bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-LB76 Impact of Age on Survival and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Cancer Patients
Authors: Buffet Camille 
Published: May 2020

Abstract
BACKGROUND
Age has been identified as a major prognostic factor in differentiated thyroid cancer (DTC). Prognostic factors of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) are poorly described. The objectives of our study were to analyze the influence of age on the survival of patients with RAIR-DTC and to determine their prognostic factors according to age.
PATIENTS AND METHOD
This single centre, retrospective study enrolled 155 patients diagnosed with a RAIR-DTC between 1991 and 2017. The primary end point was overall survival (OS). Secondary endpoints were progression free survival (PFS) and prognostic factors.
RESULTS
Median OS was 8.2 years (95% IC: 5.3-9.6). There was no difference according to age (P = 0.47) with median OS at 8.3 years in patients &lt; 65 (95% IC: 4.9-10), and 7.5 years in patients &gt; 65 (IC: 4,9-11,3). PFS after RAIR-diagnosis was 2.1 years (95% IC: 0.8-3) in patients &lt; 65, and 1 year in patients &gt; 65 (95% IC: 0.34-0.68). In both groups, progressive disease despite 131I reduced OS, in comparison with other RAIR criteria. In patients &lt; 65, an interval between the initial diagnosis of DTC and the diagnosis of RAIR metastatic disease more than 3 years was protective from poor OS (HR: 2.12; 95% CI: 1.05-4.27). In patients &gt; 65, presence of a mediastinum metastasis at RAIR-diagnosis was a significant factor for decreased OS (HR: 0.22; 95% CI: 0.11-0.44).
No difference was found between groups regarding therapeutic management. One third of patients received tyrosine kinase inhibitors in both groups (&lt; 65 years: 20 patients (28%), ≥ 65 years: 28 (33%), P = 0.49). They were also similar regarding the number of lines received or the median duration of treatment (&lt; 65 years: 19.5 months (2-59), ≥ 65 years: 19 months (1-64), p= 0.35). At least one line of TKI was transitorily or definitively withdrawn due to toxicity in 40% of patients (&lt; 65 years: 8/20 patients (40%), ≥ 65 years: 13/28 (46%), p= 0,037).
CONCLUSION
In RAIR-DTC patients, age was not predictive of the outcome. In our study, older patients seem to have benefited from intensive therapeutic management. Continual progress made in the management of RAIR-DTC, especially with the implementation of systemic therapies should probably make reconsider the natural history and conventional prognostic factors of RAIR-DTC.
SAT-LB9 Anti-Cancer Properties of RISUG Against Prostrate Cancer Cell Line PC-3 -Invitro Study
Authors: Singroul Pankaj , Singh Palak , Guha Sujoy K , Gupta Surabhi , Chaturvedi Pradeep Kumar 
Published: May 2020

Abstract
Cancer cell lines were initially established for understanding the genetic, functional, and epigenetic properties of cancer cells. The PC3 cell line is a human-derived prostate cancer cell line from the metastatic bone site of the grade IV adenocarcinoma patient. With the invention of RISUG-a polymeric male contraceptive, and studying its astonishing properties such as anti-microbial activity, there have been multiple hypotheses stating its anti-cancerous effect based on its physical and chemical nature[1]. This study focuses on understanding the effect of RISUG on prostate cancer cell line PC3 via MTT assay.For our study, 10 mg/ml working concentration of RISUG in DMSO (solvent) was used for the treatment to the cells. The dosage given to the cells for three varying incubation periods of 24 hours, 48 hours and 72 hours were analyzed for there viable cells post treatment. The dose was delivered with the media such that the final concentration of DMSO in the media is 1.5% (optimized) to avoid vehicle toxicity. The MTT assay was employed to study the cytotoxicity effect by measuring the amount of viable cells post treatment. The observations were statistically significant for the anti-cancerous effect of RISUG on PC3 prostate cancer cells for 72 hours, the optimized minimum incubation time/ time of action for RISUG to exhibit significant anti-cancer effect against PC3 cells. However, further in depth research is necessary for the understanding of the mechanism behind these actions.
