Association of Electrocardiograph Parameters and Diabetic Peripheral Neuropathy
Authors: Moon Seong Su , Lee Young-Sil 
Published: May 2020

Abstract
Aim: The purpose of this study was to assess the relation between Prolonged P wave duration with diabetic peripheral neuropathy in subjects with type 2 diabetes. Methods: We assessed the measures of electrocardiographic function in 105 in 147 Korean subjects with type 2 diabetes, who visited Dongguk University Hospital for regular health checkup using electrocardiogram (ECG). We measured several electrocardiogram parameters including ventricular rate, PR interval, QRS duration, QT, QTC and P wave duration. Subjects were grouped as without diabetic peripheral neuropathy (≤2) and with peripheral neuropathy (≥2) based on Michigan Neuropathy Screening Instrument Examination Score (MNSIES). Results: The population mean age was 61.50±11.17 years and 60.78% were men. The participants with DPN significantly found higher with age, MNSIES and P wave duration as compared to without DPN. The prevalence of drinking significantly found higher in participants with diabetic peripheral neuropathy. Furthermore, in a multiple regression analysis, MNSI examination score significantly showed positive association with prolonged P wave duration after adjustment with age, MNSIES and drinking alcohol(β, 1.123; 95% CI, .109∼2.138; p=.030). Conclusions: The current study revealed an association between prolonged P wave and MNSI examination score.
SUN-412 Graves’ Disease Displayed as a Risk Factor of Vertebral Fracture Even in Premenopausal Women
Authors: Notsu Masakazu , Yamauchi Mika , Sugimoto Toshitsugu , Kanazaki Keizo 
Published: May 2020

Abstract
Background
Hyperthyroidism is a known risk factor for osteoporosis and fractures especially in older men and postmenopausal women. However, it remains unclear whether younger patients with Graves’ diseases are at a higher risk of fracture compared to healthy individuals.
Objective
This study aimed to clarify whether premenopausal women with Graves’ disease represents a risk factor for vertebral fracture (VF).
Patients and Methods
We enrolled 30 premenopausal women (mean age, 32 ± 10 years) who were diagnosed with Graves’ disease at our institution between April 2007 and December 2017. We also enrolled 40 healthy control women who visited our hospital. The control subjects were confirmed to have no endocrine disease or any condition that might affect bone metabolism. None of the study subjects had taken drugs known to influence bone and calcium metabolism such as vitamin D, bisphosphonates, or glucocorticoids. Also, none has taken an oral contraceptive. Serum and urinary biological parameters, alkaline phosphatase (ALP), glycosylated hemoglobin (HbA1c), creatinine, serum calcium, total cholesterol, intact parathyroid hormone, free triiodothyronine (Free T3), free thyroxin (Free T4), thyroid-stimulating hormone (TSH) and urinary type I collagen cross-linked N-telopeptides (NTX; a bone resorption marker) were compared between the groups. Bone mineral density (BMD) of the lumbar spine and femoral neck was determined using dual-energy X-ray absorptiometry and vertebral fractures were diagnosed from lateral X-rays of the thoracic and lumbar spine. The chi-square and unpaired t-tests for two groups comparison were utilized to determine the statistical significance (P &lt; 0.05). Multiple logistic regression analyses were proceeded after adjustments for variables.
Results
Patients with Graves’ disease displayed the higher ALP, eGFR, Ca, free T3, free T4 and urinary NTX levels, and lower body mass index (BMI), Alb, total cholesterol and intact PTH compared to controls.
The prevalence of VFs was significantly higher in patients with Graves’ disease (20.0%) than in controls (2.5%, &lt;0.05). Such association remained significant even after adjustment for age, BMI, ALP, eGFR and free T3, but except for BMD. Among premenopausal patients with Graves’ disease, the values of several parameters, such as BMI, ALP, HbA1c, serum Ca, intact PTH and BMD and the prevalence of thyroid related antibodies did not differ significantly between those with and without VF; subjects with VF were older and exhibited lower free T3, free T4 and urinary NTX levels compared to subjects without VF. The mean value of lumbar BMD T score in subjects with VF among premenopausal patients with graves’ disease was -1.0, indicating osteopenia.
Conclusions
VF risk could be elevated even in the premenopausal women with Graves’ disease, although the BMD risk levels is not equivalent to that of osteoporosis.
SAT-271 Block and Replace Therapy Successfully Improved Symptoms in Recurrent Cyclic Cushing’s Disease
Authors: Kamigaki Risa , Kameda Hiraku , Iesaka Hiroshi , Izumihara Rimi , Ohe Yuki , Chiba Koki , Ono Wataru , Shigesawa Ikumi , Kameda Reina , Nomoto Hiroshi , Cho Kyuon , Nakamura Akinobu , Miyoshi Hideaki , Atsumi Tatsuya 
Published: May 2020

