bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-419 Monitoring Thyroid Function Tests in Patients on Lithium: Adherence to Recommended Guidelines and Comparison of Practice Patterns in a Health Care System
Authors: Aliyeva Sevil , Kirloskar Kunal , Anant Kedaari , Schroeder Pamela 
Published: May 2020

Abstract
It is well known that Lithium causes various types of thyroid dysfunction. Thus, multiple professional guidelines, for example the American Psychiatry Association, recommend that thyroid function be assessed before starting lithium therapy, within the first 6 months of initiation, and then every 6 to 12 months. We hypothesized that these recommendations are not consistently followed by all types of providers.
Methods
A total of 796 patients were identified by chart review with age ≥18 years and ICD 9/10 codes for bipolar disorder or on lithium in outpatient clinics in our multicenter system from January 2013 to December 2017.
Results
Lithium start date was known in 472 (59.3%) of 796 patients. Of these 796 patients, 518 (65 %) were followed by psychiatry, 25 (3%) by family medicine, 60 (7.5%) by internal medicine, and 193 (24%) by other specialties including endocrinology and emergency department. Patients with unknown start date were excluded from analysis of baseline and follow-up TSH. Baseline TSH was done in 178 (37%) of patients with known start date. Of these patients, 141 (79%) were followed by psychiatry, 13 (7%) by internal medicine, and 8 (4%) by family medicine. Of the 472 patients, 76 (16%) had 6-month TSH by psychiatry (42; 60.5%), internal medicine (17; 22%), and family medicine (3; 4%). Of the 796 patients on lithium, 568 (71%) had random TSH values, 200 (25%) had abnormal thyroid function tests (TFTs), and only 69 (34%) had baseline TFTs before lithium was started. Of the 200 patients with abnormal TFTs, 90 (45%) developed thyroid disease. The odds of baseline TSH for family practice and internal medicine were not significantly different than for psychiatry, (OR = 1.3 p = 0.6, and OR = 0.7, p = 0.3, respectively). Internal medicine had 5.1 times higher odds of TSH at 6 months compared with psychiatry (p &lt;0.001). The odds of 6-month TSH for family practice were not significantly different than for psychiatry.
Conclusion
Our findings revealed that TSH was not checked in most patients before starting lithium therapy and TSH values were not followed at recommended intervals. This raises the concern that a large number of patients may have undiagnosed thyroid dysfunction due to inappropriate follow up. Future plans include a quality improvement project to focus on improving practice patterns, such as EMR reminders to prompt providers when TFTs are due and educating providers about the guidelines.
SAT-034 The Effect of Natesto on Spermatogenesis, Reproductive Hormones, and Hypogonadal Symptoms. A Phase IV Study
Authors: Masterson Thomas A , Best Jordan , Bitran Josh , Molina Manuel L , Ibrahim Emad , Kaiser Ursula B , Ramasamy Ranjith 
Published: May 2020

Abstract
INTRODUCTION AND OBJECTIVE: Exogenous testosterone (T) therapy is typically long-acting and causes azoospermia in up to 65% of the men. Natesto, dosed three times a day, is a short-acting, FDA approved nasal testosterone available since 2015. We hypothesized that Natesto can preserve spermatogenesis due to its short-acting property.
METHODS: We prospectively enrolled hypogonadal men aged 18-55 years with two serum T levels &lt; 300 ng/dL (drawn before 10 AM), symptoms, and 2 semen analyses (SA) with total motile sperm counts (TMSC) &gt; 5 million in a phase IV clinical trial. Eligible men received Natesto for 6 months. Serum T, luteinizing hormone (LH), follicle stimulating hormone (FSH), 17-hydroxyprogesterone (17-OHP), 2 SA, and testis volume were collected at baseline and after 3 and 6 months of therapy. Symptoms were evaluated using the international index of erectile function 6 (IIEF-6) and the short form 36 (SF-36) questionnaires. The primary endpoints were change in T, LH, FSH, sperm concentration, sperm motility, and TMSC. Secondary end points were change in symptoms, testis volume, and adverse events (AEs). Data are presented as means (SD), t-test was used to compare changes after 3 and 6 months, p&lt;0.05 was considered significant.
