bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-202 Is a “Failed” Adrenal Venous Sampling Useful for Surgical Decision Making in Primary Hyperaldosteronism?
Authors: El Mais Rania , Acharya Runa 
Published: May 2020

Abstract
Background
Adrenal venous sampling (AVS) is important in differentiating unilateral vs bilateral primary hyperaldosteronism. A limitation is the difficult cannulation of the right adrenal vein (RAV).
A study in 2016(1) investigated the usefulness of AVS with failed right sided cannulation. The investigators calculated the ratios of plasma aldosterone and cortisol in the periphery (IVC) and in the left adrenal vein (LAV), then corrected the aldosterone/cortisol ratio of the LAV for that of the IVC with the following equation: LAV/ IVC = [aldosterone in LAV/cortisol in LAV] / [aldosterone in IVC/ cortisol in IVC]. A LAV/IVC ratio ≥5.5 and ≤0.5 predicted unilateral aldosterone hypersecretion on left and right side respectively with a 100% specificity and positive predictive value.
Clinical case
We present a case of a 51-year-old patient with primary hyperaldosteronism and a failed right sided cannulation. Patient presented with uncontrolled hypertension of 10 years and hypokalemia. His blood pressure (BP) was 190/100 on amlodipine, lisinopril, atenolol, hydralazine and spironolactone.
Screening labs obtained off spironolactone and atenolol showed:
Aldosterone 18.5ng/dl(0-30), renin 0.215ng/ml(0.167-5.738), plasma aldosterone concentration (PAC)/ plasma renin concentration (PRC) 86.
CT abdomen showed a 1.2cmX1cm left adrenal adenoma.
A 24-hour urine collection without salt loading showed an aldosterone of 43.46 microg/L (0-19). He underwent an AVS with a failed RAV cannulation with the following results:
IVC: cortisol=17.2 microg/dl, aldosterone= 8.9ng/dl, aldosterone/cortisol= 0.52
LAV: cortisol=420, aldosterone=2860, aldosterone/cortisol=6.8.
Partial left adrenalectomy was performed. Pathology showed a benign adenoma.
Although his BP initially improved, over several weeks, his BP was high again, and he had a recurrence of hypokalemia. A repeat PAC/PRC of 80 confirmed persistent hyperaldosteronism.
He refused further interventions. Eplerenone was added resulting in BP control.
Conclusion
Based on the above study, his LAV/IVC of 13 predicts the source to be the left adrenal gland. However, this ratio did not apply in our patient and should be utilized carefully.
References:
1.Pasternak JD, Epelboym I, Seiser N, Wingo M, Herman M, Cowan V, et al. Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein. Surgery. 2016;159(1):267-73.
SUN-282 Transient Infundibulohypophysitis in a Child with Central Diabetes Insipidus
Authors: Puthanpurayil Shabana Kalladi , Uddin Ahsan , Gerrits Peter Matthew 
Published: May 2020

Abstract
Case Description
A 7-year-old previously healthy female presented with a 1-month history of tiredness, excessive thirst and increased urinary frequency. Initial studies showed an elevated serum osmolality with relatively dilute urine. She underwent a water deprivation study which confirmed central diabetes insipidus (CDI). An MRI of the brain was obtained which showed markedly thickened and homogeneously enhancing pituitary stalk thickening (17mm craniocaudal x10 mm anteroposterior diameter). Workup did not reveal any signs suggestive of Langerhan’s cell histiocytosis; a skin biopsy and bone survey were normal. A pituitary stalk biopsy was scheduled, however direct endoscopic visualization of the pituitary stalk was normal, so the procedure was aborted. A repeat MRI 7 weeks later showed complete resolution of the stalk thickening. An MRI done 4 months later again showed normal anterior pituitary and normal pituitary stalk, with persistent absent posterior bright spot. She remains on desmopressin, and anterior pituitary functions have been normal to date.
