bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-049 Male Pattern Baldness and Waist-Hip Ratio as Markers of Arterial Stiffness in Transgender Men Undergoing Long-Term Testosterone Therapy
Authors: Alvares Leonardo Azevedo Mobilia , Cunha Flávia Siqueira , Oliveira Tainã Aci Amaral , Mendonca Berenice Bilharinho , Costa Elaine Maria Frade , Costa-Hong Valéria Aparecida , Bortolloto Luiz Aparecida , Domenice Sorahia 
Published: May 2020

Abstract
Introduction: Association between male pattern baldness, also called androgenetic alopecia (AGA) and risk of coronary artery disease has been suggested by several epidemiological studies. Exogenous testosterone (T) therapy in transgender men (TM) promotes the development of alopecia in genetically susceptible individuals, and increases facial and body hair, muscle mass (MM) and visceral fat. The outcome of a long-term androgenic therapy over the functional properties of large arteries and the cardiovascular system of TM are not well stablished. Objective: To investigate the possible association between AGA and arterial stiffness assessed by measurement of carotid-femoral pulse wave velocity (VOPcf) and intima-media thickness carotid artery (cIMT) in TM receiving long-term T therapy. Methods: Forty-six TM (mean age: 43 ± 10 yo) undergoing T therapy (mean time of treatment duration: 13 ± 10 y; mean serum T levels: 611 ± 439 ng/dL) were evaluated in a cross-sectional study. Hair pattern (Ferriman & Gallway scale), grades of male pattern baldness (Hamilton-Norwood scale) and waist-hip ratio (WHR) were analyzed. Subjects were considered to have AGA if they have vertex alopecia (grade ≥ 3). Arterial Hypertension was defined as systolic blood pressure &gt; 140 and/or diastolic blood pressure &gt; 90mmHg or under pharmacological treatment, and dyslipidemia as total cholesterol ≥ 240 mg/dL and/or LDL-c≥ 160 mg/dL and/or HDL-c &lt; 40 mg/dL and/or triglycerides &gt; 200 mg/dL, or under pharmacological treatment. Current smoking has been investigated. The aortic stiffness, assessed by VOPcf and cIMT, was measured using the Complior® device and carotid ultrasound, respectively. Results: TM’s Ferriman degree was 21 ± 6 and AGA was identified in 70% of them. The WHR was 0.9 ± 0.1. TM with AGA showed higher cIMT than TM without AGA (0.66 ± 0.1mm vs. 0.54 ± 0.07mm, p = 0.001), as well as higher WHR (0.93 ± 0.08 vs.0.87 ± 0.04, p = 0.02), higher score in terminal body hair (Ferriman 23 ± 6 vs. 18 ± 6, p = 0.007) and higher frequency of hypertension (94% vs. 6%, p = 0.01). The cIMT positively correlated with age (p = 0.01) and WHR (p = 0.002). The VOPcf was positively correlated with the age (p = 0.0001), androgen treatment duration (p = 0.01) and WHR (p = 0.04). There was a positive correlation between androgen treatment duration and WHR (p = 0.01). There was no difference in the VOPcf values, age, T treatment duration, serum T levels, frequency of dyslipidemia and smoking between the groups. Conclusion: The severe vertex AGA pattern may be considered a possible marker of arterial stiffness in TM undergoing long-term testosterone therapy.
MON-200 Clinical Characterizations of Aldosterone- and Cortisol-Producing Adrenal Tumors in Primary Aldosteronism
Authors: Guo Jingcui , Chen Xiaoyu , Zhang Junqing , Guo Xiaohui , Gao Ying 
Published: May 2020