Keywords: RISUG, Prostate Cancer, DMSO, Cell line,
Reference: 1. Subramanian, B., Agarwal, T., Basak, P., Maiti, T., & Guha, S. (2019). RISUG® based improved intrauterine contraceptive device (IIUCD) could impart protective effects against development of endometrial cancer. Medical Hypotheses, 124, 67-71. doi: 10.1016/j.mehy.2019.02.026
SAT-LB45 Chronic Opioid Use as a Cause of Severe Hypothyroidism: A Case Report
Authors: Slack Daniel , Brooks Danielle , Levine Alice C 
Published: May 2020

Abstract
Background: Hypogonadism and hypocortisolism are present in a sizeable proportion of chronic opioid users. (1) An association with hypothyroidism, however, has not been demonstrated.
Clinical Case: A 56-year old woman with chronic pain syndrome on opioids presented from a nursing home with decreased level of consciousness and was found to be hypotensive requiring ICU admission. Several weeks prior to her presentation, she was hospitalized for progressive weakness and was found to have evidence of panhypopituitarism: low TSH (0.209 uIU/mL, nl 0.400 – 4.200), low free T4 (0.76 ng/dL, nl 0.80 – 1.50), low LH (&lt;0.12 mIU/mL, nl 10.9 – 58.6), low FSH (1.7 mIU/mL, nl 16.7 – 113.6), and abnormal ACTH stim test (ACTH 6.4 pg/mL, nl 7.2 – 63; cortisol 0-min 3.8 mcg/dL, nl 6.7 – 22.6; 60-min 13.10). She was discharged on levothyroxine 25 mcg daily and prednisone 7.5 mg daily. On admission, her exam was notable for symmetric, non-pitting edema of the lower extremities to the knees with peau d’orange appearance. Initial tests revealed profound hypothyroidism with low TSH (0.381 uIU/mL), low free T4 (0.60 ng/dL), undetectable total T4 (&lt;0.9 mcg/dL, nl 5 – 12.2), and undetectable free T3 (&lt;1.00 pg/mL, nl 2.5 – 3.9). Thyroglobulin and TPO antibodies were within normal limits. Thyroxine binding globulin was low (6 mcg/mL, nl 13 -39). Additional biochemical studies re-demonstrated panhypopituitarism with low LH (&lt;0.12 mIU/mL) and FSH (0.9 mIU/mL). Cortisol was elevated (73.2 mcg/dL) as she had received hydrocortisone. Despite fluid resuscitation and use of vasopressors, her hypotension persisted and she remained in critical condition. She was treated as a case of myxedema coma and started on full replacement dose thyroid hormone with 120 mcg IV levothyroxine daily and liothyronine 5 mcg every 8 hours. Over the next several days, the patient’s hemodynamics and mental status improved dramatically. A contrast-enhanced pituitary-protocoled MRI was notable for a moderately flattened sella (pituitary 3.5 mm in height) and absence of usual T1 bright signal in the posterior lobe. A work-up for causes of panhypopituitarism was mostly unremarkable: low IgG 4 (0.82, neg &lt;1.50), indeterminate quant gold, negative HIV, low serum iron (35 mcg/dL, nl 50 – 200). Urine toxicology was positive only for opioids, reflective of the patient’s chronic pain regimen consisting of MS-Contin 60 mg twice daily and methadone 10 mg twice daily.
Conclusion: This case demonstrates the potential for chronic opioid use to suppress the hypothalamic-pituitary-thyroid axis and highlights the importance of maintaining an index of suspicion for hypothyroidism in this population.
