bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-281 A Pilot Study: Comparing Prolactin Measurements Between Two Different Immunoassays
Authors: Woznick Walter K , Yang Almira , Gunsolus Ian , Sarvaideo Jenna Lynne 
Published: May 2020

Abstract
Hyperprolactinemia from a prolactin-secreting pituitary tumor is the most common endocrine disorder of the hypothalamic-pituitary axis. As suggested in the 2011 Endocrine Society Guidelines on Diagnosis and Treatment of Hyperprolactinemia, macroprolactin level should be assessed in patients with asymptomatic hyperprolactinemia. However, as discussed in prior studies comparing the performance of common prolactin immunoassays in a reference population of both males and females with and without known hyperprolactinemia or macroprolactinemia, there has been poor harmonization between assays and variable reactivity towards macroprolactin, resulting in significantly different normal ranges for total and monomeric prolactin between manufacturers. The goal of our analysis is to assess the concordance of the Roche and Siemens prolactin immunoassays using cases in which prolactin and macroprolactin testing was ordered on clinical indication. We hope to educate clinicians regarding potential variability between assays that may not be fully accounted for by using established, assay-specific reference ranges. We reviewed patients 18 years and older from any gender who underwent evaluation of prolactin levels as clinically indicated and had elevated serum prolactin on a Roche assay with a subsequent normal prolactin on a Siemens assay. Seven out of 18 patients had an elevated prolactin on the Roche assay and a normal prolactin on the subsequent Siemens assay that also tests for the presence of macroprolactin. The reasons for testing prolactin in the 7 patients were: secondary hypogonadism (4), pituitary microadenoma (1), oligomenorrhea (1) and baseline labs in a transgender female starting estrogen (1). Of the 7 cases we observed with discordant Roche and Siemens prolactin results, one of our 2 female patients and one of our 4 male patients would have shown concordant hyperprolactinemia results on both assays if the Siemens reference range was narrowed to align with published studies. This study demonstrates significant analytical discordance between prolactin immunoassays, leading to variable clinical interpretation regarding the presence of hyperprolactinemia. We suggest using a single prolactin immunoassay for routine measurement of prolactin as well as investigation of macroprolactin measurement to ensure comparable reactivity towards all forms of prolactin. References: (1) Vallette-Kasic et al., J Clin Endocrinol Metab. 2002 Feb;87(2):581-8. (2) Gibney et al., J Clin Endocrinol Metab. 2005 Jul;90(7):3927-32. (3) Luisa et al., Clinical chemistry 2008 Sept; 54:10 1673-1681 (4) Shlomo et al., J Clin Endocrinol Metab, February 2011, 96(2):273-288
SAT-611 Dietary Reduction of Branched-Chain Amino Acids
Authors: Karaman Rowan , Park Eunhae , Galusha Brittany M , Flores Victoria , Davis Dawn B , Lamming Dudley W 
Published: May 2020

Abstract
Background: One of the primary risk factors for the development of diabetes is obesity. Although moderate weight loss can lead to improvements in metabolic health, reduced-calorie diets are difficult to sustain. A number of groups have shown that low protein diets are associated with metabolic health in both rodents and humans. In particular, the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine are associated with insulin resistance and diabetes in humans. Blood levels of the BCAAs decrease in humans fed a low protein diet, and we recently showed that reducing either dietary BCAAs or protein rapidly restored normal body composition and insulin sensitivity to diet-induced obese mice without reducing calorie intake. We are determining the effect of a low BCAA diet in humans with prediabetes and overweight/obesity.
Objectives: The primary outcome is the reduction of dietary BCAA intake by at least 50% in subjects in the low BCAA group while maintaining overall baseline calories. Secondary outcomes are compliance and tolerability of the low BCAA protein powder.
Method: This is a randomized, controlled, single-blind pilot study. The intervention arm uses a low BCAA protein powder to replace two meals per day for 60 days. The control arm uses a control protein powder with standard amounts of amino acids to replace two meals per day for 60 days. We are enrolling 16 males with the following criteria: ages 35 to 65, BMI 28 to 35, and hemoglobin A1c 5.7%-6.4% or fasting glucose 101-125 mg/dL. A registered dietitian reviews a 4-day food diary prior to diet initiation and creates an individualized meal plan based on those values in order to maintain baseline calories during the study diet. Baseline measurements prior to diet initiation include waist circumference, body mass index, fasting insulin and glucose, an oral glucose tolerance test, resting metabolic rate, body composition testing using dual energy x-ray absorptiometry, jumping mechanography to assess muscle function, and a stool sample to assess the microbiome. These tests are repeated after 60 days on the diet. Safety labs are performed while on the diet and 2-3 weeks after the end of the diet. Weekly safety telephone calls occur while on the diet. The food diaries are repeated after 30 and 60 days on the diet.
Results/Conclusion: Ten of sixteen subjects have completed the trial to date. One out of four subjects in the low BCAA group dropped out; the remainder successfully completed the study. BCAA intake was successfully reduced by 50%. Missed beverages were uncommon. No significant safety concerns or side effects have been noted. In conclusion, our early results suggest that replacement of two meals a day with a protein powder lacking BCAA for up to two months is a safe and feasible intervention. Ongoing analysis will determine if this intervention impacts metabolic health.
SAT-380 A Case of Primary Hyperparathyroidism on the Third Trimester of Pregnancy
Authors: Villapol Maria Alexandra Carranceja , Kanapi Maria Princess L 
Published: May 2020