Abstract
Objective: Aldosterone- and cortisol-producing adrenal tumors (A/CPTs) are considered to be a subtype of primary aldosteronism (PA). The clinical characterizations of these tumors are still unclear, and they are often neglected by clinicians. The aim of this study was to summarize the clinical characterizations of these tumors to reduce the missed diagnosis.
Methods: The clinical, imaging and pathological data of patients with PA admitted to our hospital from January 1, 2013 to December 31, 2016 was reviewed. All the PA patients with a combination of a positive aldosterone-to-renin ratio (ARR) and a positive captopril challenge test (CCT), in whom the dexamethasone inhibition test was performed as well, were included in our study. These patients were divided into two groups, A/CPTs group and simple PA group, according to the function of cortisol secretion. The data of the two groups were compared and analyzed with SPSS 23.0. P&lt;0.05 was statistically significant.
Results: There were 87 patients with PA included in our study, 32 of whom (36.8%) were diagnosed with A/CPTs. In these 32 A/CPTs patients, 31 patients (96.9%) were combined with subclinical Cushing syndrome. Compared to these in simple PA group (n=55), the patients in A/CPTs group (n=32) were elder (53.81±10.70 ys vs 48.42±10.17 ys, P=0.022), with larger diameter of adrenal tumors (1.50cm vs 1.15cm, P=0.001), higher fasting plasma glucose (5.33mmo/L vs 4.99mmol/L, P=0.047), higher serum cortisol levels and lower serum ACTH levels (all P&lt;0.05). 24 patients in A/CPTs group and 23 patients in simple PA group underwent adrenalectomy. 6 patients (25.0%) in A/CPTs group and 3 patients (13.0%) in simple PA group received glucocorticoid replacement therapy after adrenalectomy.
Conclusions:The prevalence of A/CPTs in PA is high. The patients with A/CPTs are mainly combined with subclinical Cushing syndrome, and prone to need glucocorticoid replacement therapy. Therefore, we recommend that all patients with PA should evaluate the function of cortisol secretion, and all patients with A/CPTs should be followed up closely after adrenalectomy to reduce the morbidity of adrenal insufficiency.
SAT-671 Glycogenic Hepatopathy. A Rare and Dramatic Manifestation of Poorly Controlled Type 1 Diabetes
Authors: Maciel Cassie , Salvo Rebecca , Wilson Mark D 
Published: May 2020

Abstract
Background: Glycogenic hepatopathy (GH) is a well described, yet underdiagnosed disorder in type 1 diabetes. Erratic blood glucose values and high insulin levels promote the excessive deposition of glucose storage in the liver as glycogen, resulting in hepatomegaly, right upper quadrant pain and abnormal liver function. GH was first described with the introduction of insulin as a therapy to treat type 1 diabetes in the early 20th century. As our ability to effectively treat type 1 diabetes mellitus has improved, GH is seen much less commonly. Today, GH generally effects adolescent or young adult patients with poorly controlled type 1 diabetes mellitus and DKA. It is reversible with successful treatment of hyperglycemia.
Clinical Case: An 18 year old woman with a history of poorly controlled type 1 diabetes mellitus and frequent admissions for DKA was admitted for DKA and pyelonephritis. On admission, the patient complained of significant right upper quadrant pain and was found to have elevated transaminase values of: AST 1199 U/L (&lt;37 U/L), ALT 371 U/L (56 U/L), an elevated alkaline-phosphatase of 319 IU/L (&lt;135 IL/L) and normal indices of biosynthetic function (INR/PT). After inpatient treatment of DKA and pyelonephritis, the right upper quadrant pain persisted and required pharmacologic analgesia. Radiographic evaluation demonstrated severe hepatomegaly (24 cm in maximum length) without focal lesions. Laboratory evaluation for viral hepatitis, autoimmune hepatitis, Celiac Disease, Wilson’s Disease and hemochromatosis were unremarkable. Given the patient’s persistent symptoms and severity of hepatomegaly, hepatic biopsy was performed.Biopsy findings were consistent with glycogenic hepatopathy demonstrating steatosis and glycogen deposition with nucleic glycogenation and mega mitochondria.Our patient had higher than usual insulin requirements for type 1 diabetes (~1 unit/kg/day). Abdominal pain, hepatomegaly and elevated LFTs resolved over a 2 month duration with improvement in her blood glucose control. Conclusions: GH is an established yet rare complication of poorly controlled type 1 diabetes. Glycogen deposition in the liver leads to painful hepatomegaly due to stretching of the liver capsule. GH has a female predominance (77%) and is characterized by elevated AST &gt;&gt;ALT with preserved liver biosynthetic function.It is postulated that GH is a result of elevated blood glucose levels and elevated insulin levels. The patient we describe has long standing poorly controlled type 1 diabetes mellitus, frequent admissions for DKA and high insulin requirements. To our knowledge, insulin requirements have not been investigated or previously reported as a potential risk factor for this condition.
MON-468 Hypoechoic Nodule Is Not Always the Bad Guy: Lessons Learned from a Patient with Subacute Painful Thyroiditis
Authors: Vorasart Pakaworn , Sriphrapradang Chutintorn 
Published: May 2020