Reference: (1) de Vries, F., Bruin, M., Lobatto, DJ., Dekkers, OM., Schoones, JW., van Furth, WR., Pereira, AM., Karavitaki, N., Biermasz, NR., Najafabadi, AHZ. Opioids and their endocrine effects: A systematic review and meta-analysis. JCEM. 2019. Doi: 10.1210/clinem/dgz022
OR26-05 The Correction Factor for A1C in Anemic Patients
Authors: Villacreses Maria Chang , Karnchanasorn Rudruidee , Ou Horng-Yih , Feng Wei , Samoa Raynald , Chuang Lee-Ming , Chiu Ken C 
Published: May 2020

Abstract
Diabetes can be defined by hemoglobinA1c (A1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2hPG). Despite that A1c has a tendency for underestimation of the prevalence of diabetes and overestimation of the prevalence of normal glucose tolerance, A1c is the most convenient method, since no preparation required. However, various factors could affect A1c. The objective of this project is to identify the covariates that affect A1c. The study sample included 9,952 adults (age≥20 years old) from the 2005–2016 NHANES. Subjects with established diabetes were excluded, and we analyzed subject’s documented BMI, A1c, FPG, 2hPG, Hemoglobin (Hgb), race/ethnicity, age, education, poverty index, family history of diabetes, and tobacco and alcohol consumption to determine their impact on A1C measurement. Continuous data were expressed as means with standard deviation. Either t-test or ANOVA was used to examine the influence of covariates on continuous variables. We examined the relation of A1c with FPG, 2hPG, and other covariates. With backward regression analysis, we excluded the covariates without significant impact on A1c. All the analyses were conducted in SYSTAT 13, Systat Software, Inc. In the univariate analysis, A1c was significantly corelated with FPG (r=0.5692, P&lt;0.0001) and 2hPG (r=0.5122, P&lt;0.0001). In the backward regression analysis, education, poverty index, and family history of diabetes were excluded for their low impact on A1c. In addition to FPG and 2hPG, gender (r=-0.0527, P&lt;0.0001), age (r=0.1746, P&lt;0.0001), BMI (r=0.0978, P&lt;0.0001), race/ethnicity (r=0.0478, P&lt; 0.0001), current alcohol consumption (r=0.0542, P&lt;0.0001), current smoker (r=-0.0806, P&lt;0.0001), and Hgb (r=-0.1526, P&lt;0.0001) had significant impact on A1c. Due to the significant difference in Hgb between gender, gender-based analyses were performed. In male gender, the impact of other covariates (age, BMI, race/ethnicity, current alcohol consumption, and current smoker) than FPG and 2hPG could be explained at least partially through their impact on Hgb (P&lt;0.0001). Each 1 g/dL decrease of Hgb would falsely decrease A1c by 0.053% (P&lt;0.0001). In female gender, the impact of covariates other than FPG and 2hPG on A1c could be explained by their impact on Hgb (p&lt;0.0001) except for BMI. Each 1 g/dL decrease of Hgb would falsely decrease A1c by 0.047% (P&lt;0.0001). In addition to FPG and 2hPG, A1c could be affected by gender, age, BMI, race/ethnicity, current alcohol consumption, and current smoker through their impact on Hgb, except for BMI in female gender. A1c will be falsely decreased by 0.053% in male gender and 0.047% in female gender for each 1 g/dL decrement of Hgb. Thus, A1c should be interpreted with caution in anemic patients. We propose using the gender specific correction factors for more accurate interpretation of A1c.
