bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-038 Ambulatory Blood Pressure Increases in Hypogonadal Men Who Develop Increases in Hematocrit on Oral Testosterone Undecanoate
Authors: Dobs Adrian Sandra , White William B , Carson Culley , DelConte Anthony , Khera Mohit , Miner Martin , Shahid Muhamma , Papangkorn Kongnara , Kim Kilyoung , Chidambaram Nachiappan 
Published: May 2020

Abstract
There is concern that testosterone replacement therapies might increase blood pressure (BP) with chronic use. Testosterone undecanoate is a novel oral testosterone therapy under development for the treatment of male hypogonadism. We studied the effects of testosterone undecanoate (225 mg twice daily) on ambulatory blood pressure (ABP) and heart rate, in 138 men with hypogonadism (mean age, 54 years, 79% white, 48% with a history of hypertension). Ambulatory BP and heart rate and hematologic parameters were obtained at baseline and following 4 months of daily therapy. Changes from baseline in ambulatory 24-hour, awake, and sleep systolic BP of 3.8 (p=0.06), 5.2 (p=0.01), and 4.3 mmHg (p=0.07) were observed post-treatment, respectively. Smaller changes in the diastolic BP were observed (1.2 (p=0.13), 1.7 (p=0.04), and 1.7 mmHg (p=0.11) for 24-hour, awake, and sleep, respectively). Changes in the 24-hour, awake and sleep heart rates were 1.9 (p=0.07), 2.6 (p=0.02), and 0.4 (p=0.68) beats/minute respectively. There were no significant differences in changes from baseline in the 24-hour ambulatory BP for the 57 subjects who had a medical history of hypertension versus the 61 subjects who did not have hypertension: 4.5/1.5 mmHg in the hypertension subgroup versus 3.2/0.9 mmHg in the non-hypertensive subgroup (p = 0.53/0.46 between groups). Hematocrit and hemoglobin increased by 3.2% and 0.9 g/dl in all subjects after 4 months of therapy. In those men in the top quartile of changes in hematocrit (corresponding to upper / lower boundary increases of 6 and 14% with 9.3% achieving levels &gt; 52%), the largest increases in ambulatory systolic BP (8.3 mmHg) were observed, whereas the changes in ambulatory systolic BP in the lower 3 quartiles were substantially smaller (1.6, 3.2, and 2.7 mmHg in quartiles 1, 2 and 3 of hematocrit change, respectively). In conclusion, these data demonstrate increases in ambulatory BP occurred following 4 months of oral testosterone undecanoate, particularly in those men whose hematocrit rose by &gt; 6% or whose resultant hematocrit was 52% or higher. Hence, hematocrit maybe a useful clinical parameter that could effectively predict the risk of developing increases in BP on oral testosterone undecanoate.