Abstract
Introduction: The diagnosis of subacute painful thyroiditis (SAT) is primarily based on clinical manifestations (thyroid tenderness and diffuse goiter). Suppressed TSH, elevated erythrocyte sedimentation rate (ESR) and low thyroid uptake help confirm the diagnosis. Thyroid ultrasonography and fine-needle aspiration biopsy (FNAB) are rarely necessitated. SAT produces a typical sonographic findings of ill-defined heterogeneously hypoechoic areas, which is difficult to differentiate from thyroid carcinoma. We herein report a patient with SAT who was initially diagnosed as malignancy. Case Presentation: A 36-year-old female had pain and swelling at the left thyroid gland for 3 weeks. A left thyroid nodule was diagnosed by her primary care physician. Ultrasonography revealed a poorly defined hypoechoic nodule measuring 2.5x1.1x1.5 cm at the mid pole of the left thyroid gland, for which biopsy was recommended. The nodule showed peripheral vascularity and no calcification. No suspicious cervical lymphadenopathy was detected. Histologic analysis from core biopsy found findings consistency with follicular neoplasm. Thyroid function tests were within normal range. She was treated with ibuprofen as management of thyroid pain and referred for surgery. However, the repeated ultrasonography was performed by endocrinologist in the next 2 weeks and found an interval reduction in size of hypoechoic lesion. FNAB was performed due to the risk of infiltrative malignancies. Cytologic analysis was compatible with SAT. ESR was slightly elevated. Surgery was cancelled and she was treated with ibuprofen. Two weeks later, she reported that the left thyroid pain and swelling had subsided. However, she developed thyroid pain associated with glandular tenderness and swelling of the right thyroid. On sonographic examination, the right lobe, which was previously normal was now similarly affected. Thyroid function showed thyrotoxicosis. The patient was given a further course of beta-blocker, ibuprofen and prednisolone for 2 weeks and recovered well. On follow-up at 2 months, the patient developed biochemical hypothyroidism and received levothyroxine replacement. The lesions in the thyroid gland were not visualized in the 6-month follow-up sonography. Conclusion: The ultrasonographic features of the thyroid during the acute stage of SAT may mimic thyroid carcinoma. Awareness of the sonographic findings and interval changes of SAT lesions may helpful for proper diagnosis and treatment of SAT.
MON-666 Glucokinase Within the Hypothalamic Paraventricular Nucleus Is Important in GLP-1 Release
Authors: Ratnasabapathy Risheka 
Published: May 2020

Abstract
When glucose is taken orally more insulin is secreted than when glucose is injected directly into the bloodstream. This is known as the incretin effect. Glucagon like peptide 1 (GLP-1) is one of the hormones responsible for this effect. GLP-1 is released from enteroendocrine L-cells in the gut in response to oral glucose intake. GLP-1 increases insulin synthesis and secretion. Release of GLP-1 is thought to be solely dependent upon gastrointestinal tract mechanisms. Here we identify a brain mechanism via the hypothalamic paraventricular nucleus (PVN) which is important in the release of GLP-1 in response to oral glucose. The role of the paraventricular nucleus in glucose homeostasis was previously unknown. We found that a glucokinase dependent glucose sensing mechanism in the PVN works in conjunction with the gut to regulate GLP-1 release. We show that increasing expression of GK (sense GK, sGK) into the PVN improves glucose tolerance (15 minutes glucose: GFP: 8.93±0.27mmol/L, n=11; sGK: 7.72±0.22mmol/L, n=12; p&lt;0.01 and 15 minutes insulin GFP: 2.84±0.14mmol/L, n=11; sGK: 3.73±0.27mmol/L, n=12; p&lt;0.01) and increases GLP-1 release in response to oral glucose (GFP: 6.16±0.18mmol/L, n=11; sGK: 6.90±0.26mmol/L, n=12; p&lt;0.01). On the contrary decreasing expression of GK (antisense GK, asGK) in the PVN worsens glucose tolerance (30 minutes glucose: GFP: 8.22±0.28mmol/L; asGK: 9.46±0.24mmol/L, n=8; p&lt;0.01 and 15 minutes insulin: GFP: 4.07±0.37mmol/L; asGK: 2.25±0.17mmol/L, n=8; p&lt;0.001) and blunts (GLP-1 release 30 minutes GLP-1: GFP: 6.93±0.25pMol/L, n=8; p&lt;0.01 asGK: 5.47±0.13pMol/L, n=8; p&lt;0.001). Our results demonstrate that glucosensitive GK neurones in the PVN, are important to the response to oral glucose and the subsequent release of GLP-1.
SUN-640 Sex-Specific Difference in REG3G Expression Directs the Maintenance of Islet Function in Offspring of Obese Mice
Authors: Casasnovas Jose , Jarrell James C , Kua Kok Lim 
Published: May 2020