SAT-LB307 Case of the Broken Hearted
Authors: Namboodiri Divya , Khor Lynne , Champion Bernard , Shalaby Grant , Preda Veronica Angela 
Published: May 2020

Abstract
Phaeochromocytomas are rare neuroendocrine tumours which, usually present with headache, diaphoresis, episodic tachycardia and hypertension. Takotsubo-pattern cardiomyopathy is an unusual initial presentation of phaeochromocytomas, however has been reported1. Approximately 10% of phaeochromocytomas present with cardiomyopathy. It is associated with a high mortality risk and early intervention with surgery is the key to recovery. We report a case of a previously healthy, 68 year old man who presented with symptoms of left ventricular failure, and feeling anxious. Physical examination revealed signs of left ventricular failure, with a normal blood pressure and heart rate. A transthoracic echocardiogram (TTE) revealed dilated left ventricle with severe global hypokinesis and a left ventricular ejection fraction (LVEF) of 15%. A CTPA performed to exclude pulmonary embolism revealed an incidental right sided adrenal lesion measuring 3.9 X 3.4 X 3.7 cm. Subsequently a dedicated abdominal CT confirmed the adrenal lesion. Biochemistry revealed elevated 24 hour urine catecholamines and metanephrines and an elevated plasma metanephrines. Subsequently he proceeded to have adrenalectomy. Pre-operatively the patient was managed with alpha and beta blocking agents for 3 weeks prior to surgery. Post-operative course was uneventful and histopathology confirmed right sided phaeochromocytoma. TTE performed 12 months post-operatively showed a significant improvement in his LVEF to 40 % with subsequent TTE showing maintenance of LVEF. This case demonstrates highlights the unusual presentations of phaeochromocytomas and that early recognition and early intervention with surgery is the key to recovery to avoid catastrophic cardiac events.1. Chiang YL, Chen PC, Lee CC, et al. Adrenal pheochromocytoma presenting with Takotsubo-pattern cardiomyopathy and acute heart failure: A case report and literature review. Medicine (Baltimore)2016;95(36):e4846. doi: 10.1097/MD.0000000000004846 [published Online First: 2016/09/08]
SUN-LB138 Dynamic Structural Model of Testosterone Entry Into the Unliganded Androgen Receptor
Authors: Krylova Irina , Schaufele Fred J , Guilbert Christophe 
Published: May 2020

Abstract
Background: Crystallographic structures of nuclear receptor ligand binding domains provide a static model of a receptor stably wrapped around an internalized ligand. Understanding the dynamics of a receptor at different stages of ligand binding has been hampered by the paucity of crystal structures for unliganded nuclear receptors. Molecular dynamic models have been constructed for some nuclear receptors to fill that void.
Methods: The molecular simulation docking program MORDOR (MOlecular Recognition with a Driven dynamics OptimizeR)(1) was used to study the structural dynamics of the androgen receptor ligand binding domain (AR LBD) modeled from the static structure of the AR LBD bound to testosterone (T) (PDB ID: 2AM9). The goals of the study were to understand a) the dynamic interaction of the T in its binding pocket, b) AR LBD structural flexibilities that permit T entry/exit from the binding pocket and c) a model of the unliganded AR LBD.
Results: Modeling AR LBD structure flexibility over time revealed possible alternative dynamic structures, including those without ligand, overlaid against the canonical nuclear receptor structure. The model dynamically tracks the structural changes as a ligand enters into the ligand binding domain and nestles into the ligand binding pocket. The model predicted the appearance of alpha helices within the AR LBD that transiently fold/unfold during the ligand entry phases. Once in the pocket, the ligand itself remains very dynamic in a still flexible pocket. The model predicted also AR LBD amino acids that sequentially interact with the ligand during its dynamic entry into the AR LBD. Intriguingly, those AR amino acids include those mutated in castration-resistant prostate tumors that continue to grow during androgen suppression therapy. Functional studies showed those mutant ARs had a primary consequence of enhancing response to lower level T, and other androgens, consistent with their role in creating a higher affinity AR that can scavenge low-level androgens in an androgen-suppressed patient.
Conclusions: The molecular model of T binding to the AR LBD suggests a degree of structural dynamism not evident in the crystallographic structures commonly associated with nuclear receptors. Some AR mutations activating prostate tumor growth may do so by impacting androgen entry/exit, rather than by altering androgen fit into the ligand binding pocket.
