bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-045 Free Testosterone and Cardiometabolic Parameters in Adult Men - Comparison of Algorithms for Calculation of Serum Free Testosterone
Authors: Holmboe Stine Agergaard , Jasuja Ravi , Priskorn Laerke , Jørgensen Niels , Juul Anders , Andersson Anna-Maria 
Published: May 2020

Abstract
Context. Determining the free or bioavailable testosterone level has gained increasing interest over the years and different indirect algorithms have been suggested.
Objective. To compare commonly used algorithms of calculation of serum free testosterone, specifically free androgen index (FAI), free testosterone estimated using the Vermeulen algorithm (cFTV) and the Zakharov algorithm (cFTZ) as well as total testosterone in relation to baseline and long-term cardiometabolic conditions.
Design. A prospective cohort study of men participating in four independent population-based surveys (MONICA I-III and Inter99) from 1982 to 2001 and followed until December 2012 with baseline and follow-up information on cardiometabolic parameters.
Setting and Participants. 5350 randomly selected men from the general population aged 30, 40, 50, 60, or 70 years at baseline participated.
Main Outcome Measures. Baseline cardiometabolic parameters and follow-up information on type 2 diabetes, ischemic heart disease, cardiovascular disease mortality, and all-cause mortality.
Results. Free testosterone levels calculated according to the two algorithms differed systematically but however correlated well (cFTV vs. cFTZ: r=0.9, p&lt;0.01) and the relative standard deviations ranged from 37% to 41%. In general, men having cardiometabolic conditions at baseline had lower absolute levels of FAI, cFTV and cFTZ. However, when age-standardizing the hormone levels, FAI levels were higher in this group of men whereas cFTV and cFTZ remained lower compared to men without these conditions. The associations seen for cFTV and cFTZ were in line with the association seen for total testosterone. Cox proportional hazard models revealed that men in the highest quartiles of cFTV or cFTZ had lower risk of developing type 2 diabetes (cFTV: HR=0.74 (0.49-1.10), cFTZ: HR=0.59 (0.39-0.91)) than men in the lowest quartile. In contrast, men with highest levels of FAI had a 74% increased risk of developing type 2 diabetes compared to men in the lowest quartile (HR=1.74, 95% CI:1.17-2.59). In relation to all-cause mortality, FAI showed the strongest inverse association followed by cFTV, whereas cFTZ and total testosterone did not show any association.
Conclusion. Free testosterone estimated by the Vermeulen and Zakharov algorithms differed systematically. However, the computed values correlated well and showed similar associations to baseline and long-term cardiometabolic parameters; albeit with subtle differences. In contrast, an empiric ratio, FAI showed opposite associations to several of the examined parameters and may reflect limited clinical utility.
SUN-584 Micrornas in Brown and White Adipocytes
Authors: Dimitri Federica , Alam Mohammad T , Dib Lea , Christian Mark 
Published: May 2020

Abstract
Two types of adipose tissue exist: white (WAT) and brown (BAT). WAT stores energy while BAT consumes fatty acids and produces heat by non-shivering thermogenesis through Uncoupling Protein 1 (UCP1). BAT and WAT cooperate in maintaining energy homeostasis balance. Understanding their physiology is important for the development of treatments against diseases where this equilibrium is compromised, such as obesity and associated metabolic disorders. MicroRNAs (miRNAs) are potent gene regulators and an increasing body of evidence suggests their involvement in adipogenesis and adipose metabolism. MiRNAs can also be secreted into the extracellular environment and be taken up by distal cells, mediating cell-to-cell communication. However, very little is known about adipose tissue-derived circulating miRNAs. Through miRNA PCR array analysis we identified several miRNAs that are differentially secreted among undifferentiated and differentiated brown and white adipocytes, such as miR-196a, 378a-3p and miR-138-5p. Bioinformatics target prediction revealed that these miRNAs are potentially involved in important processes regulating the functioning of adipose tissue and its cross-talk with distal cells. Among the predicted targets of miR-196a, we identified ADAM10 (A Disintegrin And Metalloproteinase Domain-containing protein 10). This protein is responsible for the proteolytic release of several cell-surface proteins involved in numerous biological processes such as inflammation and its role could be of relevant importance in the physiopathology of the adipose tissues.