Abstract
Offspring exposed to maternal obesity are more likely to develop pancreatic islet dysfunction, but the underlying mechanistic pathway is unclear. We previously reported that fetal rats exposed to in-utero hyperglycemia had decreased fetal β-cell REG3G, and then developed lower β-cell mass and insulin secretion at adulthood. REG3G is reported to bind EXTL3 which initiates heparan sulfate (HS) synthesize important for pancreatic islet integrity. In this study, we sought the delineate the impact of maternal obesity exposure in altering offspring islet Reg3g and HS, and determine how changes in Reg3g and HS alters offspring islet insulin secretion. We hypothesize that exposure to maternal obesity (MatOb) suppresses offspring β-cell REG3G leading to decreased HS affecting β-cell health/function. We induced maternal obesity by feeding female mice western style diet for 4 weeks, while control mice were fed with regular chow. Offspring were evaluated for fat body mass, glucose intolerance, insulin secretion at postnatal day 21 and at 2-month-old. MatOb mouse offspring had increased fat-to-lean ratio and glucose intolerance but no insulin resistance at postnatal day 21, indicating decreased islet function. We performed islet perifusion to measure insulin induced secretion in postnatal day 21 offsprings. We found that male offspring but not female had impaired insulin secretion. In 2-month old offspring fat-to-lean ratio persisted but only males presented glucose intolerance. We found that pancreatic islet Reg3g expression was higher in MatOb females than males. This was accompanied increased HS in pancreatic islets of MatOb females compared to males. All together our data indicates a sex-specific protective role of Reg3g/HS in pancreatic islet function.
SUN-279 A Rare Case of Atypical Rhaboid Teratoid Tumour with Germinoma Differentiation in a 59 Year Old Woman
Authors: Pasqua Melissa-Rosina , Altoukhi Huda , Panet-Raymond Valerie , Sirhan Denis , Karamchandani Jason , Garfield Natasha , Guiot Marie-Christine 
Published: May 2020

Abstract
Atypical teratoid/rhabdoid tumours (ATRT) are a rare class of central nervous system malignant tumours which are comprised of elements of ectoderm and mesoderm germ-cell layers, but exhibit microscopic similarity to skeletal muscle. These tumours are more commonly seen in pediatric patients, with few case reports recently describing adult patients with this condition, in particular middle-aged women.1–3 We present the case of a previously healthy 59-year-old woman who was found incidentally to have a pituitary mass on CT head, with retrospective symptoms of headaches, polyuria, polydipsia, diplopia, and low blood pressure. At presentation, she was found biochemically to have pan-hypopituitarism with a left cranial nerve six deficit, with an MRI depicting a 19.5 x 22 x 11 mm suprasellar mass extending into the infundibulum and hypothalamus, with displacement of the optic chiasm; repeat imaging ruled out apoplexy. She was started on supplemental levothyroxine and hydrocortisone replacement therapy, and sent for urgent transsphenoidal resection, which was complicated afterwards by hypernatremia from diabetes insipidus. Preliminary reports were suggestive of germinoma given the diffuse presence of Oct 3/4 and C-kit, with a proliferation index of 99%; further cytology of lumbar puncture revealed no malignant cells. However, upon further pathological analysis, her tumour demonstrated loss of INI-1 expression, which is diagnostic of ATRT. Given the mixed features on immunohistochemistry, the final diagnosis was concluded as an atypical teratoid/rhabdoid tumour of the sella turcica with germinoma differentiation. A multi-disciplinary approach consisted of initial radiotherapy, with chemotherapy targeted towards a germinoma-type tumour, and pituitary hormone replacement including treatment for central diabetes insipidus. This represents a unique case of a rare tumour with germinoma differentiation in an older patient that has not been previously reported.
References
1.
Journal of Clinical Neuroscience 49 (2018) 16–21
2.
Acta Neurochir (Wien) (2008) 150: 491–496
3.
Surgical Neurology International 2014, 5:75
SUN-570 The Crosstalk Between Central Leptin and PPARbeta/delta Protects the Heart Against Oxidative Stress Damage and the Development of Hypertrophy
Authors: Rubio Blanca M , Mora Cristina , Mazuecos Lorena , Pintado Cristina , Arribas Carmen , Andres Antonio , Gallardo Nilda 
Published: May 2020