Reference: (1) Guilbert C, James TL (2008) J Chem Inf Model. 2008 48(6): 1257-1268. doi: 10.1021/ci8000327
MON-LB60 Prolactin Response to Metformin in Cabergoline-Resistant Prolactinomas: A Prospective Study
Authors: Corrêa Portari Luiz Henrique , Correa-Silva Silvia Regina , Abucham Julio 
Published: May 2020

Abstract
Introduction: Prolactinomas are the most frequent pituitary-secreting tumors. Medical therapy with cabergoline (CAB), a dopamine agonist (DA), is the first line treatment, but 10% of prolactinomas are resistant to CAB. Recently, in vitro studies have shown anti-tumoral activity of metformin and other biguanids in human prolactinomas1, which prompted us to investigate that possibility in vivo. Aim: To evaluate the effect of metformin (MET) on Prolactin (PRL) secretion in patients with CAB resistant prolactinomas. Design and Setting: Prospective interventional study in a single referral center. Subjects: Ten patients (7 M; mean age: 44 ± 12y) with CAB resistant (PRL: 148 ± 125ng/ml; range: 38 - 386) prolactinomas (all macroadenomas) and metabolic syndrome on maximally tolerated CAB doses (4.3 ± 1.2 mg/week; range: 2.0-7.0) for ≥ 6 months (45 ± 39mo; range: 6-120). Intervention: Oral extended release metformin (p.o.) was prescribed according to patient’s tolerance (mean dose: 1.3 ± 0.4 g; range: 1.0-2.0). Main Outcome Measurements: Serum PRL (Elecsys, Roche, Indianapolis, USA), body weight (BW), fasting glycemia (FG) and HbA1C were evaluated before and at two time points during metformin treatment (30-60 and 120-180 days). Results: BW, FG, and/or HbA1C reductions were observed in 9/10 patients and mean FG decreased significantly (P=0.04). No significant changes were observed in serum PRL levels during metformin treatment [134 ± 124 ng/ml vs 138 ± 132 ng/ml vs 144 ± 129 ng/ml, before, at 30-60 days and at 120-180 days, respectively (P=0.499, mixed-effects analysis with the Geisser-Greenhouse correction)]. Individually, two patients exhibited a ≥ 50% decrease in PRL levels at a single timepoint (one at 30-60 days, with a further increase at 120-180 days and the other at 120-180 days). Conclusion: Metformin, at usual doses, did not inhibit prolactin secretion in patients with cabergoline-resistant prolactinomas. The discrepancy between our results and in vitro studies is not clear, but may be related to the much higher concentrations of metformin used in vitro1 as compared to the serum concentrations observed in patients during metformin treatment2. References: 1Gao J et al. Metformin inhibits growth and prolactin secretion of pituitary prolactinoma cells and xenografts. J Cell Mol Med. 2018 22:6368-79; 2 Frid A et al. Novel assay of metformin levels in patients with type 2 diabetes and varying levels of renal function: clinical recommendations. Diabetes Care 2010 33:1291-3.
SUN-LB12 Prenatal Trenbolone Exposure and External Genital Malformation: A Case Report
Authors: Chilukoti Padmaja , Farrell Ryan , Desai Riddhi , Omil-Lima Danly O , Hannick Jessica H , Gubitosi-Klug Rose Anne 
Published: May 2020

Abstract
Background Trenbolone is a synthetic anabolic steroid used for muscle growth in livestock. Human use is not FDA approved. The active metabolite, 17β trenbolone is 3 times more potent an androgen than testosterone propionate. Prenatal trenbolone exposure in rats results in female offspring with external genital malformations including an increased anogenital distance (AGD). We now report a case of prenatal trenbolone exposure in humans. Clinical Case A 10 hour old baby delivered vaginally at 37 6/7 weeks of gestation with a birth weight of 3615 grams was admitted to the NICU for concern of ambiguous genitalia. Baby was born to 30 year old G6P3 mother who was HIV positive and adequately treated with Triumeq. She had irregular cycles prior to conception and pregnancy recognized at 14 weeks. Unlike her previous pregnancies, during this pregnancy she had acne and mildly increased facial hair. Prenatal cell-free DNA screening was 46XX and ultrasound showed female genitalia. The 9 year old half-sister and 5 year old brother are healthy. No family history of early neonatal deaths. On arrival blood glucose was 55 mg/dL (45-90). On exam baby had no obvious