MON-694 EDKA and MALA in the Setting of Severe Heart Failure and Acute Renal Failure, Due to SGLT2-i
Authors: Heckart Jonathan Calvin , Shaw Michael 
Published: May 2020

Abstract
Background: EDKA is a reported potential side effect of SGLT-2i that presents a unique challenge for diagnosis and management in the setting of HF and concurrent AKI. Literature encourages wide use of SGLT-2i’s, however this case demonstrates the need of proper evaluation before initiating therapy.
Case: A 53 year old male with PMH of T2DM, Atrial fibrillation, HFrEF, presented to the Emergency Dept after a week of confusion, nausea, vomiting, and diarrhea. These symptoms were presumed due to gastroenteritis and our patient continued working on his farm in the summer heat. Following 3 days of intractable vomiting, he began to develop confusion, took his medications and presented to the ED. He was on metformin and had recently started empagliflozin following a heart failure exacerbation. Upon arrival the patient was noted to have a severe AKI with Cr of 15, hyperkalemia with potassium of 7.7, Anion gap of 45, bicarbonate of 4. Lactic acid was noted to be 7.7 and BHB was later noted to be 10.5 with a serum blood glucose of 155.
Pt was determined to have Euglycemic Diabetic Ketoacidosis with an additional Metformin associated lactic acidosis. He was started on an insulin drip with a concurrent D20 infusion to minimize fluid intake. Dextrose was titrated up to maintain a goal BG of 150-180 while on a stable insulin rate of 5u/hour, while monitoring serum ketones to resolution of DKA. Due to excess fluid intake he required intubation and later, hemodialysis due to metformin associated lactic acidosis and acute renal failure. Following 3 days of dialysis he was able to successfully wean from vent and pressors, making a complete recovery.
Conclusion:
We present a patient with EDKA likely resulting from dehydration induced AKI compounded by SGLT2i induced diuresis. As he developed his kidney injury, metformin was able to build up to toxic levels inducing lactic acidosis. Treatment in this patient was based on the underlying physiology providing glucose to allow resolution of ketosis. Treatment is not well studied, but given the origin of the pathology should resemble a standard DKA protocol with glucose repletion. SGLT2i and metformin combinations have shown an increased risk of metabolic acidosis1 and lactic acidosis2. This case highlights a potential risk of the combination in the setting of renal insufficiency and tenuous fluid states.
References:
(1) Donnan, Katherine, and Lakshman Segar. “SGLT2 Inhibitors and Metformin: Dual Antihyperglycemic Therapy and the Risk of Metabolic Acidosis in Type 2 Diabetes.” European Journal of Pharmacology, U.S. National Library of Medicine, 5 Mar. 2019.
(2) Schwetz V, Eisner F, Schilcher G, et al. Combined metformin-associated lactic acidosis and euglycemic ketoacidosis. Wien Klin Wochenschr. 2017;129(17-18):646–649. doi:10.1007/s00508-017-1251-6
SAT-633 Features of Vitamin B12 and Vitamin D Homeostasis in Patients with Type 2 Diabetes Mellitus Associated with Tuberculosis
Authors: Khalimova Zamira Yusufovna , Kholmatova Gulkhae Azimjonovna 
Published: May 2020

Abstract
The aim of the study was to study the features of homeostasis of vitamin B12 and vitamin D deficiency in patients with type 2 diabetes mellitus (T2DM) associated with tuberculosis.
Material and research methods. Under our supervision, there were 48 patients who were divided into 2 groups: group 1 - these are patients with type 2 diabetes associated with tuberculosis, who made up the main group (n = 42), group 2 - this is the control group represented by patients with tuberculosis (n = 12)
Research methods included general clinical, biochemical (glucose, glycated hemoglobin, coagulogram, lipid spectrum, etc.), hormonal (insulin. C-peptide) blood and urine tests. The content of vitamin B12 and vitamin D was studied in patients of both groups. Instrumental studies included ECG, dopplerography of the great vessels, ultrasound of the internal organs, and x-ray studies.