RESULTS: In total, 102 men were screened, and 60 men (age 19-55 years) enrolled. Of the 60 men, 44 completed 3 months, 33 completed 6 months, and 17 dropped out. Mean serum T increased from hypogonadal at baseline to 3 and 6 months (p=0.005), LH and FSH decreased (p=0.03) but remained within the normal range (2-5 IU/mL). Most importantly, semen parameters remained unchanged after 3 and 6 months of T therapy. Only 3 (7.5%) men had severe oligospermia and one (2.5%) became azoospermic but recovered at 6 months after discontinuation. Testis volume and intratesticular T (serum 17-OHP) were maintained at 3 and 6 months. There was improvement across all sub-domains of the IIEF as well as improvement in questions related to energy in the SF-36. A total of 10 men dropped out due to nasal irritation.
CONCLUSIONS: This phase IV clinical trial demonstrated that Natesto increased serum T, improved hypogonadal symptoms, maintained gonadotropins, testis volume, intratesticular testosterone and semen parameters. Natesto, and other short acting forms of testosterone therapy may help hypogonadal men maintain fertility.
MON-180 Risk for Hypercoagulability Among Patients with Cushing Syndrome. From the National Inpatient Sample
Authors: Ahmed Fatima , Abugroun Ashraf , Elhassan Manar , Seyoum Berhane , Taha Wael 
Published: May 2020

Abstract
Background: Patients with Cushing syndrome are at higher risk for hypercoagulability due to elevated levels of pro-coagulants and impaired fibrinolysis. Objective: We aimed to examine the association of Cushing syndrome and hypercoagulability using a large national database. Methods: The National Inpatient Sample (NIS) was queried for all patients diagnosed with Cushing syndrome during the year 2011-2015. Patients with Cushing syndrome were identified using the international classification of diseases (ICD-9) code “2550”. The control group was randomly selected from the same database in a 4:1 ratio matched by age and gender. Hypercoagulable state was defined by presence of either ICD-9 codes “28981 or 28982” for primary and secondary hypercoagulable state as well as personal history of venous thrombosis or pulmonary embolism identifed with ICD-9 codes “V1251 and V1255” respectively. Patients who were diagnosed with autoimmune diseases, solid tumors, metastatic cancer, as well as those who were bed-bound were excluded. Multivariable logistic regression with adjustment for patient’s demographics, socioeconomic factors, comorbidities and hospital factors was used to obtain Cushing syndrome related risk for hypercoagulability. Subgroup analysis was performed based on gender, race and age groups; young adults (aged 18-35 years), middle-aged (&gt; 35-&lt;55 years) and older adults (aged &gt; 55 years). Results: A total of 43,157 patients diagnosed with Cushing syndrome were identified. The mean age was 53.9 years (standard error of the mean 0.1). Majority of patients were females (75.2%) and of Caucasian race (74.6%). The prevalence of hypercoagulability was markedly higher among patients with Cushing syndrome 10 % vs 4%, p &lt;0.001. On multivariable analysis, presence of Cushing syndrome correlated with significanlty higher risk for hypercoagulability with adjusted odd ratio (a OR) 2.20 [95%CI: 1.98-2.44] p &lt;0.001. The risk for hypercoagulability was highest among young patients (age ≤ 35) with a OR 6.02 [95%CI: 4.06-8.94] p&lt;0.001 and among Hispanics with a OR 3.66 [95%CI: 2.38-5.64] p&lt;0.001. No significant gender difference on risk for hypercoagulability. Conclusion: Patients with Cushing syndrome are at higher risk for hypercoagulability. This risk is markedly higher among young patients and among Hispanics. Particular attention for early detection and prevention of venous thromboembolism in patients with Cushing Syndrome is advisable.