facial dysmorphic features or midline defects. Hand creases were normal and no extremity edema was noted. Genitalia appeared symmetrical and, showed prominent soft tissue of clitoris without corpus enlargement. No gonads were palpable in the groin or labioscrotal folds. Significant posterior labioscrotal fusion was noted. Anogenital ratio was 0.8 (normal &lt;0.5). A single orifice at the base of the clitoral hood was noted, consistent with likely urogenital sinus. Additional history provided by mother included her disclosure of use of 200 mg of IM trenbolone weekly for 5 weeks, for muscle building, prior to her knowledge of being pregnant. Multidisciplinary care included pediatric endocrinology, genetics, pediatric urology, and pediatric infectious disease. Labs at 24 hours of life: Sodium - 139 mmol/L (131-144), Potassium - 5.3 mmol/L (3.2-5.7), Serum glucose - 75 mg/dL (45-90), Random cortisol - 34.1 mcg/dL (1.0-10.0), 17 hydroxyprogesterone - 124 ng/dL (&lt;460), CAH diagnostic panel - normal with exception of elevation in Progesterone - 3400 ng/dL (5-53), Newborn screening - normal, Chromosomal analysis - 46,XX and absent SRY, Ultrasound pelvis - normal Müllerian structures and bilateral intra-abdominal gonads present. Baby was hemodynamically stable, voided well, gained weight by discharge on DOL 4. Baby was stable on follow-up in endocrinology clinic on DOL 10. Surgical repair of anatomic malformation to be performed at 6 months of age by urology team. Conclusion To our knowledge, this is the first report of virilization of female offspring following human prenatal exposure to trenbolone. Women must be cautioned that trenbolone poses risks of external genital malformation to the developing fetus.
SAT-LB110 Sulfonylurea-Induced Hypoglycemia: To Use Octreotide or Not
Authors: Romeu Jose , Dodge Hannah , Mears Chad , Kozlow Erin , Patel Ravi , Vunnam Rama , Bhatt Dhirisha , Sahu Nitasa , Golamari Reshma , Jain Rohit 
Published: May 2020

Abstract
Background: Sulfonylurea poisoning can cause sustained hypoglycemia refractory to intravenous dextrose. Traditional treatment for sulfonylurea induced hypoglycemia includes intravenous dextrose and glucagon as well as diazoxide in refractory cases. Octreotide is recommended for sulfonylurea poisoning in adult and pediatric patients with laboratory evidence of hypoglycemia.
Clinical Case: An 89 year-old female with chronic kidney disease stage III, hypothyroidism, and diabetes mellitus type II, hypertension who presented with intractable nausea and diarrhea. Patient had been taking cefdinir for an UTI the prior week. On CT scan of the abdomen, colitis was demonstrated. Clostridium Difficile Assay was positive. She was incidentally found to have profound hypoglycemia with a blood glucose level of 30 mg/dL. Patient had hypoglycemia unawareness. Despite receiving 4 ampules of dextrose 50%, glucose level did not significantly improve. In the ED, patient was afebrile and hemodynamically stable. Her labs were significant for a hyponatremia of 125 mmol/L with an acute kidney injury [AKI] (Cr 1.94 mg/dL from 1.5 mg/dL). Patient was placed initially on a dextrose 5% normal saline infusion, but glucose levels continued to decline after brief response. Due to poor IV access, internal jugular central line was placed and patient was placed on D10NS infusion with good glycemic response. Patient had taken sulfonylurea despite not eating appropriately for 2 days. After 24 hours on D10 normal saline infusion, patient was able to maintain normal to slightly hyperglycemic levels with consistent carbohydrate diet. Her nausea and diarrhea had considerably improved after starting vancomycin 125 mg every 6 hours. Sulfonyurea was indefinitely discontinued.
Conclusion: Patients presenting with sulfonylurea induced hypoglycemia complicated by poor PO intake, AKI, and infection can be safely treated with supportive measures like proper hydration, and dextrose infusion medication is appropriately metabolized by body without the need for octreotide infusion.
References:Glatstein M, Scolnik D, Bentur Y. Octreotide forthe treatment of sulfonylurea poisoning.Clin Toxicol (Phila). 2012 Nov;50(9):795-804. doi:10.3109/15563650.2012.734626. Epub 2012 Oct 10.