Discussion
CDI in children can be due to infectious, neoplastic, traumatic or genetic processes that disrupt the hypothalamus or pituitary stalk. One third of children with CDI present with pituitary stalk thickening (PST) on initial evaluation with MRI. There are wide variations in the degree of PST. Previous studies have shown that the degree of PST is different depending on the underlying etiology. Furthermore, regression of PST has been observed in many cases of CDI with PST which has been attributed to idiopathic or autoimmune process (infundibulohypophysitis). Most studies have demonstrated that PST &gt; 4 mm is unlikely to regress and may be more likely to progress with eventual diagnosis of a neoplastic process such as germinoma or Langerhan’s cell histiocytosis. Based on review of the literature, the earliest resolution of PST was in 3 months in a patient who received steroid therapy at diagnosis. [1]
Conclusion
Our case illustrates that in children with central diabetes insipidus, isolated pituitary stalk thickening may resolve in as short a period as 7 weeks. While ongoing evaluation is warranted with serial pituitary imaging, unnecessary invasive procedures may be avoided in patients without evidence of other underlying anatomic pathology. Anterior pituitary function requires initial and continued surveillance.
References
1. Shaefers J et al. Clinical presentation and outcome of children with central diabetes insipidus associated with a self-limited or transient pituitary stalk thickening, diagnosed as infundibuloneurohypophysitis. Clin Endocrinol (Oxf). 2017 Aug;87(2):171-176. doi: 10.1111/cen.13362. Epub 2017 Jun 5.
MON-100 Prevalence of Goitre and Thyroid Disorders in Healthy School Children of Kashmir Valley. A Multistage Cross-Sectional Survey
Authors: Sood Mona , Masoodi Shariq Rashid , VASUDEVAN Vishnu , Bhat Moomin Hussain 
Published: May 2020

Abstract
Background There has been a gradual transition among pattern and prevalence of thyroid dysfunctions among paediatric population post iodisation phase making it imperative to look into it with periodic surveys. Objective To comprehend the existent thyroid disease burden along with goitre prevalence in healthy paediatric population of Kashmir Valley. Design It was a cross sectional survey including 666 healthy school children of Kashmir valley of the age 6-18 years out of which 421 were girls and 245 were boys. Goitre was graded as per WHO grading system. Thyroid function test (TFT-TSH, TT4, TT3) were measured in all study subjects. Urinary iodine excretion UIE was measured in 40 subsampled children. Results The overall prevalence of thyroid dysfunction (goiter and or abnormal TFT) among children was 7.8% (CI 5.9-10.1%) with a prevalence of 9.3% in females (CI 2.9-8.9%) and 5.3% (CI 6.7-12.4%) in males. The overall prevalence of goitre was 2.4% with a significant difference observed in boys and girls as all 16 children with goitre were girls. UIE ranged from 71 to 558ug/gm of creatinine (median,150). TFT results were available in 563 children with abnormal results observed in 6.6% (n=37) subjects. Most common TFT abnormality was subclinical hypothyroidism (SCH) with total of 4.3% while 1.6% subjects had overt hypothyroidism and 0.7% had subclinical thyrotoxicosis. Children with subclinical disease were observed and those with overt hypothyroidism were treated accordingly. Conclusions Total goitre prevalence has decreased in Kashmir Valley post iodisation and continues to decrease further when we compared with previous prevalence study by Masoodi et al 2013*. However, there is a need for periodic large-scale cross-sectional surveys to know the thyroid status of our population. The most frequent thyroid function abnormality in our survey was SCH which needs judicious management as treating these children strain out stretched health resources.
*Masoodi S R et al. Goitre and urinary iodine excretion survey in schoolchildren of Kashmir Valley. Clin Endocrinol (Oxf) 2014;80(1):141–7.
