bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-929 An Unusual Presentation of Insulinomas-Profound Hypophosphatemia
Authors: West William , Uwaifo Gabriel Ikponmosa 
Published: May 2020

Abstract
BACKGROUND: Insulin induces intracellular shift of phosphorus, causing hypophosphatemia. This is mild, transient and quiescent in normal persons. Persistent hyperinsulinemia in patients with depleted phosphorus stores can cause profound symptomatic hypophosphatemia. Clinical Case: A 36yr old man with MEN 1 presented in follow-up. His original manifestation of MEN 1 was familial primary hyperparathyroidism (pHPT) for which he had parathyroidectomy in 2009. At one of his endocrine clinic visits, he was noted to have asymptomatic hypophosphatemia with serum phosphorus of 2.4 (2.7–4.5 mg/dL) and mildly elevated PTH of 89 (9–77 pg/mL). This was presumed to be due to mild persistent/recurrent pHPT, and he was advised to increase dietary phosphorus intake. About a year later, he presented to the emergency room (ER) with palpitations and marked asthenia. Serum phosphorus was 1.0. He was treated with intravenous phosphorus and discharged on oral phosphorus replacement with advice to increase his dietary phosphate intake. Despite this, he continued to have recurrent spells of dizziness, weakness, palpitations, and marked hypophosphatemia several requiring repeat ER visits. His degree of mild pHPT remained stable and imaging studies to identify a possible cause for tumor induced osteomalacia with phosphate wasting was unrevealing. He volunteered at a follow up visit that he had a long history of low blood sugar spells (confirmed by fingerstick) that he had learnt to manage with frequent carbohydrate rich snacks. This prompted the consideration of a possible insulinoma as the cause for his persistent hypophosphatemia. Despite significant hypoglycemia on an abbreviated supervised fast, an OGTT and mixed meal test showed profound severe insulin mediated hypoglycemia. CGMS also showed multiple extended early morning severe hypoglycemic spells &lt;50mg/dl over a 2 wk period. Multiple imaging tests were negative but a Gallium Dotatate scan revealed multiple areas of uptake in his pancreas. Endoscopic ultrasound of the pancreas demonstrated multiple masses in the pancreas: one 7 x 5 cm mass in the body and one 4 x 4 cm mass near the neck of the pancreas. Fine needle aspiration biopsy revealed well-differentiated neuroendocrine tumors. He had distal pancreatectomy and tumor enucleation of 5 tumors identified on intraoperative sonography. Histopathology confirmed multiple neuroendocrine tumors, with immunostaining for insulin. He has had no further episodes of hypophosphatemia since despite being off oral phosphate supplements. Conclusion: Profound hypophosphatemia can be the dominant presentation of persistent hyperinsulinemia seen in patients with insulinoma. Insulinomas and other causes of persistent hyperinsulinemia need to be considered in the differential diagnosis of persistent/recurrent hypophosphatemia.
MON-501 Physician-Reported Misuse of Thyroid Ultrasound
Authors: Chen Debbie W , Reyes-Gastelum David , Radhakrishnan Archana , Hamilton Ann S , Ward Kevin C , Haymart Megan R 
Published: May 2020

Abstract
BACKGROUND: Over the past four decades, there has been a substantial increase in the incidence of thyroid cancer with studies suggesting that greater use of thyroid ultrasound contributes to the rise in incidence. However, little is known about physician reported practice patterns on ultrasound use.
Methods: Patients diagnosed with differentiated thyroid cancer in 2014–15 from the Surveillance, Epidemiology and End Results registries of Georgia and Los Angeles were surveyed and asked to identify the surgeon who performed their thyroid surgery, and the endocrinologist and other doctors most involved in their thyroid cancer treatment decision making. We surveyed all physicians identified by more than one patient, and a random sample of physicians identified by one surveyed patient (N=610; 65% response rate). Surveyed physicians were asked to identify the clinical scenarios in which they would schedule a thyroid or neck ultrasound. We generated descriptive statistics for all categorical variables and used multivariable logistic regression to identify factors associated with thyroid ultrasound misuse.