Abstract
BACKGROUND: Cyclic Cushing’s disease is rare and treatments have not been established for post-surgical recurrent cases. Here, we report a patient with recurrent cyclic Cushing’s disease, whose subjective symptoms improved by administration of metyrapone and hydrocortisone. Clinical Case: A 45-year-old woman had exhibited face and peripheral edema, hyperphagia, weight gain, hair loss and limb numbness since September X-10. In May X-9, her ACTH and cortisol levels were high (87.8 pg/mL and 28.8 µg/dL, respectively), and she was referred to our department. A brain MRI revealed a pituitary adenoma of 7mm in diameter. Because blood ACTH and cortisol levels turned normal and typical Cushingoid features were absent at the admission to our department, cyclic Cushing’s disease was suspected. Later in September, because subjective symptoms recurred accompanied with blood cortisol level elevation, she was diagnosed as cyclic Cushing’s disease with the examinations including inferior petrosal sinus sampling. Transsphenoidal surgery was performed in November, and immunohistology confirmed ACTH-producing pituitary adenoma based on ACTH positivity. After the surgery, endocrine test results were normalized and subjective symptoms were ameliorated. In March X-3, the blood ACTH level increased again; however, no subjective symptoms were observed. From May X, she had experienced limb numbness, hyperphagia and weight gain again. MRI showed no apparent recurrence, but endocrine tests showed the activity of Cushing’s disease. Urinary free cortisol (UFC) increased to 300–400 µg/day in a 1-week cycle, indicating the recurrence of cyclic Cushing’s disease. Metyrapone treatment was initiated, and the patient was finally discharged after block and replace therapy with metyrapone 2,000 mg/day and hydrocortisone 15 mg/day. After metyrapone treatment, subjective symptoms improved and UFC was normalized. Conclusion: Block and replace therapy with metyrapone and hydrocortisone may be effective for recurrent cyclic Cushing’s disease, especially in cases with a very short cycle.
SAT-520 Unusual Case of Hypothyroidism Possibly Due to Dialysis Leading to Van Wyk Grumbach Syndrome (VWGS)
Authors: Chummar Jenice , Salemi Parissa 
Published: May 2020

Abstract
BACKGROUND: Van Wyk Grumbach Syndrome (VWGS) is characterized by precocious central puberty in the setting of juvenile chronic primary hypothyroidism with symptom regression following thyroxine replacement.
Clinical Case: A 2 year old girl with dysplastic kidneys and chronic renal disease had been treated by her nephrologist with growth hormone for poor growth. She was referred to Endocrinology for evaluation of bloody dialysate thought to be retrograde menstrual flow. Pelvic US showed bilateral large cystic adnexae possibly ovarian cysts versus septated collections of dialysate fluid. Hormone measurements showed pubertal levels of LH 0.4mIU/mL and FSH 5.4mIU/mL, with a relatively low Estradiol 5.3pg/mL. Brain MRI showed impressive pituitary enlargement measuring 1.3cm craniocaudally. Additional laboratory testing was notable for a low normal free T4 fT4 0.9ng/dL and markedly elevated TSH&gt;1000uIU/mL and Prolactin 835ng/mL. Thyroid US showed thyroid enlargement, and echogenic and hyper vascular gland. Anti-thyroid antibodies titers were normal, AM cortisol and IGF1 were also normal for age. We speculate that this case of profound hypothyroidism was due to dialysis, as thyroid function improved after the child underwent renal transplantation. Levothyroxine was discontinued 5 months after renal transplantation. Elevated TSH may induce a form of pseudopuberty as the TSH alpha subunit is similar to that of LH and binds to the LH receptor to stimulate the ovaries with cyst formation.
Conclusion: In VWGS, primary hypothyroidism with elevated TSH induces central precocious puberty. This child’s bloody diasylate was likely the result of transient central precocious puberty associated with uncontrolled primary hypothyroidism with elevated TSH and prolactin. Although the literature on dialysis suggests minimal thyroid hormone losses, this case shows the importance of monitoring thyroid hormones in dialysis patients. Early recognition of VWGS and initiation of thyroid hormone replacement can lead to resolution of symptoms.
MON-010 Effects of Delta-9-Tetrahydrocannabinol (THC) on Oocyte Competence and Early Embryonic Development
Authors: Misner Megan , Favetta Laura A 
Published: May 2020