MON-019 Maternal Behaviour in Mice Is Modified by a High Fat Diet in Pregnancy
Authors: Moazzam Showall , Noorjahan Noshin , Jarmasz Jessica S , Jin Yan , Siddiqui Tabrez J , Cattini Peter Andrew 
Published: May 2020

Abstract
Background: About a third of pregnant women of age 20-39 are obese, which carries significant risks for the mother and fetus, and adversely impacts pregnancy outcome. Specifically, women with obesity are at increased risk for peripartum depression. Maternal behaviour in mice is influenced by changes in hormone signaling in pregnancy, which is associated with effects on adult neurogenesis in the brain. Thus, we used mouse as a model system to gain further insight into the possible relationship between overeating/obesity and brain physiology and maternal behaviour. Objective: To assess the ability of a high-fat diet (HFD) versus a regular chow diet (CD), starting up to 10 weeks pre-pregnancy, to modify glucose clearance before and during pregnancy and affect maternal behaviour in the CD1 mouse. Study Design: Two groups of 3-4 week-old female CD1 mice were fed a HFD (fat=60 kcal%; carbohydrate=20 kcal%; protein=20 kcal%) or CD (fat=14 kcal%; carbohydrate=60 kcal%; protein=26 kcal%) and maintained on their respective diets throughout the study and weighed periodically. After at least 4 weeks of feeding on their diets, mice were allowed to breed. Glucose tolerance was tested using 2 g/kg of i.p. glucose at gestational day (GD) -1) after fasting (16 hours-overnight) as well as during pregnancy at GD16.5. An even number of pregnant and non-pregnant females were selected for each diet for maternal behaviour testing. Tests include an assessment of nest building at GD16.5-17 (use of nesting material and nest quality), and after birth pup retrieval at postpartum day (PD) 3, 4 and 5 (time of retrieval of each of the four pups within six minutes) using video capture. Results: The HFD led to a significant increase in weight relative to mice fed a CD. HFD impaired glucose-load clearances at GD -1 and 16.5 (p&lt;0.05) compared to mice fed a CD. Mice fed on HFD performed poorly in the nest building task (p&lt;0.01) as well as demonstrated a reduced completion rate on the pup retrieval test on PD3 (CD=8/10 vs. HFD 2/9 mice) but their retrieval response latency was improved by PD4 (CD=8/10 vs. HFD 8/9 mice) and PD5 (CD=7/10 vs. HFD 7/9 mice). Conclusions: Initial observations suggest that a HFD for at least 4 weeks before and during pregnancy results in overweight CD1 mice with impaired glucose clearance, and a negative effect on maternal behaviour as assessed by nest-building during pregnancy and pup retrieval postpartum; however, with regard to the latter, mice on the HFD show the ability to learn. Additional behavioural tests for locomotion, anxiety, risk avoidance and object recognition memory during or after pregnancy, as well as associated changes in hormonal signaling and adult neurogenesis are also currently under investigation.
SAT-519 Armour Thyroid and Liothyronine Combination Potentiated Thrombosis
Authors: Shin Tai Ho , Smith Pinar , Goulden Peter 
Published: May 2020

Abstract
Objective To describe a case presentation of multiple sinus thrombosis while on combination therapy of liothyronine and Armour Thyroid for Hashimoto’s thyroiditis with other risk factors of thrombosis. Methods A case report with medical history, diagnostic and treatment course is presented with discussion. Results A 47-year-old female with a history of Hashimoto’s thyroiditis on liothyronine and Armour Thyroid, on oral contraceptive use and cigarette smoking presented to Emergency Room with complaints of severe headache, neck pain and dizziness later developing confusion, word-finding difficulty and various left-sided neurological deficit. She was found to have superior sagittal sinus and right transverse sinus thrombosis, both with partial to complete occlusion and involved hematoma. Patient went through endovascular intervention for successful thrombectomy with recanalization, and neurosurgical intervention for decompressive evacuation of hematoma. Patient was found to have undetectably low thyroid stimulating hormone level, and her base-line level from one year ago was 0.147 milli-international units per liter while having been on liothyronine and Armour Thyroid for years. Patient was started on daily oral levothyroxine and recovered eventually from neurological deficits. Repeated thyroid function test showed improving results. Evaluation for other causes of thrombosis included positive results for prothrombin gene mutation, confirming her inherited thrombophilia condition that has been undiagnosed until this event. Discussion Primary hypothyroidism is one of the most prevalent endocrine disorders, occurring in up to 5% of the population. While synthetic thyroxine has been standard therapy for the primary hypothyroidism for many years, many alternative thyroid therapies have resurfaced recently. For instance, there has been increasing trend of using liothyronine in addition to levothyroxine with symptomatic benefit despite insufficient evidence. Armour Thyroid, which is a natural porcine derivative thyroid supplement often used as a weight loss supplement without proper monitor by physician, has repeatedly been controversial. Many studies have raised concerns for cardiovascular disease including arrhythmia with high thyroid hormone level. Also a number of case reports have shown association with hyperthyroidism and pro-thrombotic state. Although there are scarce publications associating liothyronine or Armour Thyroid and hypercoagulable thrombotic event, significant drug interactions may exist with patient who are more vulnerable with inherited condition or other risk factors.