The results of the study. The first group consisted of 17 men and 19 women, whose average age was 54.4 ± 2.2 / 55.5 ± 1.7 (m / f), respectively. The duration of diabetes in men was within 6.8 ± 1.4 years, and in women 4.6 ± 0.7 years. The duration of tuberculosis in men was 1.8 ± 0.3, and in women 1.9 ± 0.2 years.
The average HbA1C content was in the range of 8.9 ± 0.50 / 9.9 ± 0.51, and glucose 10.6 ± 0.61 / 15.0 ± 0.82 nmol / L in patients of the 1st group. The average insulin level was 11.3 ± 2.09 / 11.7 ± 2.2 pg / ml, and Vit B12 403 ± 33.7 / 407 ± 45.7 (normal 193-982 pg / ml, on average 450 pg / ml), the content of vit D was in the range of 13.1 ± 2.1 / 11.1 ± 3.08 ng / ml, respectively (normally from 30-100 ng / ml).
The second group consisted of 9 men and 3 women, the average age was 49.5 ± 5.2 / 45.0 ± 8.0 years. The duration of tuberculosis in this group was 1.8 ± 0.4 / 1.0 ± 0.2 years. The average content of HbA1C was in the range of 4.1 ± 0.2 / 4.9 ± 0.7, and glucose 5.1 ± 0.1 / 5.8 ± 0.4 nmol / L in patients of the 1st group. The average insulin level was 9.6 ± 1.9 / 16.3 ± 1.3 pg / ml, and Vit B12 376.7 ± 91.1 / 402.0 ± 13.3 (normal, 193-982 pg / ml, average 450 pg / ml), the content of Vit D was in the range of 14.5 ± 1.4 / 11.6 ± 1.7 ng / ml, respectively (normally from 30-100 ng / ml).
Conclusions. In both groups of patients, the average content of vitamin D in the blood was significantly reduced (p &lt;0.001), while the average levels of vitamin B12 in both groups were within normal limits, remaining below average normal values.
OR08-04 Differences in Advanced Lipoprotein Profile Between Rabson-Mendenhall Syndrome and Lipodystrophy
Authors: Al-Jundi Mohammad , Lightbourne Marissa , Startzell Megan , Shamburek Robert D , Brown Rebecca J 
Published: May 2020

Abstract
Insulin resistance (IR) is associated with metabolic dyslipidemia (high triglycerides [TG] and low HDL) and increased cardiovascular disease (CVD) risk. In obesity-associated IR, dyslipidemia is thought to be caused by increased insulin-mediated stimulation of hepatic lipogenesis, whereas IR in glucoregulatory pathways leads to hyperglycemia. This dichotomy in insulin signaling pathways is termed selective insulin resistance. Rare human conditions exist in which there is extreme, non-selective, IR impairing all insulin signaling pathways (e.g. mutations of the insulin receptor, INSR) or extreme IR affecting only selected intracellular insulin signaling pathways analogous to obesity (e.g. lipodystrophy). Lipodystrophy leads to very high TG, low HDL, and increased CVD, while INSR mutation leads to low TG and high HDL, with unknown CVD risk. We sought to further characterize the lipid phenotype and atherogenicity in these conditions in order to understand effects of different insulin signaling pathways on CVD risk.
We studied 7 patients with INSR mutation (42% female; 5 homozygous; 2 heterozygous) and 21 with lipodystrophy (85% female; 5 generalized; 16 partial). Fasting lipoprotein profiles were assessed by NMR using the LP4 deconvolution algorithm. The major lipoprotein particle categories defined by this method are small, medium, and large HDL and LDL particles (HDLP and LDLP) and very small, small, medium, large, and very large TG rich lipoprotein particles (TRLP).