Abstract
Cannabis is the highest used recreational drug amongst individuals of reproductive age. Fertility clinics advise against cannabis use when undergoing fertility treatments, but the literature backing this statement is weak. This rise in cannabis use has occurred simultaneously with the increase in the percentage of the main psychoactive component of cannabis, delta-9 tetrahydrocannabinol (THC) (1). Current literature suggests that THC mimics the effects of endogenous cannabinoids, binding to cannabinoid receptor 1 (CB1), which has been identified in reproductive tissues (2).
Our research aims to study the impact of THC on oocyte maturation and pre-implantation embryonic development. An in vitro bovine system was used as it is the most appropriate translational model to humans for in vitro reproductive toxicity studies. Bovine oocytes were collected and matured under five treatment groups: control, vehicle (1:1:18 ethanol: TWEEN: saline), low THC (0.032uM), mid THC (0.32uM) and high THC (3.2uM). These doses mimic plasma concentrations reached after therapeutic (0.032uM) or low/high recreational (0.32uM and 3.2uM) cannabis use (3). We hypothesise that THC affects oocyte competence and proper early embryonic development in vitro.
A negative THC dose-dependent response in cleavage rate was observed, with the highest THC group cleaving at 70.2% rate compared to 86.8% and 85.5% of control and vehicle groups, respectively (p&lt;0.0001, n=7). There was no significant difference in blastocyst rate, suggesting that oocyte THC exposure affects the numbers of oocytes capable of development, but those able to cleave will properly reach blastocyst stage. We analyzed changes in gene expression, i) by a full RNA transcriptome analysis (24,128 transcripts screened) and ii) by quantification of Connexin 37 (CX37) and 43 (CX43) mRNA levels. Connexin expression is correlated to oocyte competence (4). RNA transcriptome analysis showed 62 genes that were significantly downregulated only in the low THC group. CX mRNA levels were measured via droplet digital PCR in both cumulus-oocyte complexes (COCs) and blastocysts. No significant differences were detected in blastocysts, however, a significant decrease in both CX37 and CX43 levels was measured in the low THC group in COCs (p&lt;0.05, n= 9). Differences seen exclusively at the low THC dose suggest a role of THC as partial agonist of CB1.
This research aims to understand the effects of cannabis on fertility, as current knowledge during pre-implantation development is limited, making it difficult for physicians to properly advise patients undergoing IVF.
Reference: (1) ElSohly et al., Biol Psychiatry. 2016 Apr 1;79(7):613–9. (2) El-Talatini et al., PLoS ONE. 2009 Feb 24;4(2):e4579. (3) Whan et al., Fertil Steril. 2006 Mar;85(3):653–60. (4) Wang et al., Am J Physiol Endocrinol Metab. 2012 Jun 15;302(12):1511–8
SAT-240 Hypothalamic Lipoma and Growth Hormone Deficiency
Authors: Rochtus Anne Maria , Vinckx Joseph , de Zegher Francis Edouard 
Published: May 2020

Abstract
Introduction: Intracranial lipomas are rare, congenital lesions, most often located at the midline. Most hypothalamic lipomas are asymptomatic, but some cases have been associated with precocious puberty, hypothermia, headache and/or obesity.
Case: A 7-year-old boy was referred for short stature, and proved to be partially growth-hormone deficient. Magnetic resonance imaging (MRI) revealed a lipoma in the paramedian hypothalamus. Growth hormone treatment resulted in swift and uncomplicated catch-up growth.
Discussion: The present case appears to be the first to link hypothalamic lipoma to GH deficiency. The neuro-endocrine pathophysiology underpinning this link remains to be explored.
SAT-252 A Rare Case of Crooke’s Adenoma
Authors: Taiwo Adeyinka , Correia Marcelo , Peyton Nicole 
Published: May 2020