SAT-506 Rare Case of Durvalumab-Induced Thyroiditis, Transient Secondary Adrenal Insufficiency and Autoimmune Diabetes
Authors: Gorantla Yamuna , Amblee Ambika , Lee Yee Liong , Yap Sara Elizabeth T 
Published: May 2020

Abstract
Introduction:
Cancer Immunotherapy (CI) is rapidly advancing field with different immune check point inhibitors (ICPi) targeting different cancers, with Durvalumab being one of the recent ICPi. Durvalumab induced endocrinopathies are common, mostly irreversible and if managed appropriately do not require cessation. Here we are presenting a patient (pt) who developed 3 different endocrinopathies simultaneously.
Case:
A 69 year old female with type 2 diabetes mellitus (T2DM), Stage III lung cancer was started on Durvalumab for unresectable cancer. 2 months later, presented to Emergency Department with fatigue, poor appetite, dizziness, palpitations, heat intolerance, polydipsia, polyuria. Labs suggestive of Thyrotoxicosis, blood glucose of 600mg/dl, AM Cortisol & ACTH consistent with central adrenal insufficiency (AI). Her previously well controlled T2DM (A1C 6.1%), suddenly became uncontrolled (A1C 9.5%), Antibodies were positive suggesting superimposition of autoimmune diabetes (AID). Pt was discharged on Methimazole (MMI), hydrocortisone (HC) and modified Insulin regimen.
After discharge patient stopped MMI and HC. TFT’s 2 weeks after stopping MMI were suggestive of hypothyroidism. AM Cortisol 10 days after stopping HC was normal, her subsequent AM cortisol remained normal. Her clinical picture with rapid conversion of thyrotoxicosis to hypothyroidism is suggestive of Thyroiditis from Durvalumab.
Discussion:
Durvalumab an ICPi is a programmed death-ligand 1(PD-L1) blocking antibody, initially approved for urothelial cancer, but was later shown to be effective in other solid tumors. Immune-related adverse events (irAE) due to Durvalumab therapy are mostly thyroid-related, AID and AI rarely reported. Pathogenesis of AID is likely related to PD-L1 blockage on autoreactive T cells that target islet cells. Ansari et al showed the development of autoimmune antibodies in a mouse model, later demonstrated in few human studies. irAE can affect more than one endocrine gland, typically occur in 10-11 weeks, can happen at same time or in succession. ICPi-induced hypophysitis should be considered prior to committing to diagnosis of primary AI. American Society of Clinical Oncology (ASCO) recommends screening for endocrine irAE with TSH/FT4 every 4-6 weeks, checking BG at baseline, every cycle for 12 weeks and then every 3 to 6 weeks. In patients with suspected type 1 DM, ASCO recommends checking antibodies, insulin, and, C-peptide levels. For AI, routine diagnostic work-up not recommended if asymptomatic.
Conclusion:
Our pt with T2DM developed AID, thyroiditis which progressed to hypothyroidism, central AI. This is a rare case where pt developed all 3 endocrinopathies secondary to durvalumab and also a rare case where AI self-resolved when pt still on durvalumab.
SAT-063 Polymicrobial Suppurative Thyroiditis Masquerading as Thyroid Storm
Authors: Finn Erin E , Tommerdahl Kalie L , Hayes Kari L , Chan Christine L 
Published: May 2020

Abstract
Introduction:
The thyroid gland is highly resistant to infection due to a robust blood supply, good lymphatic drainage, and high iodine concentration. Suppurative thyroiditis (ST) often presents with fever, tachycardia, leukocytosis, tenderness, and euthyroid labs. However, when ST occurs with thyrotoxicosis, it can meet criteria for thyroid storm, which presents a diagnostic dilemma.