SUN-057 Endocrine Dysfunction After Pediatric Epilepsy Surgery: A Report from the Global Pediatric Epilepsy Surgery Registry
Authors: Jones Monika , Zeitler Philip Scott 
Published: May 2020

Abstract
RATIONALE: Epilepsy surgery in children is no longer considered a last resort for drug-resistant seizures; however, there are no studies that address the impact of pediatric epilepsy surgery on endocrine function. We reviewed patients in the Global Pediatric Epilepsy Surgery Registry to assess the prevalence of various endocrinopathies after epilepsy surgery in childhood.
METHODS: Retrospective data was collected for 122 patients, via parent proxy, who had epilepsy surgery before age 18. Data were collected on age, height, weight, seizure etiology, and surgery type, as well as reported endocrine diagnoses. Descriptive statistics were tabulated and group differences assessed.
RESULTS: 22.7% of patients were followed by an endocrinologist after surgery, but not before. 9.8% of patients reported one diagnosed endocrine disorder post-operatively, including precocious puberty (5.7%) and diabetes insipidus (0.8%); 3.3% had more than one diagnosed endocrine disorder. A higher incidence of diagnosed endocrinopathies was found in children after hemispherectomy surgery (12.64%) or who acquired hydrocephalus after surgery (30%) than in other forms of surgery. 16.4% of parents report that the child had “excessive weight gain” after surgery and 9.8% report “excessive weight loss” after surgery.
CONCLUSION: Endocrine dysfunction, including precocious puberty and disorders of water balance, appears to be common after epilepsy surgery in childhood, especially hemispherectomy. Longitudinal studies are needed to better understand the etiology and true prevalence of these disorders. The Global Pediatric Epilepsy Surgery Registry is the first longitudinal study with this aim.
MON-627 Number of Antihypertensives Required for Achieving BP Goals in Individuals with Diabetes and Hypertension-A Cross-Sectional Observational Study
Authors: Bhattacharyya Supratik 
Published: May 2020

Abstract
BACKGROUND: The 2019 ADA Standards of Medical Care in Diabetes, recommends blood pressure (BP) target of &lt;130/80 mmHg for individuals with diabetes and hypertension at higher cardiovascular (CV) risk and a BP target of &lt;140/90 mmHg for individuals at lower risk for CV disease.1 Monotherapy can attain goal BP in some patients with diabetes and hypertension. This is most likely to occur in those with BP that are only modestly above goal. However, combination therapy is eventually required in most patients.2
AIM: To assess the number of antihypertensives that are required for optimal control of BP in Indian patients with type 2 diabetes mellitus (T2DM) and hypertension.
METHODS: Data was retrieved from the electronic database of a tertiary super-speciality hospital in Kolkata over a period of four weeks in July to August 2018. The inclusion criteria- T2DM patients with hypertension between 35 to 55 years of age. Patients with recent weight gain, recent use of SGLT 2 inhibitors and those with prior cardiac events were excluded from the study.
The study included 2000 adult patients with T2DM with normal renal function. Of these, 58% were male patients. The mean age was 48 years. The mean HbA1c was 7.4% during the period of observation. Patients were being treated with oral hypoglycaemic agents (OHA) (except SGLT 2 inhibitors which might affect BP) or insulin. All patients were receiving statins. The antihypertensives that were considered were analysis were telmisartan, amlodipine, and hydrochlorothiazide.
RESULTS: The number of T2DM Hypertensive patients requiring 3 or more drugs were 640 (32 %). Out of the 640 patients, 300 patients (15 %) required higher dose of telmisartan 80 mg.