Abstract
BACKGROUND: Crooke’s cell adenoma is a rare variant of ACTH-secreting corticotroph adenomas (&lt;1%). These are aggressive macroadenomas and usually invade the cavernous sinus producing visual symptoms.
Clinical Case: A 48-year old male presented with acute right eye and right temple pain, and diplopia that started 6 days prior. Past medical history included hypertension, type 2 diabetes, hyperlipidemia, traumatic brain injury, CSF leak with bacterial meningitis s/p sphenoid repair and palsy of the right III,
V and VI cranial nerves. Head CT showed a 1.9 x 2.1 x 1.5 cm soft tissue-density mass medial to the right cavernous carotid artery extending into the sphenoid sinus. There was expansile bony change to the floor and right dorsum of the sella. The mass showed mild contrast enhancement and abutted the superior orbital fissure. A brain MRI was not obtained due to history of a left cochlear implant. He did not have any cushingoid features on exam. Neuro-ophthalmology exam revealed, severe sixth cranial nerve palsy, bilateral optic disc pallor and a mild right superotemporal visual field defect. Pre-operative pituitary function tests revealed ACTH 103 pg/ml (7–63), cortisol 14 ug/dl (6.0–18.4), FSH 2.7 mIU/ml (1.5–12.4), LH 3.8 mIU/ml (1.7–8.6), prolactin 17.6 ng/ml (4–15.2), total testosterone 175 ng/dl (249–836), TSH 1.10 uIU/ml (0.27–4.20), free T4 0.67ng/dl (0.8–1.8) and IGF-1 208 ng/ml (69–224). He underwent successful endoscopic trans-sphenoidal resection of a 4.2 x 2.5 x 0.5 cm mass. Pathology revealed hyaline deposits in the cytoplasm and perinuclear cytokeratin in more than 50% of the adrenocorticotroph cells consistent with Crooke’s cell adenoma. Post-operatively, his right eye pain and abduction deficit improved, and diplopia returned to baseline. He was placed on a short hydrocortisone taper. Due to high risk of recurrence, he received 54Gy in 30 fractions to the sella. Six and 12-month follow-up head CTs revealed stable residual enhancing tissue. Pituitary function tests done 9 months post-surgery were normal and no hormone replacement was needed. He was clinically stable 12 months after surgery.
Conclusion: We described a rare case of invasive Crooke’s cell pituitary adenoma with visual disturbances that was managed with resection and radiotherapy. The patient remained free of recurrence 1 year later. However, lifetime surveillance is necessary due to high incidence of recurrence.
Reference:
1.
Crooke’s Cell Tumors of the Pituitary. Neurosurgery, Volume 76, Issue 5, May 2015, Pages 616–22
MON-031 A Gene Expression Profile of the Adolescent Breast and the Impact of Obesity
Authors: Akrobetu Dennis Y , Burkholder Adam B , Ton Thai-Vu T , Kim Susan , Pandiri Arun , Labow Brian I , Nuzzi Laura C , Firriolo Joseph M , Schneider Sallie S , Fenton Suzanne E , Shaw Natalie D 
Published: May 2020

Abstract
Environmental exposures that occur early in life affect breast development and breast cancer (BC) risk in adulthood. Puberty is one such developmental ‘window of susceptibility’ when estrogen (E) stimulates breast adipocytes and stromal and epithelial cells to proliferate at an exponential rate, making them vulnerable to carcinogens. Excess adiposity during adulthood may increase BC risk through obesity-associated inflammation and/or aromatase activity, which increases local E levels. While obesity during puberty might be expected to also increase future BC risk, epidemiological studies suggest that pediatric obesity may actually be protective. The current studies investigated the gene expression profile of the normal adolescent breast and how early life factors such as obesity may influence these profiles.
We performed RNA-seq in 62 histologically-normal breast tissue samples from adolescent girls and young women (mean age 17.8 yrs) who underwent breast reduction surgery. Twenty-nine patients were normal weight (NW; mean BMI 23.2 kg/m2) and 33 were overweight/obese (OB; BMI 31.7). Comparison of our adolescent dataset with published mammary RNAseq datasets from pubertal mice, rats, macaques, and adult women (mean age 38 yrs) revealed relatively poor (~ 30%) overlap with other species, but 88% overlap with adults for the 500 most highly expressed genes in each dataset. The small gene set (n=43) common to all groups was enriched for extracellular matrix components.
We used DESeq2 to identify differentially-expressed (DE) genes in NW vs OB samples. To avoid confounding due to differences in the cellular composition of NW and OB samples, we first used CIBERSORT to computationally estimate the adipocyte fraction of each sample and included this estimate as a covariate. We identified 74 up-regulated and 73 down-regulated genes in NW vs. OB (padj &lt; 0.05). We used Ingenuity Pathway Analysis (IPA) to determine whether the DE genes might reflect activation or inhibition of upstream transcriptional regulators in OB samples. IPA identified the cytokines CSF1 and CSF2 and the chemokine receptor CCR2 as the most highly activated upstream regulators, suggesting a signature of increased inflammation in OB samples. While classical E receptor (ER) targets (e.g., PR, AREG) were not DE’d, IPA identified ESR1, 17-α-ethinyl estradiol, genistein, and PR, as well as growth factors/receptors (EGF, IGF-1, HGF, HER3) and kinases (AKT1, ERK) involved in hormone-independent ER activation, as activated upstream regulators in OB samples.
These studies represent the first investigation of the human breast transcriptome during late puberty and demonstrate that in adolescents, as in adults, OB is associated with increased inflammation which may augment E action in the breast microenvironment.