Clinical Case:
A 17 year old female with family history of Graves’ disease presented to the ER with a sore throat. She was diagnosed with viral pharyngitis and treated with dexamethasone. Over the next 2 weeks, she developed fatigue, body aches, nausea, vomiting, and chills. She returned to the ER and was found to have tachycardia, hyperthyroidism [free T4 5.64 ng/dL (0.8 - 2.0 ng/dL), TSH &lt;0.015 uIU/mL (0.5 - 4.5 uIU/mL)], and WBC 11 k/uL (3.5 - 11.5 k/uL). She was prescribed atenolol and referred to Endocrinology. Three days later she developed fever, diaphoresis, ear pain, vomiting, and abdominal pain. In the ER, she was febrile to 101.2°F with a heart rate (HR) of 117 BPM. Labs showed a free T4 6.14 ng/dL, TSH &lt;0.015 uIU/mL, and WBC 20 k/uL. She was treated with methylprednisolone, propylthiouracil, and labetalol with improvement and transferred for concern of impending thyroid storm. Exam showed left-sided thyroid enlargement with tenderness. Thyroid ultrasound showed an enlarged heterogenous left thyroid lobe with 2 nodules, one 25 x 33 x 21 mm heterogenous and one 19 x 11 x 19 mm homogenous, without discrete abscess. That night she developed vomiting, hand tremors, HR in the 130’s BPM, fever to 104.1°F, and a headache. Treatment was initiated with methimazole, SSKI drops, propranolol, and dexamethasone. Symptoms improved save persistent neck tenderness and dysphagia. CT neck demonstrated a left-sided 25 x 17 x 90 mm abscess with concern for 4th branchial apparatus abnormality. She underwent incision and drainage with drain placement. Cultures grew Streptococcus anginosus and Fusobacterium necrophorum. Broad spectrum antibiotics were started and later narrowed to ampicillin-sulbactam. Betablockers and methimazole were discontinued and thyroid labs nearly normalized by discharge [T4 11.8 mcg/dL (4.5-11.5 mcg/dL), free T4 2.0 ng/dL (0.8-2 ng/dL), and total T3 78 ng/dL (100-210 ng/dL)]. Thyroid auto-antibodies were negative.
Discussion:
In patients with ST, only 11% present with hyperthyroidism. Current thyroid storm scoring systems are sensitive but not specific so an acute bacterial infection with thyrotoxicosis can easily meet criteria. While ultrasound is standard for assessing for thyroid abscesses, in the setting of high clinical suspicion, further imaging with contrasted neck CT is warranted.
SAT-487 Untreated Primary Hypothyroidism Presenting as Pica with Concurrent Hyponatremia and Rhabdomyolysis
Authors: Mirza Mehwish A , Ayala Ricky , Savage Jacqueline 
Published: May 2020

Abstract
Background:
Psychosis is a rare but known presentation of hypothyroidism, whereas other mental health disorders are less commonly associated. Pica, the consumption of non-nutritive, non-food substances, has not been reported to be associated with hypothyroidism. We describe a case of untreated severe hypothyroidism in which the patient presented with pica that reversed with treatment with levothyroxine.