Results: The cohort consisted of primary care physicians (PCPs; N=162), endocrinologists (N=176), otolaryngologists (N=130), and general surgeons (N=134). In addition to physicians reporting ultrasound use for accepted reasons such as palpable nodule on exam (98%), large goiter (92%), and nodule seen on other imaging test (88%), a substantial number of physicians endorsed ultrasound use for clinically unsupported reasons: patient request (33%); abnormal thyroid function tests (28%); and positive thyroid antibodies (22%). In multivariable analysis, compared to PCPs, endocrinologists, otolaryngologists, and general surgeons were significantly more likely to schedule an ultrasound in response to patient request (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.27–5.11; OR 2.98, 95% CI 1.57–5.79; OR 2.14, 95% CI 1.17–3.97, respectively). Physicians in private practice were more likely to schedule an ultrasound for abnormal thyroid function tests (OR 2.44, 95% CI 1.33–4.73) and positive thyroid antibodies (OR 2.47, 95% CI 1.27–5.21) compared to those in academic medical centers. Physicians who managed ten patients or less, compared to more than 50 patients, with thyroid nodules in the past 12 months were less likely to schedule an ultrasound for positive thyroid antibodies (OR 0.43, 95% CI 0.19–0.95).
Conclusion: Physicians report scheduling thyroid ultrasound for reasons not supported by clinical guidelines and in conflict with the Choosing Wisely recommendations. Understanding why physicians use thyroid ultrasound and factors that correlate with clinically unsupported reasons is essential to creating targeted educational interventions to improve physician adherence to guidelines, reduce unnecessary imaging, and curb the overdiagnosis of low-risk thyroid cancer.
SAT-638 An Academic Center Experience with the Eversense Continuous Glucose Monitoring System and Assessment of Intrapatient Variability with Repeated Same-Pocket Insertion
Authors: Lee Warren , Gierman Jim , Hirsch Irl B , Wright Lorena Alarcon Casas 
Published: May 2020

Abstract
BACKGROUND:
The Eversense continuous glucose monitoring (ECGM) system is a 90-day implantable device approved for patients with diabetes. The manufacturer recommends alternating arms each subsequent insertion to ensure adequate healing. To date, the intra-patient sensor variability using the same subcutaneous pocket has not been evaluated. We aim to assess change in glucometrics upon continuous use and the use of the same insertion pocket.
Methods:
Retrospective study (October 2018-October 2019), that included all patients using the ECGM. Demographics, and glucometrics data: transmitter wear time (TWT), average glucose (AG [mg/dL]), coefficient of variation (CV), time in range (TIR), time below range (TBR) and time in serious hypoglycemia (SH) data were obtained. Paired T-test was used to compare means (±SD) of the initial 90 days of sensor data (P1) with data of subsequent device insertions, grouped by periods of data time: period 2, 3 and 4 (P2, P3, P4). Analysis was done as a group, by insertion period, and by cohorts: cohort 1: same subcutaneous pocket, cohort 2: alternating insertion site.
Results:
Nine female, 7 male patients, age 37±11 years old, weight 85±10 Kg. Fourteen with T1DM, one with T2DM and one from pancreatectomy. There were 7 patients in each cohort, 2 patients had only one device inserted resulting in only 1 period of 3-month data; 7 patients had 2 consecutive devices inserted i.e. 2 consecutive 3-month periods of data (P1 and P2), 4 had 3 consecutive devices inserted, three 3-month periods of data (P1, P2 and P3) and 3 had 4 consecutive devices inserted, i.e. four 3-month consecutive periods of data (P1, P2, P3 and P4).
Baseline, first insertion, initial 3-month period of data (P1) showed TWT 69.7±23 for the entire group, AG 175±30 mg/dL, CV 36.7±7.6, TIR 52.6±17, TBR 2.69±2.5, SH 1.5±2.3.
We found no statistical significance for TWT, AG, CV, and TIR, as a whole and when analyzed by cohorts and period of data: P1 vs P2, P1 vs P3, P1 vs P4. TBR and SH decreased with continuous ECGM use. TBR mean difference comparing P1 vs P2, P3 and P4 was -0.15±0.9 (p=0.9), 1.16±1.8 (p=0.02), and 1.8±1.6 (p=0.001) and for SH -0.05±0.8 (p=0.8), 0.6±1.3 (p=0.09), and 0.9 ±1 (p=0.004).
There were 3 device failures; 2 post first insertion, one post repeat insertion in the same pocket. No infections, or serious bleeding were observed.