Abstract
Introduction: This is the case of a pregnant woman on her 3rd trimester who was diagnosed with primary hyperparathyroidism. Since there are two patients involved, the potential complications that can be brought about by the diagnostic tests and the treatment had to be weighed against the benefits.
Case: The patient is SA, a 34-year old female on her 29th week of pregnancy, admitted due to a month history of abdominal pain described as intermittent, crampy, generalized, non-radiating, and mild-to-moderately severe in intensity. She was advised to do tests but did not comply. In the interim, there was recurrence of symptoms but with resolution. However, the crampy abdominal pain recurred, now localized at the right upper quadrant and epigastric areas, radiating to the right upper back, moderate in intensity, and with associated nausea and vomiting, leading to admission.
She was first managed under OB-Gynecology, given hydration, pain management and Betamethasone. She was also referred to Cardiology for blood pressure control, and Surgery for evaluation of the abdominal pain. Due to an increasing trend of her blood glucose, she was referred to Endocrinology and started on insulin. Mild bilateral nephrocalcinoses seen in an abdominal ultrasound prompted work-up showing an elevated serum ionized calcium at 1.88 meq/L (n 1.12-1.32 meq/L), elevated intact PTH at 451.13 pg/ml (n &lt;67.9 pg/ml), and low Vitamin D at 10.96 ng/ml (n &gt;30ng/ml). Parathyroid ultrasound showed nonthyroidal tissue measuring 0.4 x 0.6 cm at the right inferior area. Saline hydration and diuresis with Furosemide were started to manage the hypercalcemia. A multi-disciplinary meeting was held to discuss the options for management and risks involved. The goal was to deliver the baby in stable condition possibly to term, while keeping maternal calcium levels and blood pressure normal.
However on her 30th week of gestation, she had persistent elevated blood pressure and underwent emergency caesarian section. After delivery, the patient was advised against breastfeeding for adequate management of her hypercalcemia. She was started on Cinacalcet, Calcitonin, and Ibandronic Acid. A Parathyroid Sestamibi Scan done showed a parathyroid adenoma on the right inferior lobe, and she underwent right inferior parathyroidectomy, with left thyroidectomy and isthmusectomy. Findings showed a right inferior parathyroid adenoma and a benign follicular nodule on the left thyroid. She was started on Calcium Carbonate and Calcitriol, and discharged stable.
Conclusions: This case shows that when two lives are at stake every step of the management, whether diagnostic or therapeutic, must be communicated well to the patient and to the other members of the team. It is ultimately a choice made by the expectant mother but through the proper guidance and updated knowledge of the team, combined with a good clinical eye especially in the treatment of pregnant women.
SAT-596 POMC Expression in GABAergic Neurons Suppresses NPY Overexpression and Restores Food Intake in Obese Mice
Authors: Trotta Milagros , Bello Estefanía P , Alsina Ramiro , Tavella María B , Ferrán José L , Marcelo Rubinstein , Bumaschny Viviana Florencia 
Published: May 2020