A total 980 patients (49%) required a combination of two drugs (telmisartan and amlodipine) for optimal BP control. Out of these 980 patients, 360 patients (18%) required higher dose of telmisartan i.e. 80 mg. One hundred and eighty patients (9%) required a combination of telmisartan and hydrochlorothiazide. Out of these 180 patients, 80 patients (4%) required higher dose of Telmisartan i.e. 80mg. Two hundred patients (10 %) required only one drug i.e. telmisartan for achieving optimal BP. Out of these 200 patients, 110 patients (5.5 %) required the higher dose of telmisartan i.e. 80 mg
CONCLUSION: The optimal control of BP is mandatory in T2DM patients in order to reduce cardiovascular events as well as microvascular complications. As evident from our study majority of patients required more than one antihypertensive, 32% required triple drug therapy and 49 % required dual therapy for optimal BP control. Regular monitoring of BP and timely up-titration of antihypertensives are of utmost importance to prevent future micro- and macro- vascular complications in young diabetic hypertensives.
MON-475 Discrepant Thyroid Function Tests in Adenocarcinoma-Is This a True Thyroid Disorder?
Authors: Tameemi Mohammed Al , Gilden Janice L 
Published: May 2020

Abstract
Background: Many causes of abnormal thyroid function tests (TFTs) occur that may or may not reflect a true thyroid disorder. The most common include: immune check point inhibitors therapies (ICI) used to treat various types of cancers; biotin supplements, which may interfere with thyroid function test assays; euthyroid sick syndrome; as well as amiodarone therapy for cardiac disorders. Clinical Case: A 67-year old female patient with type 2 diabetes mellitus, taking insulin and oral antihyperglycemic agents, with hyperlipidemia, hypertension and coronary artery disease, who had abnormal TFTs (TSH was 3.7 to 4.9 uIIu/ml; ref range 0.27-4.2 uIU/mL), and Free T4 was 0.92 to 1.06 ng/dL; ref range 0.55-1.6 ng/dl) prior to the diagnosis of metastatic adenocarcinoma of the lungs. She was initially treated with radiation. TFTs were unchanged. Her CEA was noted to be 129.5 (0-3.0 ng/mL). However, following chemotherapy with Tarceva (Erlotinib) 50 mg po daily, the TSH increased to 7.6 uIU/ml with Free T4 of 3.19 ng/dL. She remained clinically euthyroid. A thyroid ultrasound showed 1 -small sub centimeter nodule in each thyroid lobe. The patient later admitted to also taking biotin for an unknown period of time. TSH antibodies and TSI were both negative. Free T4 by dialysis was normal. While still taking Tarceva her TSH was noted to be 2.5 to 3.8 uIU/ml and both Free T4 and Free T3 were elevated and was 6.57 pg/ml;ref range=2.52-4.34 pg/mL). Six months later, the Free T4 decreased to 1.08 ng/dL. Thyroid antibodies and thyroglobulin remain normal. The patient remained clinically euthyroid. Conclusion: It is important to note that several factors can cause abnormal thyroid function tests, such as Immune check point inhibitors therapy, with the exact mechanism for abnormal TFTs unknown, and can also be associated with either Grave’s hyperthyroidism or Hashimoto’s hypothyroidism,as well as other autoimmune endocrine disorders. Biotin, a common supplement, has also been reported to interfere with the thyroid function test assays for free thyroxine (T4), total T4, free triiodothyronine (T3), total T3, TSH, and various cancer markers. However, It is important to clinically evaluate the patient for thyroid disorders, and recognize that therapy may not always be required, when discrepant and fluctuating thyroid function tests are obtained, such as in this patient. References: (1) Holmes EW, Samarasinghe S, Emanuele MA, Meah. Biotin interference in clinical immunoassays: a cause for concern. . Arch Pathol Lab Med. 2017;141:1459-1460. (2) Rossi E, Sgambato, De Chaira G, et al. Thyroid-induced toxicity of check-point inhibitors immunotherapy in the treatment of advance non-small cell lung cancer. J. Endocrinol Diabetes 2016;3:1-10.