Clinical case:
A 65-year-old female with a history of cigarette smoking and chronic marijuana use was brought to the emergency department by family after she was found attempting to eat non-food objects such as pens and a toothbrush. She reported new onset unsteady gait and having frequent falls over the past several months in addition to being increasingly forgetful. She complained of fatigue and reported recent unintentional weight loss, but denied cold intolerance, skin or hair changes, or constipation. On admission, she was noted to be hypothermic with body temperature between 94-95 degrees Fahrenheit. Physical examination was essentially unremarkable with normal thyroid size and reflexes. No pretibial edema was noted. Admission labs showed hemoglobin of 14.0 g/dL with a white cell count of 8000 cells/uL, without evidence of anemia or infection. Sodium was low at 123 mmol/l and creatinine kinase was elevated at 989 U/L which peaked at 1356 U/L during her admission. CT of the head was negative for any acute intracranial process. Further workup was significant for TSH 85.6 mIU/L (0.27-4.20 mIU/L), free T4 &lt;0.1 ng/dL (0.80-1.90 ng/dL), total T4 0.7 mcg/dL (5.1-11.9 mcg/dL), total T3 &lt; 25 ng/dL (76-181 ng/dL), and TPO antibody 416 IU/ml (&lt;9 IU/ml). AM cortisol was 27.0 ug/dL (6.2-19.4 ug/dL) at 8 AM, ruling out hypocortisolemia. The patient had not seen a medical provider in 10 years, had no recent health maintenance, and had no prior known history of thyroid disease. She was given IV fluids and started on oral levothyroxine 100 mcg daily due to the severity of hypothyroidism. Her sodium improved to 130 mmol/l over the next 4-5 days. Mental status returned to baseline with improvement in memory function and in gait and balance. Creatinine kinase trended down to 688 U/L over the next 2 days. She did not exhibit any additional behavior of eating non-food objects during the hospital stay. Patient was diagnosed to have severe hypothyroidism presenting as pica along with hyponatremia and rhabdomyolysis. Patient was discharged on levothyroxine 75 mcg daily.
Clinical lessons/conclusions:
Hyponatremia, rhabdomyolysis, and psychosis are relatively uncommon but known reported complications of untreated primary hypothyroidism. Acute psychosis has been reported as a presenting feature of undiagnosed hypothyroidism, but hypothyroidism presenting as pica as seen in our patient is extremely rare. This case highlights the importance of screening for hypothyroidism in patients presenting with unexplained pica.
SUN-524 Patient with Pseudohypoparathyroidism Type 1B, Graves Disease, and False Positive HIV Screen- a Rare Presentation
Authors: Desai Viraj V , Kumar Pratima V 
Published: May 2020

Abstract
Background: Pseudohypoparathyroidism 1B (PHP1B) is a disorder that can lead to thyroid stimulating hormone (TSH) resistance and hypothyroidism, although it is rarely associated with thyrotoxicosis.
Clinical Case: A 25-year-old female with a history of PHP1B, seizures due to hypocalcemia, and family history of PHP1B in her three sisters and brother presented to our emergency room with a fever of 1030F and generalized malaise. Two months prior, she was seen at an outside hospital with palpitations and bulging of the left eye. There, she was diagnosed with hyperthyroidism, started on methimazole, and asked to continue levetiracetam and calcitriol upon discharge.
On our exam, she had tachycardia of 120 beats per minute, left eye proptosis, positive Chvostek sign, and a large goiter with bruit. Reflexes were 3+.
Laboratory evaluation revealed corrected serum calcium of 6.1 (8.5-10.5 mg/dL), TSH &lt; 0.01 (0.34-5.60 mU/L), free T4 2.81 (0.60-1.60 ng/dL), free T3 13.0 (2.4-4.2 ng/dL), and iPTH 131 (12-88 pg/mL). ELISA testing for screening of HIV was positive. She was treated with IV calcium gluconate, methimazole, propranolol, and hydrocortisone. Her home doses of calcitriol and calcium were resumed. She was referred for total thyroidectomy as an outpatient once she became euthyroid. The confirmatory Western blot test for HIV was negative. It was determined that presence of thyroid stimulating immunoglobulin resulted in the false positive ELISA test.
Discussion: Hyperthyroidism with Graves disease seen in PHP has only very rarely been reported. (1) It has been postulated that abnormal electrolytes and elevated parathyroid hormone from PHP may lead to stimulation of the thyroid gland and perpetuate Graves disease symptoms. (2) Furthermore, the presentation of thyrotoxicosis despite TSH resistance in PHP indicates that there may be other mechanisms for TSH receptor antibodies to take effect in these patients which have not yet been determined. (3) Lastly, autoimmune diseases, including Graves disease, can cause a false-positive HIV ELISA as seen in our patient.