Very small TRLP (median 189.6 [68.7, 315.0] vs 4.5 [0.00, 9.4], p=0.0001), small LDLP (mean 1425.0 ± 636.2 vs 612.8 ± 233.9, p=0.003), small HDLP (mean 14.0 ± 4.7 vs 9.0 ± 3.2, p=0.014) were more elevated in patients with lipodystrophy vs INSR mutation. This lipoprotein profile has been associated with increased atherosclerotic coronary artery disease. GlycA, a marker of inflammation was also more elevated in lipodystrophy vs INSR mutation (435.9 ± 107.2 vs 315.7 ± 74.4, p=0.01). Insulin resistance assessed by HOMA-IR was higher in patients with INSR mutation vs lipodystrophy (mean 93.5 ± 94.4 vs 15.6 ± 14.7, p=0. 00085).) Lipoprotein insulin resistance (LPIR), an index of IR based on lipoprotein particles, was lower in patients with INSR mutation (25.0 ± 19.0 vs 84.0 ± 9.0, p &lt; 0.0001) despite their higher HOMA-IR.
In conclusion, severe, selective insulin resistance in patients with lipodystrophy was associated with a more atherogenic lipoprotein particle profile and increased inflammation compared to severe, non-selective insulin resistance caused by INSR mutations. Patients with INSR mutations had a striking discrepancy between a glucose/insulin-based index of insulin resistance (HOMA-IR) and a lipid-based marker of insulin resistance (LPIR). These findings point toward a key role of selective insulin resistance in the development of an atherogenic lipid profile, which should lead to increased CVD risk.
MON-337 Peripheral Neurological Complications in Pregnancy- Is Idiopathic Transient Osteoporosis of Pregnancy Concerning?
Authors: Aljaberi Asma Khaled , Szolics Miklos 
Published: May 2020

Abstract
Idiopathic transient osteoporosis of pregnancy (ITOP) is a rare and under-reported condition that has affected healthy pregnancies. ITOP usually presents in the final trimester of a normal pregnancy. Radiographic studies detect drastic loss of bone mass, elevated rates of turnover in the bone, and edema in the affected portion.
We present a 26-year-old previously healthy woman, who was admitted at 39 weeks of gestation with severe left hip pain and inability to walk for one month.The pain was constant, progressive, involving left lower limb, and associated with numbness and weakness. Neurological exam revealed diminished power in the left hip (motor power was 2/5), and inability to stand and walk due to pain in the left hip. She was unable to stand by herself. Investigations revealed anemia, low vitamin B12, low vitamin D and magnesium. Bilateral hip MRI showed increased T2WI signal in the left femoral head consistent with idiopathic transient osteoporosis of the left hip (ITOP). DXA scan showed bone mass density (BMD) below expected for age.The patient had induced vaginal labor without complication. The left hip pain improved after delivery. She was treated conservatively with Calcium, Magnesium and vitamin D. The patient symptoms completely resolved in 3 months post-delivery. DXA scan and Hip MRI at 1 year interval showed normal BMD and complete resolution of previous bone marrow edema and changes seen in MRI hip.
This case report serves to highlight the effect of pregnancy on bone mass during third trimester which may result in transient osteoporosis of pregnancy leading to weakness and gait disturbance. Clinical symptoms can be misdiagnosed as a peripheral neurological complications instead of bone metabolism changes of pregnancy.
MON-322 The Characteristic of Reproductive Disorders in Women with ACTH-Dependent Cushing Syndrome in the Republic of Uzbekistan (RUz) and Republic of Karakalpakstan (RKK)
Authors: Khalimova Zamira Yusufovna , Irgasheva Oydin Bahodirovna , Mirsaidova Umida Akmalovna , Jabborova Gavhar Muzravjanovna 
Published: May 2020

Abstract
The aim- to study the characteristic of the reproductive function in patients with ACTH-dependent Cushing Syndrome in (CS) in all regions of the RUz and RKK.
Material and methods. Under our supervision in the all regions of RUz and Tashkent-city there are 120 women of fertile age with ACTH-dependent Cushing Syndrome were observed in the framework of project. Middle age of patients was 27,6 ± 3, 4 years.