Abstract
Hypothalamic arcuate proopiomelanocortin (Arc-POMC) neurons are involved in different physiological processes such as the regulation of energy balance, glucose homeostasis and stress induced analgesia. Since these neurons heterogeneously express different biological markers and project to many hypothalamic and extrahypothalamic areas, it is proposed that Arc-POMC neurons could be classified into different subpopulations having diverse physiological roles. The aim of the present study was to characterize the contribution of the subpopulation of Arc-POMC neurons co-secreting gamma-aminobutyric acid (GABA) neurotransmitter in the control of energy balance. Arc-Pomc expression restricted to GABAergic-POMC neurons was achieved by crossing a reversible Pomc-deficient mouse line (arcPomc-) with a tamoxifen-inducible Gad2-CreER transgenic line. Tamoxifen treatment of arcPomc-/-:Gad2-CreER mice at P60 resulted in Pomc expression in ~25 % of Arc-POMC neurons and ~23 % of Pomc mRNA levels, compared to Gad2-CreER control mice. Rescued mice normalized food intake, glycemia and fasting-induced hyperphagia, and significantly reduced body weight. Energy balance was also improved in arcPomc-/-:Gad2-CreER mice treated with tamoxifen at P25. Distribution analysis of rescued POMC immunoreactive fibers revealed that the DMH is a major target site of GABAergic-POMC neurons. Interestingly, the expression of the orexigenic neuropeptide Y (NPY) in the DMH was increased in arcPomc-/- obese mice but completely restored after Pomc rescue in arcPomc-/-:Gad2-CreER mice. Finally, we performed stereotactic intracerebral injections of fluorescent retrobeads into the DMH followed by in situ hybridization for Gad1 and found that ~75 % of Arc-POMC neurons projecting to the DMH are GABAergic. In conclusion, in the present study we show that the expression of Pomc in the subpopulation of Arc-GABAergic-POMC neurons is sufficient to maintain normal food intake. In addition, we found that DMH-NPY expression is negatively correlated with Pomc expression in GABAergic-POMC neurons, suggesting that food intake may be regulated by an Arc-GABAergic-POMC --&gt; DMH-NPY pathway.
SUN-067 Pituitary Dysfunction in Children with Ectopic Posterior Pituitary
Authors: Naji Ghada , Poletto Erica , Kubicky Rita Ann 
Published: May 2020

Abstract
Background: Imaging studies aid in the detection of structural abnormalities that may be associated with pituitary dysfunction, such as ectopic posterior pituitary (EPP). The location of the ectopic lobe can vary, but it is most commonly located along the median eminence in the floor of the third ventricle. An EPP could result from complete or partial defective neural migration during embryogenesis, which could explain the different loci of EPP. Affected individuals have either severe isolated growth hormone deficiency (IGHD) or combined pituitary hormone deficiencies (CPHD); diabetes insipidus is not a feature, indicating that the EPP is functioning normally.
Aim: To detect the prevalence of IGHD or CPHD in children with EPP. In addition, to evaluate the association between the location of EPP and pituitary dysfunction.
Methods: A retrospective chart review of MRI reports at St. Christopher’s Hospital for Children (SCHC) from 2006-2018 that were found to have EPP. Pituitary hormone function was evaluated in the majority of the patient population.
Results: Of the 26 patients with EPP, [16 males (M) and 10 females (F)], mean chronologic age was 5.98+5.18 yrs, only 20 patients had an endocrine evaluation at SCHC. Of the 20 children, 14 had CPHD and 4 had IGHD.
Patients were classified into 3 groups (upper, middle & lower) according to EPP location along the pituitary stalk. Of the 21 patients with upper EPP, 17 had pituitary dysfunction (14 with CPHD, 3 with IGHD). Of the 4 children with middle EPP, only 1 had pituitary dysfunction which was IGHD. One patient had lower EPP with hyperprolactinemia. Diabetes insipidus was not identified in any of the children.
Conclusion: Our study supports previous reports that CPHD and IGHD are frequent in patients with EPP. Similarly, our data further demonstrate that no cases of diabetes insipidus have been reported in children with EPP.
In our study, EPP is most commonly located along the upper third of pituitary stalk at the median eminence level, with a higher prevalence of CPHD and IGHD, a finding similar to prior studies. No CPHD was reported in middle/lower but IGHD was found in the middle EPP group.
SUN-006 Light and Exercise Therapy Improves Depression in Women with Premenstrual Syndrome
Authors: Tsikirai Tino Michelle , Ramirez Francisco , Nedley Neil 
Published: May 2020