SAT-257 Coexisting Craniopharyngioma and Acromegaly
Authors: Yang Almira , Engel Ashley , Maas Diana 
Published: May 2020

Abstract
Background: Craniopharyngioma has a bimodal age distribution with adults having more pronounced hormone deficiencies.1 Studies indicate hormone deficiencies in &gt;80% of cases, most commonly growth hormone (GH) deficiency.2 Comparatively, acromegaly is due to excess GH primarily from a pituitary adenoma.3 Coexistence of a craniopharyngioma and a secretory pituitary adenoma is extremely rare,4 and here we present a case with both. Clinical Case: A 59-year-old woman presented with a two-month history of acutely worsening headache and a week of vision change. A computerized tomography (CT) head scan revealed a 2.2 cm partially solid and cystic sellar mass compressing the optic chiasm. The patient underwent emergent resection. Pre-operational biochemical studies demonstrated normal hypothalamus-pituitary axes except a mildly elevated insulin-like growth factor 1 (IGF-1). Pathology revealed an adamantinomatous craniopharyngioma. Although decreased, IGF-1 remained elevated post-operatively and magnetic resonance imaging (MRI) showed a small non-enhancing area within the pituitary. The patient recalled a gradual increase in shoe and glove size, coarser facial features, weight gain, bilateral carpal tunnel, and mild fluid retention in ankles over the past few years. The GH remained unsuppressed in a glucose suppression test. Conclusion: We present a case of pathology proven craniopharyngioma and concurrent GH excess. The patient presented with a sellar mass with mass effect prompting emergent pituitary resection. Although findings of combined solid and cystic with calcification on MRI point to craniopharyngioma diagnosis,1 it is difficult to discern a concurrent GH-secreting tumor as it tends to be smaller and hypointense on T2-weighted MRI.5 While most craniopharyngioma patients demonstrate hormone deficiency, comprehensive hormonal evaluation and close follow-up are warranted, as in rare cases, patients can have co-existing secretory pituitary adenoma and craniopharyngioma. Early diagnosis and intervention can help prevent detrimental complications related to excess growth hormone. References: 1. Müller HL. Craniopharyngioma. Handb Clin Neurol. 2014;124:235-53. 2. Zoicas F, Schöfl C. Craniopharyngioma in adults. Front Endocrinol. 2012;3:46. 3. Gadelha, M. et al. Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocrine Reviews. 2019;40(1):268-332. 4. Fountas A, Chai ST, Ayuk J, Gittoes N, Chavda S, Karavitaki N. A rare challenging case of co-existent craniopharyngioma, acromegaly and squamous cell lung cancer. Endocrinol Diabetes Metab Case Rep. 2018;2018:18-0018. 5. Potorac I, et al. Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocrine Related Cancer. 2015;22:169-77.
MON-299 Risk Factors of Re-Growth of Non-Functional Pituitary Adenomas
Authors: Khalimova Zamira Yusufovna , Urmanova Yulduz Mahkhakamovna 
Published: May 2020

Abstract
The aim of investigation to determine clinical aggressiveness diagnostic markers in patients with non-functional pituitary adenomas (NFPA) in the formation of gravity neuroendocrine disease symptoms. Material and Methods: We observed in 87 patients (including man - 44 women -43) of which have a verified diagnosis of NFPA after surgery - 31 which were subjected transnasal adenomectomy of the pituitary (TAG). Further analysis was performed on these patients, who were followed from 1 to 3 years. Results. After the analysis of the frequency of remission and relapse NFPA data selectively in patients we studied the correlation between various parameters and the frequency of relapses. NFPA developed the scale of aggressiveness allowed to identify the risk factors of markers on the 3rd degrees, allowing to create a set of measures of tumor growth relapse prevention. According to MRI data of the brain and pituitary gland, in 15 patients an endosellar tumor was found, in 16 - an endo-extrasellar tumor. In an MRI study, the structure of the NFPA had a predominantly soft tissue (n = 16) and cystic (n = 11) structure. In 4 cases (13%), the structure of the NFPA was represented by a hemorrhagic component, and in 2 (6.4%) of them, both cystic and hemorrhagic components were present. In 18 patients, microadenoma was revealed, in 12 - pituitary macroadenoma and in 1 - a giant pituitary adenoma. The developed scale of aggression markers of NFPA allowed identifying factors by 3 degrees, which allows developing a complex of measures for the prevention of tumor growth recurrence. Conclusions. 1) According to our data, the number of patients with large-cell chromophobic pituitary adenoma predominated - 24 (77.5%). In 2nd place were patients with small cell NFPA - 6 cases (19.3%). And only in 1 case was observed (3.2%) a giant malignant pituitary macroadenoma with recurrence of growth and metastasis in the brain of a teenage girl, in which dark-cell pituitary adenoma was histologically determined, 2) According to our preliminary data, the markers of aggressiveness of the course of NFPA are: young patient age, first symptoms of the disease manifest, large tumor size, asymmetry and deformation of the pituitary gland, signs of tumor invasion into adjacent tissues / arteries / cavernous sinus, presence of small cell and / or dark extracellular chromophobic adenomas, STH hypopituitarism, panhypopituitarism.