Conclusion: Although rare, thyrotoxicosis may present in patients with PHP1B. Additionally, it should be kept in mind that autoimmune diseases such as Graves disease can cause a false positive HIV ELISA, and follow-up Western blot testing should therefore be performed.
References:
(1) Gerhardt A, Hackenberg K. 2002. Pseudohypoparathyroidism and Graves’ disease: a rare combination of two endocrinological diseases. Exp Clin Endocrinol Diabetes. 110:245-247
(2) Morón-Díaz et al. 2019. A rare case of Graves’ disease in a patient with type 1B pseudohypoparathyroidism and associated TSH resistance. Endocrine Abstracts. 63:96
(3) Richard Prokesch. 2010. Navigating False Positive Testing. HIV Specialist (AAHIVS). 2:27
SUN-911 Immunotherapy Use in Adrenocortical Carcinoma with Encouraging Results- a Case Report
Authors: Madhavan Parvathy , Shichman Steven , Raj Nitya , Reidy-Lagunes Diane L , Malchoff Carl D 
Published: May 2020

Abstract
Adrenocortical carcinoma (ACC) is a rare cancer with a very poor prognosis with median survival of around 17 months. We present a patient with metastatic ACC in whom the response to PD1 inhibitor pembrolizumab has been promising.
Case report: A Caucasian female patient presented at the age of 19 y with weight gain, hypertension, moon facies, supraclavicular fullness and increased hair growth on her upper back. Serum potassium concentration was 2.6 mmol/l, cortisol was 46 mcg/dL (nl = 3-12mcg/dL), and plasma ACTH concentration was &lt; 5 pg/ml (nl = 6-58pg/ml). CT abdomen revealed a 5.4 cm right adrenal mass. For ACTH-independent Cushing’s Syndrome, she underwent right adrenalectomy within 1 week of presentation. Pathology revealed a 6.5 cm ACC with negative margins, with sinusoidal invasion, but no vascular or capsular invasion. Mitosis rate was 15-20/HPF with atypical mitotic figures. Immunohistochemistry showed no loss of expression of mismatch repair gene products associated with microsatellite instability. She was unable to tolerate mitotane. Genetic analysis was negative for TP53 mutation, and she underwent radiation to the adrenal bed within 6 months following adrenalectomy. She remained without biochemical or structural evidence of disease recurrence until 2.5 years following adrenalectomy, when AM cortisol was 6 mcg/dL (nl &lt; 1.8) after 1 mg and after 2 mg of dexamethasone the previous evening. CT scan of the pelvis, abdomen, and chest revealed 5 solid masses scattered within the lungs. The largest of these being 2.3 cm and 2 cm, and the other 3 being approximately 1 cm. Fine needle aspiration biopsy of the lung lesion revealed ACC metastases. Immunotherapy with pembrolizumab 200 mg every 3 weeks was initiated and continued for 2 years, with a side effect being grade 1 diarrhea. At 1 year after initiating pembrolizumab, she developed primary adrenal insufficiency that is being treated with 0.1 mg/d of fludrocortisone and low dose glucocorticoid replacement (hydrocortisone: 10mg in the morning and 5 mg in the evening), to avoid immune suppression. Pulmonary nodules decreased in size to 6 mm over the 2 years of pembrolizumab therapy and remained stable in size 1 year following completion of pembrolizumab therapy at which time the early morning serum cortisol concentration remained undetectable with a plasma ACTH concentration of 1177 pg/ml (nl = 6-50 pg/ml). In summary, this patient with ACC with normal mismatch repair gene expression demonstrated both structural and biochemical responses to 2 years of pembrolizumab therapy. The major side effect has been primary adrenal insufficiency. The biochemical and structural responses have been durable for 1 year after completion of pembrolizumab therapy.
Conclusion: This patient with microsatellite stable ACC has had a 36-month response to pembrolizumab.