The complex of researches, including clinical, biochemical hormonal (ACTH, LH, FSH, cortizol, prolactin), ultrasound investigations, pituitary and adrenals CT/MRI was executed all patients.
Results. The patients were divided into 2 groups: 1 group - patients with conservative treatment - 47 cases (39,1%), 2 group -patients with pituitary surgery - 65 cases.(54,1%), 3 group - combined therapy - 8 patients (6,6%).
The reproductive disorders had 63 women from 120 (52,5%): amenorrhoea -35%), oligomenorrhoea (30%), polimenorrhoea (7,5%). It was found that with ACTH - dependent Cushing’s syndrome, primary infertility was 17,6%, secondary 23.5%,
We found hyperandrogenemiya and hypercortizolemiya in patients of all groups before treatment. Estradiol levels were significantly inversely correlated with cortisol levels. One year after surgery we established normal range of LH, FSH, ACTH, cortizol, prolactin in all women of 2 group, but in 1 and 3 group we didn’t achieve compensation yet.
After 1 year only 1 (2,1)% women from 1 group can pregnant. After 1 year 30 women from 65 patients of second group after pituitary surgery (46,1%) achieved pregnancy without stimulation therapy. There are 2 (25%) women of 3 group achieved pregnancy.
The restoration of reproductive function in women with CS was observed in 3,5% of cases in patients treated with medical therapy, 33,3% in patients with adrenalectomy and combination therapy, and 50% after transsphenoidal adenomectomy of pituitary tumor.
Conclusions. The fertility function in women with ACTH-dependent CS can improve after pituitary surgery without stimulation therapy. In 46,1% of cases, in patients with combined therapy -in 25%and in women after conservative therapy - in 2,1%.
SUN-078 Clinical, Hormonal, Psychosexual Aspects, Gonadal Tumors and Genetic Background of an Androgen Insensitivity Syndrome Cohort
Authors: Batista Rafael Loch , Ramos Raquel Martinez , Almeida Gomes Nathalia Lisboa Rosa , Ferrari Maria Tereza Martins , Elias Felipe Martins , Rodrigues Andresa De Santi , Nishi Mirian Yumie , Silva Juliana M , Costa Elaine Maria Frade , Domenice Sorahia , Mendonca Berenice Bilharinho 
Published: May 2020

Abstract
Introduction: Androgen Insensitivity Syndrome (AIS) is the most common cause of Differences of Sexual Development (DSD) in 46, XY individuals. It is a X-linked genetic disease caused by allelic variants in the Androgen Receptor Gene (Xq11-12), leading to 3 different phenotypes: Complete (CAIS), Partial (PAIS) or Mild (MAIS). Methods: Patients with clinical suspicion of AIS (familial history, atypical genitalia, primary amenorrhea and/or inguinal hernia) performed hormonal serum measurements (LH, FSH, estradiol, testosterone) and molecular sequencing of the ARgene, including all exonic regions (8 exons) and the 5’UTR region. Psychosexual variables (gender identity, gender role and sexual orientation) were evaluated through questionnaires. Gender identity was also evaluated through projective psychological test (HTP test). A histopathological study and immunostainining of CD240 and OCT3/4 were carried out for all individuals submitted to gonadectomy.Results: This cohort is made up of 64 individuals: CAIS (n=26) and PAIS (n=38), from 46 different families (24 PAIS; 22 CAIS). Inguinal hernia was the first clinical presentation in 35% of CAIS. Among the PAIS, 20 (52%) were assigned as female at birth, while 18 (48%) as male. Among In the group of PAIS, external genitalia virilization (Sinnecker score) influenced sex assignment (p&lt;0.01). Final height and weight were similar between PAIS and CAIS. Furthermore, gender identity at adulthood, gender role at childhood and sexual orientation were in agreement with sex assignment in virtually all cases of both PAIS and CAIS. No gender change was observed. Molecular diagnosis was obtained in 96% of CAIS and in 87% of PAIS. There were 10 novel AR allelic variants (4 in CAIS - 2 small deletions, 1 missenseand 1 at splicing site and PAIS - 5 missenseand 2 synonymous variants (both causing a new exonic splicing site leading to a short AR protein). LH ranged from 9 to 48 UI/L (mean 19), testosterone from 190 to 1500 ng/dL (mean 438), without phenotype differences. Seminoma was identified in 2 out 24 (8%) individuals with CAIS (at 19 and 20 years of age). This rate was higher taking into account only those who underwent gonadectomy after puberty (16 years old or later: 2 out 17 (12%). Among PAIS there were 2 cases of NICG (at 3 and 19 years of age) and none of seminoma. Conclusion: Hormonal levels did not enable us to differ PAIS and CAIS. Inguinal hernia is a common clinical presentation of AIS. External genitalia appearance in PAIS influenced sex assignment. The psychosexual development in AIS usually complies with sex assignment. No gender change was observed. There is a risk of seminoma in CAIS, especially after puberty, which is not low enough to be ignored.