SAT-648 Flash Glucose Monitoring Helps Achieve Better Glycemic Control Than Conventional Self-Monitoring of Blood Glucose in Non-Insulin-Treated Type 2 Diabetes: A Randomized Controlled Trial
Authors: Wada Eri , Onoue Takeshi , Kobayashi Tomoko , Handa Tomoko , Hayase Ayaka , Ito Masaaki , Furukawa Mariko , Okuji Takayuki , Okada Norio , Iwama Shintaro , Sugiyama Mariko , Tsunekawa Taku , Takagi Hiroshi , Hagiwara Daisuke , Ito Yoshihiro , Suga Hidetaka , Banno Ryoichi , Kuwatsuka Yachiyo , Ando Masahiko , Goto Motomitsu , Arima Hiroshi 
Published: May 2020

Abstract
Background and aims: Flash glucose monitoring (FGM) is a novel system with which glucose levels are monitored and has been reported to improve glucose variability and glycemic control in type 1 and type 2 diabetes patients treated with insulin. The present study aimed to evaluate the effects of FGM and conventional self-monitoring of blood glucose (SMBG) on glycemic control in patients with non-insulin-treated type 2 diabetes. Reseach design and Methods: In this 24-week, multicenter, open-label, randomized (1:1), parallel group study, non-insulin-treated type 2 diabetic patients at 5 hospitals in Japan were randomly assigned to the FGM (n = 49) or SMBG (n = 51) groups and were provided FGM or SMBG devices for 12 weeks. The primary outcome was change in glycated hemoglobin (HbA1c) level. This trial is registered with UMIN-CTR (UMIN000026452). Results: Forty-eight participants in the FGM group and 45 in the SMBG group completed the study. The mean HbA1c levels were 7·83% (SD 0·25) in the FGM group and 7·84% (SD 0·27) in the SMBG group at baseline, and the values were reduced in both FGM (−0·43%; 95% confidence interval [CI], −0·57 to −0·28; p &lt; 0·0001) and SMBG groups (−0·30%; 95% CI −0·48 to −0·13; p = 0·001) at 12 weeks. On the other hand, HbA1c was significantly decreased from baseline values in the FGM group, but not in the SMBG group at 24 weeks (FGM: −0·46%, 95% CI −0·59 to −0·32, p &lt; 0·0001; SMBG: −0·17%, 95% CI −0·05 to 0·11, p = 0·124); a significant between-group difference was also observed (difference −0·29%, 95% CI −0·54 to −0·05; p = 0·022). Diabetes Treatment Satisfaction Questionnaire score was significantly improved, and the mean glucose levels, standard deviation of glucose, mean amplitude of glycemic excursions, and duration of hyperglycemia were significantly decreased in the FGM group compared with the SMBG group. Conclusions: Glycemic control was better with FGM than with SMBG after cessation of glucose monitoring in non-insulin-treated type 2 diabetic patients.
SAT-055 A De Novo 1p13.2 Deletion Related to Short Stature, Hypothyroidism and Mild Developmental Delay
Authors: Vlachopapadopoulou Elpis Athina , Dikaiakou Eirini , Panagiotopoulos Ioannis , Papoulidis Ioannis , Manolakos Emannouil , Michalacos Stefanos 
Published: May 2020

Abstract
Background: Chromosomal deletions may lead to variable phenotypic alterations, depending on which loci and genes are deleted. We present the case of a boy with a de novo 1p13.2 deletion which was diagnosed by array-CGH analysis.