SAT-447 Thyroid Function, Cardiovascular Disease, and Mortality: A Mediation Analysis
Authors: Inoue Kosuke , Ritz Beate , Brent Gregory A , Ebrahimi Ramin , Rhee Connie , Leung Angela M 
Published: May 2020

Abstract
Background: Subclinical hypothyroidism is a common clinical entity among the United States (U.S) adults and has been associated with increased risk of cardiovascular disease (CVD) and mortality in some studies. However, the mediation effect of CVD from elevated serum thyroid stimulating hormone (TSH) to mortality has not yet been well established or sufficiently quantified. In this study, we aimed to elucidate the extent to which subclinical hypothyroidism or high-normal thyroid stimulating hormone [TSH] concentrations (i.e. upper normative-range TSH concentrations) contribute to mortality through its effect on CVD among U.S. adults.
Methods: This study relies on the U.S. representative samples of 9,020 adults enrolled in the National Health and Nutrition Examination Surveys (NHANES) 2001-2002, 2007-2012 and their mortality data through 2015. We employed Cox proportional hazards regression models to investigate associations between the TSH concentration categories (subclinical hypothyroidism or tertiles of serum TSH concentrations within the reference range) and all-cause mortality. Utilizing mediation analysis within the counterfactual framework, we estimated the mediation effect of CVD on the association between TSH and all-cause mortality.
Results: The median duration of follow-up for mortality ascertainment was 7.3 (interquartile range, 5.4–8.3) years, during which 435 deaths from all causes were identified. Subjects with TSH in the subclinical hypothyroidism and the high-normal TSH tertile concentrations were associated with increased all-cause mortality (subclinical hypothyroidism: hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.14–3.19; high-normal TSH: HR, 1.36; 95% CI, 1.07–1.73) compared with the middle-normal TSH tertile concentration. CVD mediated 14.3% and 5.9% of the effects of subclinical hypothyroidism and high-normal TSH on all-cause mortality, respectively, with the CVD mediation effect being most pronounced in women and subjects ≥60 years old. No mediation through CVD was found for low-normal TSH levels and all-cause mortality.
Conclusion: CVD mediated the effects of subclinical hypothyroid and high-normal TSH concentrations on all-cause mortality in the U.S. general population. These findings may have potential implications for treatment, and early and more aggressive CVD screening for such at risk populations. Further studies are needed to examine the clinical impact of targeted therapy towards mid-normal TSH concentration.
MON-375 A Sporadic Case of Camurati-Engelmann Disease: A Rare Sclerosing Bone Disorder
Authors: Kosugi Rieko , Usui Takeshi , Matsuyama Midori , Matsuoka Hideaki , Kinoshita Akira , Inoue Tatsuhide 
Published: May 2020

Abstract
Background: Camurati-Engelmann disease (CED)is a rare sclerosing bone disorder. The skull and the diaphyses of the long tubular bones are mainly affected. The symptom developed in childhood and patients suffer from bone pain, easy fatigability, and decreased muscle mass and weakness. CED is caused by mutations in the transforming growth factorβ1 (TGFβ1)gene on chromosome 19q13.113.3. This condition is inherited in an autosomal dominant pattern. Case: A 20- year-old male. He has a so-called marfanoid habitus with long and narrow limbs. At the age of 19,he presented pain in lower limb, then walking became difficult. None of his relatives had similar symptoms. In biochemical tests,calcium, Phosphorus and bone-related hormones levels were all in the normal range. 25(OH)vitamin D levels were low probably due to his eating habits. On radiological evaluation, X-ray showed thickening of the bone cortex of the bilateral tibia. Bone scintigraphy revealed markedly increased tracer uptake in the bilateral temporal bone, femur, and tibia. Based on clinical and radiological features CED was suspected. Sequence analysis of the transforming growth factor β1 (TGFB1)gene revealed a previously reported pathological variant (p.R218H). Discussion: CED is a rare pan-ethnic condition with more than 300 published cases worldwide. Although this case was difficult to diagnose because there was no family history and the onset of adulthood not childhood, this disease was suspected due to the typical localization of affected bone lesions by bone scintigraphy and was diagnosed by genetic testing. The majority of CED are missense variants in exon 4 leading to single amino acid substitutions in the encoded protein. Exon 4 encodes a latency-associated peptide (LAP) that suppresses the activity of TGF-β1 protein. No consensus management guidelines have been developed to date. Treatment with corticosteroids may relieve the pain, improve the muscle weakness and fatigue. Recently, the efficacy of losartan has been reported in some patients. Conclusion: Here we report a de novo case of CED diagnosed by genetic testing. Osteosclerotic diseases are very rare and are often difficult to diagnose. Genetic testing plays an important role in confirming the diagnosis.
