bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-691 Association of Serum Level of Omentin-1, Hs-CRP and Atherosclerosis in Patients with Type 2 Diabetes
Authors: Amara Mohamed Fahmy 
Published: May 2020

Abstract
Omentin-1 has been identified as an interesting novel adipokine that may modulate the action of insulin. Serum omentin-1 levels were associated with endothelial dysfunction and cardiovascular diseases, which highly contribute to morbidity and mortality of patients with diabetes, however its exact biological function is still unclear. The aim of this study was to assess the level of circulating plasma Omentin-1 level in patients with type 2 diabetes compared to control subjects, and to investigate the relationship of circulating Omentin-1levels with HOMA, BMI, lipid profile, epicardial fat, visceral fat and subcutaneous fat in early stages of atherosclerosis measured by carotid intima media thickness (CIMT). This is a cross-sectional observational study which included 45 patients with type 2 DM (not previously diagnosed as ACVD patients) and 30 (age and sex)-matched healthy control subjects. Patients with a history of recent acute infection, malignancy, metabolic or endocrinal diseases, cardiac failure, renal and hepatic impairment were excluded. Participants were subjected to measurement of FPG, HbA1c, lipid profile, calculation of HOMA2, hs CRP, serum omentin-1, CIMT, estimation of visceral, epicardial and subcutaneous fat through CAT scanning. There was no statistically significant difference between both groups in the mean circulating omentin-1 level, a mean of (793.86 ± 195.81) ng/ml in type 2 diabetes Vs (804.93 ± 205.76) ng/ml in the control group,(p=0.654). However, there was a highly statistically significant difference in hs-CRP between both groups, mean hs CRP is (4.29 ± 4.87 mg/l) vs (0.92 ± 0.53 mg/l) respectively. There was a statistically significant negative correlation between omentin-1 and hs CRP (r= -0.278, p= 0.016).There were no statistically significant correlations between omentin-1 with BMI, HbA1c, HOMA, lipid profile or adiposity. These findings may denote the anti-inflammatory effects of omentin-1 which maybe unrelated to insulin resistance and dyslipidemia. Further studies are required to confirm the cardioprotective role of omentin-1 in patients with type 2 diabetes, focusing on its local anti-inflammatory role.
Nothing to disclose: MA, NA, NK
No Sources of Research Support
SUN-271 Langerhans Cell Histiocytosis: A Difficult Diagnosis in Cranial Diabetes Insipidus
Authors: Ng Ivy Hoi Yee , Cheung Elaine Yun Ning , Kam Grace Yee Wai 
Published: May 2020

Abstract
Background
Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder that is rare in adults, with a reported incidence of 1-2 cases per million per year. Cranial diabetes insipidus (CDI) is the most common and often the first endocrine manifestation of LCH, when histiocytes infiltrate the pituitary. Anterior pituitary dysfunction, when present, usually develops after onset of CDI. Unlike most other etiologies of CDI, multisystem involvement is frequent in LCH, especially the bones, skin, and lungs.
Case
A 23-year-old man of good past health presented with 3 months of polyuria and polydipsia in 2015. CDI was confirmed by water deprivation test, and his symptoms resolved with DDAVP treatment. There were no anterior pituitary hormone deficiencies on presentation. Pituitary MRI showed loss of the posterior bright spot and a contrast enhancing pituitary stalk thickening (PST) of 5 mm, with no compression on the optic chiasm. Lumbar puncture showed no evidence of CNS infection or neoplastic cells. Beta HCG, AFP, IgG4, ANA, and chest Xray were unremarkable. Three months later he developed central hypogonadism, and was treated with testosterone after sperm banking. A repeat MRI showed persistent PST of 5 mm, and biopsy of the pituitary suggested lymphocytic infundibulo-hypophysitis (LIH). Unfortunately the biopsy was complicated with irreversible focal visual field defect.
It was then noted that a bone scan had been arranged earlier for intermittent left hip pain, which revealed a 3.5 cm osteolytic lesion over the left ilium. The concomitant pituitary and bone lesions thus make LCH the more likely diagnosis. However bone biopsy showed nonspecific fibrosis only. The pathologist was then contacted for further immunohistochemical analysis. This identifies clusters of Langerhans cells with positive stain for S100, CD1a, and Langerin (LCH cell markers) in the pituitary tissue, and BRAF V600E mutation was detected by PCR, compatible with the diagnosis of LCH. Systemic chemotherapy was proposed due to multisystemic disease, but was declined by patient. At 4 years of follow-up, the PST spontaneously regressed to 2 mm but the CDI and central hypogonadism persisted.