SUN-023 Changes in Microct Bone Density and Reduced Bone Formation in a “Postmenopausal” PCOS Rat Model
Authors: Comim Fabio Vasconcellos , Comim Fabio Vasconcellos , Mujica Lady Katerine S , Macari Soraia , Silva Tarcilia A , Barrioni Breno R , Stein Carolina S , Valente Fernanda , Miyazato Ligia G , Antoniazzi Alfredo Q , Moresco Rafael N , Premaor Melissa Orlandin 
Published: May 2020

Abstract
Polycystic ovary syndrome (PCOS) affects women during their entire lifespan. Evidence from the literature suggests an association of PCOS with decreased bone formation markers (osteocalcin and P1NP), although no conclusive data about the incidence of fractures exist. In the present study, we investigated the consequences of androgenization in rats on bone markers and femur microCT and the changes in these parameters after ovariectomy. This study was approved by the local Animal Ethics Committee. Briefly, Wistar rats (n= 38) were divided in 4 groups: 1) “Control OVX” (single dose of corn oil s.c. at day 5 of life and ovariectomy at day 100, n=9); 2) “Control SHAM” (n=9); 3) “Androgenized OVX”(single dose of testosterone propionate 1.25 mg s.c. at day 5 of life and ovariectomy at day 100, n=10); and 4) “Androgenized SHAM” (n=10). Full characterization of estrous cycles and weight was performed during growth, and all animals were euthanized at day 180 during metestrus/diestrous. Evaluation of glucose levels, lipids, estradiol, P1NP levels (a marker of bone formation), and analysis of the femur micro CT Skyscan 1174 (Aartselaar, Belgium) was performed in at least eight animals of each group. Ovariectomy increased the weight of Androgenized OVX rats on day 180: these animals were heavier than Control OVX, Control SHAM, or Androgenized SHAM (ANOVA p&lt;0.001). However, metabolic changes were observed in ovary-intact Androgenized SHAM rats who exhibited higher total cholesterol (ANOVA p&lt;0.001), increased LDL (ANOVA p=0.03), and elevated TyG index, a marker of insulin resistance (ANOVA p&lt;0.001) against all other three groups. This group (Androgenized SHAM rats)also exhibited an increase in MicroCt bone density (g/cm-3) (mean + SEM) of 1.117 + 0.06 against the other - Control SHAM 0.8433 + 0.03, Control OVX 0.5527 + 0.001, and Androgenized OVX 0.6284 + 0.02 (ANOVA p&lt; 0.001). Although the values of bone density between Control OVX and Androgenized OVX groups were similar, gonadal removal produced a different pattern of bone density reduction between Control OVX and Androgenized OVX (Two-Way ANOVA p=0.001). Moreover, we found P1NP levels significantly decreased in the Androgenized OVX group (mean + SEM) of 58.57 + 4.41 ng/ml against 88.02 + 8.49 ng/ml in Control OVX versus (ANOVA p&lt;0.0001) indicating lower bone formation. Our results suggest that bone and metabolic features of Androgenized rats are affected by ovariectomy with a negative impact on bone formation.