Conclusions:
Continuous ECGM use decreased time below range and time in serious hypoglycemia, without change in TWT, AG, TIR and CV. There was no significant intrapatient variability comparing consecutive device insertions regardless of whether patients elected to use the same pocket or alternate arms, suggesting that using the same insertion pocket may have the same efficacy as placement into a fresh insertion site, while decreasing the number of punctures, pain, procedure time, risk of bleeding and infection.
MON-104 The Relationship Between Metabolic Syndrome Indicators and Body Composition Measured by Bioelectrical Impedance Analysis Methods in Obese Children
Authors: Kim Seulki , Lee Yoonji , Lee Na-yeong , Lee Seonhwa , Choi Yujung , Ahn Moon Bae , Kim Shin Hee , Cho Won kyung , Cho Kyung Soon , Jung Min Ho , Suh Byung-Kyu 
Published: May 2020

Abstract
Purpose: This study aimed to compare obesity indices with impedance analyzed body composition data, and to investigate the association between impedance analyzed body composition data and the prevalence of metabolic syndrome.
Methods: 123 prepubertal children (49% girls 3-to-8- year-old, 51% boys 3-to-9-year-old) who are below or equal to body mass index (BMI, kg/m2) 85th percentile were retrospectively reviewed. Height, weight, waist circumference, blood pressure, serum lipid profiles, fasting plasma glucose and serum insulin were measured. Body fat percentile (BFP), fat-free mass (FFM) were measured by BIA and fat mass index (FMI), fat-free mass index (FFMI) were calculated. We investigated the relationship between metabolic syndrome indicators and body composition measured by BIA. Metabolic syndrome (MetS) was defined as including more than or equal to three of the metabolic abnormalities according to the modified National Cholesterol Education Program Adult Treatment Panel III.
Results: The overall prevalence of MetS was found to be 15.4%(19/123). The prevalence of MetS, MetS indicators, and body composition measured by BIA were not significantly different between males and females. BMI z-score was positively correlated with BFP, FMI and FFMI (r=0.51, P=0.001; r=0.63, P=0.001; r=0.29, P=0.001, respectively), so was waist-to-height ratio (WHR) (r=0.57, P=0.001; r=0.70, P=0.001; r=0.33, P=0.001). Homeostatic model assessment for insulin resistance (HOMA-IR) index was associated to BFP, FFM, FMI, and FFMI (r=0.305, P=0.003; r=0.359, P=0.001; r=0.331, P=0.001; r=0.24, P=0.018, respectively). Regression analysis showed chronological age (CA) and BMI z-score affect HOMA-IR (β=0.61, P=0.001; β=0.93, P=0.002, respectively) and CA was considered as a potential risk factor of MetS (Odd ratio of 3.09 and 95 % confidence interval of 1.25–7.65).
Conclusion: BIA seems to be a good tools for measuring obesity but not a good tool for predicting complications of obesity in prepubertal children. Further study is needed on the risk factors for complications of obesity in prepubertal children.
MON-054 First Report of Monozygotic Twins with Russell Silver Syndrome in China: Recombinant Growth Hormone Therapy and 3-Year Observation
Authors: Liu Shu , Jiang Jianhui 
Published: May 2020

Abstract
BACKGROUND: Russell Silver syndrome (RSS) is a rare genetic condition that includes an important index of suspicion when a child presents with hemihyperthrophy. There are more than 400 cases described in the literature, but twin pairs with RSS have rarely been reported. Up to now only six monozygotic twin pairs have been described [1]. However, this has not been reported in east Asian population yet.
Clinical Case: A 4 years and 9 months old monozygotic twin girl with a history of growth retardation was admitted to our hospital. The first impression of the patient was: poor growth, specific facial features, asymmetry of the lower and upper limbs for length and width. Detailed physical examination revealed a small triangular face with prominent forehead, micrognathia, lips with downturned corners, and fifth finger clinodactyly on bothhands. On admission into our hospital, the examination measured a weight of 9.0 kg (-4.9SD) and a length of 88.4 cm (-5.2SD). Anthropometrically she was classified as second grade malnutrition according to World Health Organization (WHO) charts. By contrast, her twin sister was physically and anthropometrically normal.