MON-661 Association of 25-Hydroxyvitamin D Serum Levels with Markers of Glycemic Control in Diabetic and Nondiabetic Patients on Maintenance Hemodialysis
Authors: Falcetta Pierpaolo , Lucchese Teresa , Garofolo Monia , Penno Giuseppe , Cupisti Adamasco , Del Prato Stefano , Egidi Maria Francesca 
Published: May 2020

Abstract
Introduction: In type 2 diabetic patients (T2DM) with end-stage renal disease (ESRD) on hemodialysis (HD), an inverse relationship between 25(OH)D and glycated hemoglobin (HbA1c) have been reported. However, because of anemia and altered red cells turnover, glycated albumin (GA) has been proposed as a more reliable glycemic marker in these subjects. Therefore, we have examined whether an association exists between 25(OH)D and GA in HD diabetic and nondiabetic (ND) subjects.
Material and methods: A total of 121 HD (M/F: 69/31%; age 69±15), of whom 43 (35.5%) had T2DM, were analyzed. Median Hb level was 10.2 g/dL (IQR, 9.35-10.9) and median albumin was 3.44 g/dL (IQR, 3.09-3.77). The median dialysis vintage was 29.3 months (IQR, 11.6-67.44). In all subjects, 25(OH)D, HbA1c, and GA were determined on the morning of the dialysis.
Results: Median 25(OH)D concentration in the whole study population was 25.5 mcg/mL (IQR, 17.7-33.75), while median HbA1c level was 37 mmol/mol (IQR, 32-43) and GA was 16.5% (IQR, 14.3-20.2). The median serum concentration of 25(OH)D was lower in T2DM group compared to ND (19.0 vs. 27.3 mcg/mL; P=0.002). In the entire cohort, there was an inverse relationship between 25(OH)D and GA (r: -0.255; P=0.005), while there was no significant correlation between HbA1c and 25(OH)D (r:-0.158; p=0.086). The relationship between GA and 25(OH)D levels was confirmed among T2DM patients (r: -0.375; P=0.013) but not in ND (r: -0.036; P=0.751), while HbA1c didn’t significantly correlate with 25(OH)D neither in T2DM (r: -0.255; P=0.099) nor in ND (r: -0.002; P=0.986). Both in the whole cohort as well in T2DM, the independent association of GA and 25(OH)D persisted upon adjustment for age, sex, BMI, dialysis duration, and vitamin D supplementation. By these regression analyses, it was calculated that 10 mcg/mL decline in 25(OH)D was associated with a 2.4% increase in GA. When T2DM individuals were considered, this increase was 75% greater (4.2%).
Conclusions: In HD patients, serum 25(OH)D is more strongly associated with GA than HbA1c in both diabetic and nondiabetic subjects. This might reflect the higher reliability of GA in assessing glucose control in this category of subjects. Furthermore, lower serum 25(OH)D concentration was associated with poorer glycemic control among T2DM subjects, but not in ND. Since 25(OH)D deficiency was more prevalent in T2DM than ND, these findings could emphasize the importance of adequate vitamin D repletion in this category of patients. Whether correction of vitamin D insufficiency might affect GA levels remains to be explored.