Abstract
Cardiovascular disease is a common cause of morbidity and mortality in obese people with type 2 diabetes, which is often associated with increased levels of leptin. While many studies hint at the existence of important roles for both hyperleptinemia and leptin resistance in obesity and diabetes-associated cardiovascular disease, others support that leptin has cardioprotective effects. Leptin action comprises direct effects on cardiac tissue and indirect effects mediated via the sympathetic nervous system. Since the molecular underpinnings of leptin-regulated pathways in cardiac tissue in normoleptinemic animals remain less well defined, we addressed the effects of central leptin infusion on cardiac function and remodeling analyzing FOXO1/3 and mTORC1 pathways, paying special attention to PPARβ/δ as a key leptin signal regulator. We found that central leptin regulated dynamically the network between PPARβ/δ, FOXOs, and mTORC1 in cardiac tissue, through antioxidant, thermogenic and autophagy programs. Intracerebroventricular (ICV) leptin infusion (0.2µg/day) for 7 days in male 3-months-old Wistar rats induced protection from hypertrophy without increasing TBARS and protein carbonylation nor ROS/RSN cardiac levels. These effects were further supported by both increased of Sod2 and Ucp1 expression and reduced Tnf-α. Atrophy-related ubiquitin ligase Atrogin-1, accompanied by Beclin-1 and LC3II, gene products of the autophagic pathway response, were all upregulated by central leptin. In addition, mTORC1 activity and OXPHOS protein levels were decreased without affecting cellular function. Moreover, the content of carbonylated proteins did not increase upon the central leptin treatment, suggesting a key role of leptin in preventing cardiac oxidative stress. Finally, the pharmacological inhibition of PPARβ/δ, via in vivo administration of the selective antagonist GSK0660, blunted the induction of FOXO1/3 and Atrogin-1 in the heart mediated by icv leptin infusion. Together these data support that PPARβ/δ may act as a mediator of central leptin effects on cardiac cellular reprogramming through the activation of FOXO1/3 and the inactivation of mTORC1 pathways, and the upregulation of Atrogin-1 and the genes involved in energy uncoupling.
MON-324 Management and Therapeutic Response Comparison in Prolactinomas According to Tumor Size
Authors: Flores-Cardenas Romina 
Published: May 2020

Abstract
Prolactinomas are the most common type of functioning pituitary adenomas and up to 50% of all adenomas in clinical practice. Prolactinomas are more prevalent in women; nonetheless, they may occur at any age and in both genders, and represent the most common cause non-physiological hyperprolactinemia. Prolactin-secreting adenomas are classified by their tumor size as follows: microprolactinomas (&lt;1 cm), macroprolactinomas (&gt;1cm) and giant prolactinomas (&gt;4 cm). The clinical presentation of these tumors might differ from age, sex and size. Dopamine agonists, such as cabergoline or bromocriptine, have become the first line of treatment, since these agents decrease tumor size and prolactin (PRL) secretion. In Mexico, recent studies have focused on giant prolactinomas but there is missing data of the clinical and biochemical manifestations of the tumor size-effect within the three types of prolactinomas in our population. Objective: To determine the effect of the tumor size in the clinical and biochemical presentation, and the follow up in prolactinomas. Methods: This an observational, retrospective, retrolective study. Results: Patients were classified according to their tumor size and 489 patients with confirmed diagnosis of prolactinoma were included. The mean age was 36+-12 years old and 86% were women. The size was different among sex with 14 (2.9%) and 259 (52.9%) patients with microprolactinoma and 34 (6.9) and 152 (31.1%) with macroprolactinoma in men and women, respectively (p &lt;0.001). The median PRL levels were higher among patients with bigger tumors, 115 (97-150) ng/mL for microprolactinomas, 219 (115-777) ng/mL for macroprolactinomas and 2000 (154-4000) ng/m for giant prolactinomas (p &lt;0.001). Clinically, hypogonadism was more prevalent in women with bigger tumor size (p &lt;0.001), as well as visual defects (p &lt;0.001) and headache (p 0.008). Conclusion: The tumor size of prolactinomas affects the clinical and biochemical presentation as well as the years of follow up required.
References
1.
Lopes M.B.S. (2019). Pathology of prolactinomas: any predictive value? Pituitary doi: 10.1007/s11102-019-00997-1