Intrauterine growth retardation, postnatal growth retardation, normal head circumference and asymmetry of the body were the major criteria that made the clinical diagnosis of Russell-Silver syndrome. Confirmation of Russell-Silver syndrome was made based on clinical findings, birth history and results of molecular genetic testing showed hypomethylation of the paternal imprinting center 1 (IC1) of chromosome 11p15.5.
Recombinant human growth hormone (rhGH) was administered by subcutaneous injection once daily, in the evening, at a dose of 0.05 mg/ kg/day. The check-up visits in the outpatient were held every three months, and the following issues were evaluated: response to treatment, tolerability, and laboratory test results, with particular emphasis on carbohydrate metabolism and bone age progression. Currently, after 28 months of rhGH treatment, the girl has grown 18 cm, reaching a body height of 106.5 cm (-3.2SD, ΔHt SDSCA: 2SD). Her current weight is 14.1 kg (-2.9SD, ΔWt SDSCA: 2SD). So far, no serious adverse events have been observed.
Conclusion: This is the first case of monozygotic twin with Russell Silver syndrome reported in east Asian population. The possibility of rhGH treatment can be considered in cases of documented GH deficiency in patients with Russell Silver syndrome, under close endocrinic supervision.
OR21-01 Pre-Operative Calcitonin Value as a Predictive Factor of Cancer Related Death in Sporadic Medullary Thyroid Carcinoma
Authors: Matrone Antonio , Cappagli Virginia , Donati Delio Stefani , Prete Alessandro , Valerio Laura , Giani Carlotta , Bottici Valeria , Viola David , Agate Laura , Molinaro Eleonora , Vitti Paolo , Elisei Rossella 
Published: May 2020

Abstract
Introduction: Medullary thyroid carcinoma (MTC) is a rare tumor, it originates from the C cells producing calcitonin (CT) and can occur as sporadic or associated to germline RET mutation. The initial treatment is represented by total thyroidectomy associated with central compartment lymph nodes dissection and possible extension to the laterocervical compartment. CT is the main marker of follow-up of MTC, conversely its pre-operative role as diagnostic and prognostic factor is still debated. The aim of the present study was to evaluate several predictive factors of cancer related death in a large series of sporadic MTCs. Patients and Methods: We evaluated 537 consecutive patients surgically treated for sporadic MTC, from 2000 to 2019, and followed at the Operative Unit of Endocrinology 1 of the University of Pisa. We evaluated epidemiological, clinical and pathological data and pre and post-operative CT values, and their correlation with cancer related death. Results: At the end of the follow-up (average 75 months), 300/537 (55.9%) pts were cured, 100/537 (18.6%) pts showed biochemical disease, 88/537 (16.4%) pts showed metastatic disease and 49/537 (9.1 %) pts died for the disease. The factors significantly correlated with the cancer related death to the univariate analysis were the male gender, dimension of the primary tumor&gt; 4 cm, the presence of lymph node metastasis to histology (N1) and/or distant metastasis (M1) at the time of diagnosis, multifocality, minimal extrathyroidal extension (mETE), initial staging, pre-operative CT values&gt; 500 pg/ml and post-operative&gt; 20 pg/ml. At multivariate analysis, statistical significance persisted only for pre- and post-operative CT and for the staging. Conclusions: 1) In our study we observed a significant improvement in the outcome and survival in the medium-long term of sporadic CMT patients, compared to the previous studies. 2) A more advanced staging at the time of diagnosis has been confirmed as a negative prognostic factor and it is evident that an early diagnosis is an essential requirement for improving cancer related death. 3) This is the first study that showed, in a large monocentric series of sporadic MTCs, as pre-operative CT represents a prognostic factor associated with cancer related death, as well as the value of post-operative CT.