Conclusion
Our case illustrates the diagnostic challenge in a patient presenting with CDI, given a pituitary biopsy with histological features mimicking LIH and an inconclusive bone biopsy. However, a diagnosis of LIH would not explain for the unusual bone lesion in a young man, and bone biopsies can be prone to crush artifacts limiting analysis. The importance of actively looking for and biopsying extracranial lesions before biopsying the pituitary cannot be understated as the latter entails risks of hypopituitarism and visual defect, as had happened to our patient. When clinical and pathologic findings do not match, communication with the pathologist for histological review had been essential in establishing the diagnosis of LCH.
SUN-351 Sex Is a Strong Variable in the Mineral Metabolism Defects and Endocrine Dysfunction Associated with the Murine Adenine Diet Model of Chronic Kidney Disease (CKD)
Authors: Liesen Michael P , Noonan Megan L , Clinkenbeard Erica , Ni Pu , Agoro Rafiou , Tippen Samantha P , Hum Julia , White Kenneth E 
Published: May 2020

Abstract
The adenine diet is widely used in animal models to produce a tubulointerstitial fibrosis and inflammation that mimics human CKD in many aspects. These include the biochemical manifestations hyperphosphatemia and anemia, as well as endocrine dysfunction with elevated FGF23 and hyperparathyroidism. Male rodents are known to be less tolerant of adenine diet regimen than females, however the underlying mechanisms driving the sex differences remain unclear. Additionally, much of the data for adenine studies arises from rats, whereas mice are more commonly used in laboratory settings and are far easier to manipulate genetically. To this end, as part of a larger study to test the effects of iron-handling in CKD, we assessed the biochemical, molecular, and physical differences between male and female mice receiving an adenine diet to induce CKD. Flox-Fgf23 mice (8 weeks of age, n=4-6/group; mice were Cre negative, thus phenotypically wild type) were placed on a 0.2% adenine-containing diet (CKD); a matching casein-based diet served as control. After 6 weeks, mice were euthanized, and blood and tissues were collected for analysis. As expected, body weight at baseline was initially higher in males than in females, however males lost significantly more weight. Serum BUN was also elevated in both sexes receiving adenine, although males were higher (1.2 fold; p&lt;0.01). Males also had elevated creatinine and lower total serum iron from baseline whereas females had no significant changes. FGF23 was elevated in all mice, with no significant differences between sexes. Kidney fibrosis and inflammation markers were elevated in the CKD mice, with males having higher expression of Col1a1 and -3a1 versus females (3.5/1.5 fold; p&lt;0.001) and TNFα mRNA (2 fold; p&lt;0.001). Renal expression of the anabolic vitamin D metabolizing enzyme Cyp27b1 (1α-hydroyxlase) and early growth response 1 (Egr1) were increased in CKD mice, with males having higher expression over females. Conversely, CKD males had lower kidney Klotho mRNA expression, and both sexes fed adenine expressed significantly lower NPT2a (sodium- phosphate co-transporter2a) mRNA. Liver expression of ferritin (Fth1) was elevated in male CKD mice compared to diet controls, whereas female mice had no differences. Elevated FGF23 has been linked to ventricular hypertrophy, and CKD males had significantly higher heart weight to femur ratio at completion of the study. Our results support that male mice succumb more rapidly than females to adenine diet mediated CKD phenotypes, potentially enhanced by fibrosis and inflammation. It remains to be determined whether the more rapid onset of defects in iron handling parameters accelerate the severe male CKD phenotype.
SUN-135 Characterization of Transcription Factor Immunostaining and Null Cell Adenoma Status in Hormone Negative Pituitary Adenomas
Authors: Baertsch Hans C , Pangal Dhiraj J , Garrett Trey , Brunswick Andrew , Rutkowski Martin , Hurth Kyle , Michael John D , Zada Gabriel 
Published: May 2020

Abstract
Introduction: Since the 2017 W.H.O. classification of pituitary adenomas redefined null cell adenomas (NCAs) as negative for all adenohypophyseal hormones and the transcription factors (TFs) SF-1, PIT-1, and T-PIT, limited data exist characterizing these tumors1. We characterize NCAs in comparison to hormone negative adenomas (HNAs), which demonstrate negative hormone immunostaining in the context of positive TF immunoreactivity.