Clinical Case: A Greek boy, who was referred for evaluation of growth failure, was investigated. He was delivered at term by cesarean section, with normal birth weight (3.060 kg), birth length (51 cm) and head circumference (35.5 cm). There was no positive family history for short stature. Target height was on the 25th percentile. He presented with growth deceleration since the age of 12 months leading to stature lower than the 3rd percentile at the age of two years, while his weight was at the 3rd percentile. Macrocephaly was appreciated (53 cm, &gt;95th percentile). Dysmorphic facial features resembling Noonan syndrome, such as frontal bossing, depressed nasal bridge and low-set ears were recognized. His motor development was normal. Laboratory examination revealed hypothyroidism and treatment with L-thyroxine was initiated. He had regular follow-ups at 6 months intervals. A mild delay in speech development and motor skills was appreciated. At the age of five years old, as his growth rate remained slow, growth hormone (GH) stimulation tests were performed. GH had a borderline normal peak of 9.9 ng/ml. IGF-1 levels were also within normal range (123.7 ng/ml). Magnetic Resonance Imaging (MRI) of the pituitary gland and the brain was normal. Array-CGH analysis detected a loss of approximately 800 Kb on chromosome 1p13.2; these alterations affect 8 genes in the OMIM database. The deleted segment was mapped at chr1: 115,186,092_115,977,647 region. The genomic coordinates are listed according to genomic build GRCh37/hg19. The genetic material analysis did not show the presence of a deficit in chromosomal region 1p13.2 (chr1: 115,186,092_115,977,647) in neither of the parents, indicating that this finding was created de novo.
Conclusion: We describe a patient with a Noonan like phenotype, due to a 1p13.2 deletion. In the international literature and databases of Database of Genomic Variants and Database of Chromosomal Imbalance and Phenotype in Humans Using Ensemble Resources there are no reports of normal individuals or patients with a similar finding in chromosomal region 1p13.2. Regular follow up of the patient is needed in order to better understand the evolution of the phenotype.
OR22-06 Bone Outcomes Following Sleeve Gastrectomy in Adolescents and Young Adults with Obesity Versus Non-Surgical Controls
Authors: Misra Madhusmita , Singhal Vibha , Carmine Brian , Bose Amita , Kelsey Megan Moriarty , Stanford Fatima Cody , Bram Jennifer , Aidlen Jeremy , Inge Thomas , Bouxsein Mary L , Bredella Miriam 
Published: May 2020

Abstract
Background: Sleeve gastrectomy is the most commonly performed weight loss surgery in adolescents with moderate-to-severe obesity. While studies in adults have reported on the deleterious effects of gastric bypass surgery on bone structure and strength estimates, data are lacking for the impact of sleeve gastrectomy on these measures in adolescents.
Objective: To evaluate the impact of sleeve gastrectomy on bone outcomes in adolescents and young adults over 12 months using dual energy x-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HRpQCT).
Participants and Methods: We enrolled 33 youth 14-22 years old with moderate to severe obesity; 17 underwent sleeve gastrectomy and 16 were followed without surgery. DXA was used to assess areal bone mineral density (aBMD). HRpQCT was used to assess bone geometry, microarchitecture and volumetric BMD (vBMD) and finite element analysis to assess strength estimates (stiffness and failure load) at the distal tibia and distal radius at baseline and 12 months. 25(OH) vitamin D (25OHD) levels were obtained at baseline and follow-up.
Results: The surgical group lost 28.2% of total body weight compared to 1.4% in the non-surgical group. The groups did not differ for changes in 25OHD levels (P=0.181). After controlling for age and sex, compared to the non-surgical group, the surgical group had reductions in aBMD Z-scores at the femoral neck and total hip (p≤ 0.0005). At the distal tibia, there were reductions in cortical thickness and trabecular number, and increases in trabecular separation and cortical vBMD, without changes in strength estimates in the surgical group vs. controls (p≤0.043). Changes were less marked at the distal radius. While sleeve gastrectomy resulted in deleterious effects on most bone parameters, there was an increase in cortical vBMD at both sites, possibly from a decrease in cortical porosity. Most differences were attenuated after adjusting for changes in BMI over 12 months.
Conclusions: Over 12 months, weight loss associated with sleeve gastrectomy in adolescents had deleterious effects on areal BMD, bone geometry and trabecular microarchitecture at weight-bearing sites. However, strength estimates did not decrease, possibly because of a simultaneous increase in cortical volumetric BMD. Additional research is necessary to determine the relative contribution(s) of weight loss and the metabolic effects of surgery, and whether the observed effects on bone stabilize or progress over time.