MON-125 Structure, Process and Outcomes of Transitional Care in Endocrinology: Pilot Results from the Intersect Study (International Study of Endocrine Care During Transition to Adult-Oriented Care)
Authors: McGauley Colleen , Shen Hongjie , de Graaff-Herder Laura , Hauschild Michael , Dwyer Andrew A 
Published: May 2020

Abstract
BACKGROUND: Structured transitional care (TC) is the planned, purposeful transfer from pediatric to adult care that aims to maintain high quality, developmentally appropriate continuous care. Relatively little is known about how endocrine TC is structured internationally, the process of TC and what outcomes are a priority for endocrine TC. This pilot study aimed to better understand endocrine TC and identify key elements for successful implementation internationally. METHODS: The Donabedian framework (structure-process-outcome) guided the international web-based survey examining TC programs for adolescents and young adults (AYAs) 16–25 years-old. The survey examined: 1) best practices i.e. six core elements of TC (Center for Health Care Transition Improvement ‘Got Transition’); 2) nursing involvement; 3) perceived importance of the ‘10 priority outcomes’ identified by an international multidisciplinary Delphi process (Fair et al. JAMA Pediatrics, 2016); and 4) promoters/barriers to implementation. Descriptive analysis was conducted for close-ended questions and thematic analysis for open-ended questions. Rankings by endocrine clinics were compared to the ‘10 priority outcomes’. RESULTS: Invitations were sent to authors of publications/posters on endocrine TC from the past 10 years. Eight responses were recorded from academic medical centers across seven countries with structured (n=3), semi-structured (n=2) and unstructured TC (n=3). Only 2/8 received institutional funding. Two practices involved nurses in assessing transition readiness and cited direct clinical care, therapeutic education and emotional support for AYAs/families as important contributions. Groups lacking nursing involvement expressed desire for a nursing role if financed. The most commonly used ‘Got Transition’ core elements were: providing supporting materials, confirming adult visit and consulting with adult providers. Only one group formally collected TC outcome data. “Self-management” was rated the most important TC outcome. “Understanding the condition/complications” and “attending medical appointments” were seen as having relatively higher priority for endocrine TC. Barriers related to lack of financial support and low institutional priority. Involving key stakeholders facilitated implementation. Having a dedicated nurse was noted as an opportunity for improving TC. CONCLUSIONS: Implementation of structured TC has been piecemeal and most practices do not fully utilize recommended best practices (‘Got Transition’). Few practices formally collect outcome data. The major perceived barrier to implementing TC is financial. Practices incorporating nurses value discipline-specific contributions. These pilot data point to a role for nursing in providing comprehensive, high quality, comprehensive care for AYAs with chronic endocrine conditions.
SAT-446 Transcriptome Comparison of a Natural T3 Regulated Process and a Treatment with T3
Authors: Buisine Nicolas , Rigolet Muriel , Duvernois-Berthet, Master Evelyne , Sachs Laurent M 
Published: May 2020

Abstract
Thyroid hormones (TH) act mainly on the expression of the genome. It is well accepted that differential gene expression following treatment with TH recapitulates the expression profiles taking place during natural processes induced by these hormones. Although both processes seem to correlate at the scale of a few target genes, this hasn’t been addressed in a systematic manner. Our objectives were first to compare transcriptome variations after TH treatment with transcriptome variations during a TH controlled natural process and second to evaluate the proportion of the direct TH-response. The measurement of gene expression at genome scale (transcriptome) is obtained by sequencing all the messenger RNAs (RNA-seq). Direct response was sorted out by linking the transcription start sites of target genes using RNA-PET analysis with TR binding sites mapping using chromatin interaction analysis by paired-end tag sequencing (ChIA-PET). Indeed, ChIA-PET not only allow to map TR binding sites but also the physical interactions between them and transcription start sites of regulated genes. Our model is one of the striking developmental processes orchestrated by TH: amphibian metamorphosis. Tadpole transformation is marked by dramatic changes including de novo morphogenesis (limb), tissue remodelling (brain, intestine...) and organ resorption through apoptosis (tail). These changes involve cascades of gene regulation initiated by TH and their receptors. Because metamorphosis has close and interesting parallels with the perinatal period in mammals (including human), metamorphosis is thus an attractive model to analyze in a physiological context, the functions and mechanisms of action of TH. Here, we have focused on one Xenopus tropicalis organs, the tail fin skin which will disappear through cell death. We have compared natural metamorphosis with 24h of 10nM triiodothyronine (T3) treatment. We were able to observe several differences between T3 treatment and natural development. First, the genes regulated by T3 only correspond to a proportion of genes differentially expressed during metamorphosis. Second, T3-response genes start to be regulated well before tail regression (several days). Finally, T3-direct target genes represent a few percent of all the genes differentially expressed during tail regression. In conclusion, the comparison of transcriptomes of natural and induced metamorphosis allow us to reach a more precise understanding of TH action