Methods: Retrospective review of 22 patients with HNAs between 2011-2019. Samples were stained for PIT-1 and SF-1. Negative ACTH staining served as a proxy for T-PIT given demonstrated prior concordance of these stains2. Demographics, tumor characteristics, preoperative symptoms, and postoperative outcomes were assessed.
Results: Fifteen samples (68%) stained negative for both PIT-1 and SF-1 and were classified as NCAs. Seven were positive for SF-1 (n=3), PIT-1 (n=3), or both (n=1) and were classified as HNAs. NCA patients were predominantly female (80%), while those with HNAs were predominantly male (57%). All tumors were macroadenomas, with mean maximal tumor diameter of 28mm in NCAs vs 23mm in HNAs (p=0.2705). NCAs were more likely to demonstrate suprasellar invasion (100% vs. 71%, p=0.0325), and although not statistically significant, cavernous sinus invasion (53% vs. 43%, p=0.6695), and higher MIB-1 proliferative index (2.271 vs. 1.971, p=0.733). The most common preoperative symptoms were headache (73% NCA, 71% HNA) and vision loss (53%, 40%). Postoperative improvements in headache (60% NCA, 71% HNA) and vision (53%, 50%) were comparable. Sixty-four percent of NCAs underwent gross total resection vs. 43% of HNAs (p=.3712). There were no recurrences or progressions in either group over 24mo. Few comparisons reached significance, potentially due to limited sample size.
Conclusion: A majority of HNAs demonstrated negative TF immunostaining and met criteria for NCAs. NCAs may be more common in females and demonstrate more suprasellar invasion than HNAs, but otherwise, do not vary significantly. TF staining may be of limited clinical utility in identifying high-risk pathology, however future studies with larger cohorts are warranted.
References:
1. Osamura RY, Lopes MBS, Grossman A, Matsuno A, Korbonits M, Trouillas J, Kovacs K (2017) Pituitary adenoma. In: Lloyd RV, Osamura RY, Klöppel G, Rosai J (eds) World health organization classification of tumours of endocrine organs, 4th edn. IARC, Lyon, pp 14-18.
2. Nishioka H, Inoshita N, Mete O, Asa SL, Hayashi K, Takeshita A, Fukuhara N, Yamaguchi-Okadad M, Takeuchi Y, Yamada S (2015) The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas. Endocr Path 26(4):249-55.
SAT-472 An Atypical Presentation of Severe Hypothyroidism, a Case of Large Posterior Pericardial Effusion Without Hemodynamic Compromise
Authors: Garay Paola Andrea Sanchez , Restifo Daniele , Rao Swathi , Espinoza Diana , Ionescu Madalina Liliana , Lichtenberg Robert 
Published: May 2020

Abstract
BACKGROUND We are reporting a case of a Hispanic female who presented with a pericardial effusion as a complication of hypothyroidism, untreated due to lack of medical care, which demonstrates health disparities in chronic diseases. CLINICAL CASE The patient is a 48 year-old Hispanic female with PMHx of hypothyroidism, non-compliant with medical therapy, who presented to the ED with fatigue and dyspnea. Despite progressively worsening symptoms for the past 4 months, she had refused to be seen by a physician because she was uninsured. Her physical exam was notable for generalized pallor and bradycardia, with otherwise normal cardiopulmonary exam. Her initial laboratory data showed hemoglobin of 5.5 g/dl. CXR demonstrated an enlarged cardiac silhouette, which on CT was found to represent a large pericardial effusion. On admission her laboratory data demonstrated low ferritin, TSH of 94 mIU/L and T4 of 1.4 mcg/dl. m. Cortisol was 9 mcg/dl at 11 am. Repeat hemoglobin post-transfusion was 9 g/dl The patient was started on IV levothyroxine and hydrocortisone. Echocardiogram showed a large posterior wall pericardial effusion without evidence of RV strain. Pericardiocentesis was attempted but was unsuccessful because of difficult access to the fluid location. She was discharged on levothyroxine 88mcg QD and recommended to follow up with endocrinology and cardiology as an outpatient. It is well known that the United States spends a disproportionate amount of money in healthcare in comparison to developing countries (1). Underinvestment in social services and high prices set by pharmaceutical companies are likely contributing factors (1). Unfortunately, the resulting outcomes do not necessarily reflect the spending. Minorities are well known to have a higher morbidity and mortality as well as to present more frequently with dramatic manifestations of chronic diseases. This can often be attributed to a lack of access to medical care and poor follow up. Our patient was diagnosed with pericardial effusion as a complication of untreated hypothyroidism, a condition that is underdiagnosed despite a high incidence (3-37%). This pericardial effusion was initially concerning due to its large volume. The fact that she was hemodynamically stable reflects its chronicity, but it could have led to a fatal complication if she continued without appropriate therapy for a longer period of time. CONCLUSION A case such as this should make us question what more we can do to improve healthcare outcomes for minorities in the USA. REFERENCES (1). Papanicolas, Irene, Liana R. Woskie, and Ashish K. Jha. “Health care spending in the United States and other high-income countries.” Jama 319.10 (2018): 1024-1039.
MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
Authors: Momen Donia , Wu Gloria , Luu Shannon , Leung Brian 
Published: May 2020

Abstract
Background: Tear glands in the eyelids, meibomian glands, play a role in tear film production and tear film stabilization. Diabetic patients often complain of dry eye and eye pain. Recently, there are new infrared (820nm) photography techniques to image meibomian glands easily in patients.
Purpose: To study meibomian glands in diabetic patients with dry eye.
Methods: A retrospective chart review (2017-2019) of Type 2 Diabetes Mellitus (T2DM) patients and non-diabetic patients with the diagnosis of “dry eye” in EHR (eClinicalworks, Westborough, MA) was performed. Infrared eyelid imaging (820 nm wavelength, Heidelberg Spectralis, Heidelberg, Germany) was taken. T2DM: Inclusion criteria: 1) HbA1c of &gt; 5.7% who also had infrared eyelid imaging performed + 4 weeks of their HbA1c lab test results; 2) the percentage loss of meibomian glands for each eye, then averaged, for each patient. Control: Inclusion criteria: 1) non-diabetic patients; 2) HbA1c lab test results; 3) infrared eyelid imaging was performed; 4) percentage loss of meibomian glands was calculated for each eye, then averaged per patient. Exclusion criteria for both T2DM and Controls: younger than the age of 18 years old, older than 90 years old, no glaucoma topical medications, no eyelid surgery, no corneal surgery, no conjunctival surgery.
Results: n=120 patients, Avg Age=69.6 years (sd=15.1, range 23-89 years). Diabetic patients: n=60 patients, Male=30, Female=30, Avg Age=65.1 years (sd=11.50, med=65.5, range 36-85 years). Controls: n=60 patients, Male=37, Female=23, Avg Age=54.1 years (sd=16.4, med=56.5, range 23-89 years). Meibomian gland loss: Diabetics=51.54%, Controls=11.29% (p&lt;0.0001, t-test). Of the 60 DM patients: 35/37pts with HbA1c &gt; 6.6% had greater loss of meibomian glands (&gt;40%), compared to 12/23 DM patients with HbA1c &lt; 6.5%, p=0.0001.
Discussion: Loss of meibomian glands in diabetic patients have been recently investigated; however, its relationship to HbA1c as a possible biomarker has not been widely discussed in literature. In this small study, loss of meibomian glands occur more frequently with elevated HbA1c, perhaps due to microischemia of the eyelids, thereby resulting in loss of meibomian glands.
Conclusion: Loss of meibomian glands may suggest a need for HbA1c testing and further monitoring of the patient’s diabetic condition. Infrared imaging of the eyelid may be useful in characterizing dry eye in diabetic patients.
SUN-079 Baseline Body Satisfaction in Gender-Diverse Youth
Authors: Gohil Anisha , Donahue Kelly , Eugster Erica A 
Published: May 2020

Abstract
Background: Body dissatisfaction often contributes to the distress experienced by transgender and nonbinary individuals. However, limited data exist regarding body image in the pediatric age range.
Objective: To establish baseline ratings of body satisfaction among gender-diverse youth prior to puberty blocking medication.
Methods: Subjects were recruited from the gender health clinic at Riley Hospital for Children beginning in January 2018. Eligible subjects met clinical criteria for a puberty blocker, were treatment naïve, and were anticipated to be on a blocker alone for ≥ 1 year. We assessed self-reported body satisfaction at baseline using the Body Image Scale-Gender Spectrum. Subjects rated various body parts on a scale of 1 (very satisfied) to 5 (very dissatisfied). For analysis, body parts were grouped into gendered features (primary sex, secondary sex, & neutral characteristics) and also body areas (appearance/hair/voice, head & neck, musculoskeletal, hips, chest, & genitals/gonads).1
Results: Twenty subjects (mean age 12.0, range 8.4-14.0) were enrolled of whom 13 were transmasculine (TM) and 7 were transfeminine (TF). TM subjects had a mean BMI percentile of 73.7% and height z-score of 0.50, with breast Tanner stage (TS) of II (n=2), III (n= 3), IV (n=3) and V (n=4). Estradiol levels ranged from &lt;20-120 pg/mL and testosterone levels ranged from &lt;10-38 ng/dL. TF subjects had a mean BMI percentile of 65.3% and height Z-score of 0.58, with testicular volumes of 5 cc (n=1), 6 cc (n=2), 9 cc (n=1), 10 cc (n=1) and 15 cc (n=1). Testosterone levels ranged from &lt;10-215 ng/dL and estradiol levels ranged from &lt;5-31 pg/mL. Among all subjects, mean satisfaction ratings for gendered features were 4.45 (primary sex characteristics), 3.21 (secondary sex characteristics), and 2.61 (neutral characteristics). Mean satisfaction ratings for body areas were 4.45 (genitals/gonads), 3.85 (chest), 3.23 (appearance/hair/voice), 3.03 (hips), 2.83 (musculoskeletal), and 2.55 (head & neck). The only significant between-group difference in satisfaction was for the chest region, with TM subjects reporting higher dissatisfaction (4.35 vs 2.93, p &lt;0.004).
Conclusion: The gender-diverse youth in our study reported high degrees of dissatisfaction with their genitals/gonads and, for TM subjects, their chest. In contrast, they reported generally neutral feelings toward many of their other body parts. To the best of our knowledge this is the youngest cohort of gender-diverse youth in whom body satisfaction has been explored. Further studies of the effects of endocrine treatment on body image in gender-diverse youth are warranted, specifically as they relate to other measures of well-being.
References: 1. van de Grift TC et al. Body satisfaction and physical appearance in gender dysphoria. Archives of sexual behavior. 2016;45(3):575-585.
SAT-449 Factors Associated with Reduced Thyroid Hormones in Cushing Syndrome Patients Before and After Surgical Cure
Authors: Shekhar Skand , McGlotten Raven , Nieman Lynnette K 
Published: May 2020

Abstract
Background: Hypercortisolemia adversely affects thyroid hormone secretion. We previously described the temporal pattern of thyroid function recovery in 23 patients (1). However, the factors leading to suppression and recovery of the hypothalamic-pituitary-thyroid (HPT) axis in Cushing’s syndrome (CS) are not fully understood. We performed two separate studies to investigate these factors. Methods: In study 1, we examined patients (pts, n=62) with CS who underwent curative surgery and recorded their serum morning and evening cortisol, ACTH, tumor volume and duration of symptoms and 24-hour urine free cortisol (UFC) at baseline and the morning serum free T4, TSH and T3 at six-month intervals after cure. Data were log-transformed and Pearson correlations were performed. Linear mixed models were used to study factors that predict recovery of thyroid function. In study 2, we examined the diurnal variation of TSH by performing hourly TSH measurement between 3—7 PM and 12—4 AM on a cohort of pts (n=45) before surgery. Wilcoxon Signed-Rank method was used for comparisons of mean TSH across time and Pearson correlations were performed on log-transformed data. P values &lt;.05 were considered significant. Results: Study 1: In this larger cohort, we confirmed previous findings of suppressed or low normal fT4 and TSH values with active hypercortisolism, with normalization after cure that reflected changes in the T3:TSH, fT4:TSH and T3:fT4 ratios. There were inverse linear correlations between log10 UFC, serum AM and PM cortisol; and log10 TT3, fT4 and TSH before surgery. Independent negative prognosticators of circulating fT4 recovery included UFC greater than 1000mcg/day (nl: 3.5—45mcg/day), duration of symptoms of less than one year, and ACTH levels greater than 60pg/mL(nl: 5—45pg/mL) Study 2: The nocturnal (12 - 4AM) TSH surge was reduced, so that the difference in day and night TSH values was not statistically significant; this contrasts with the 30—50% nocturnal TSH increase above daytime values seen in healthy subjects. There was an inverse relationship between UFC and nocturnal TSH, daytime TSH and TBG values, but there was no direct relationship between UFC and percent changes in nocturnal TSH values. Conclusions: Our findings suggest that a deficit in TSH stimulation of the thyroid gland may explain the reduction in T3 and T4 levels. There is a dose-response relationship between various measures of hypercortisolemia and both thyroid hormones and the pattern of TSH secretion. Finally, the severity of hypercortisolism correlates with a longer time to recovery of the HPT axis in pts with CS after curative surgery. 1. Shekhar S et al. HPG and HPT Axes in Cushing Syndrome. J Endocr Soc, 3 S1, April May 2019