Abstract
Objective This study documents the effects that light and exercise therapy have in women experiencing premenstrual syndrome (PMS). Design Methods Study participants were fertile-aged females that were involved in a non-profit community depression and anxiety education program. Participants met in once a week and were taught about the effects of healthful cooking, regular exercise (at least 40 minutes of exercise five times a week), bright light exposure (20 - 40 minutes of exposure) from the sun or from a light box, and other healthy behaviors on their mental health. All participants took a 75-item questionnaire at the beginning and the end of the program to establish a baseline and measure changes in depression levels. The questionnaire measured depression level based on DSM-5 [The Diagnostic and Statistical Manual of Mental Disorders Volume 5] criteria. Participants were asked to provide their demographical information and patient history, including information about premenstrual syndrome. Depression was classified into 4 categories as none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). Results From 1968 females 803 reported suffering from PMS mean age 38.8, SD 8.9. Baseline mean depression was 15.3, SD 15.3, median 16 and mode of 18. At the end from the 803, 280 established exercise and light therapy, that group had a depression average of 6.2 (SD 5.5), median 5, mode 0 and 83 (29.6%) of them reported no longer PMS symptoms. At the end those 125 did not established the exercise and light therapy had a depression average of 7.7 (SD 5.5), median 7 and mode 8 and 34 (27.2%) no longer reported PMS symptoms. Conclusions Women experiencing PMS exhibit improved mental health as a result of light and exercise therapy. Lifestyle intervention for maladies related to this syndrome may be an effective alternative to pharmaceutical medications.
SAT-494 An Unusual Presentation of Hypothyroidism
Authors: Sukumaran Anju 
Published: May 2020

Abstract
Introduction: Pediatric Endocrinologists see many children with congenital hypothyroidism. Complications from long standing untreated hypothyroidism reports are rare in children. This is a case report on an unusual presentation of hypothyroidism caused by noncompliance.Clinical Case: A 11-year-old boy with history for congenital hypothyroidism, lost for follow up for 10 months, presented to an outside hospital with pain on face, joints and all over his body. Initial labs showed elevated creatinine, liver enzymes and TSH &gt;300 mcIU/mL with free T4 &lt;0.1 ng/dL. He was transferred to University for further care. In our Emergency Room, patient had normal vitals. On exam he had puffy appearance, sluggish reflexes otherwise unremarkable exam. Chest X-ray was done due to cough and congestion symptoms and showed cardiomegaly. EKG showed low voltage complexes otherwise normal. ECHO obtained showed normal left ventricular function and small pericardial effusion. Cardiology recommended no intervention at this time. Endocrinology was consulted due to abnormal thyroid labs. Patient had normal mental status, no hypothermia or bradycardia or hypotension or hypoventilation. He had normal sodium. He had macrocytic anemia. Recommended to get creatinine kinase (CK) levels as he had elevated serum creatinine. CK levels came back at 3600 U/L. He was started on intravenous hydration and Synthroid. Doses were increased daily. Once serum creatinine trended down and glomerular filtration rate (GFR) normalized he was discharged home. CK was still elevated but trended down. He had Tanner 3 testes size on exam. His LH and testosterone levels were pubertal consistent with central puberty activation and not just macroorchidism. He was seen as outpatient a month after discharge. His thyroid levels were normal. Serum creatinine and CK had normalized and he continues to progress in puberty. Conclusion: Long standing untreated hypothyroidism can cause multiple organ dysfunctions. Our patient presented with cardiomegaly, acute kidney injury from rhabdomyolysis. It is important to look out for other system involvement as this happen rarely in children and myxedema coma can be life threatening.
SUN-673 Development of Euglycemic Diabetic Ketoacidosis in a Patient with Well-Controlled Type 2 Diabetes Mellitus on a Sodium-Glucose Transporter 2 Inhibitor
Authors: Narang Disha K , Anthony Pick , Anca Zegrean , Balu Simona , Mateo Tole 
Published: May 2020

Abstract
Background: We describe the case of a patient with euglycemic diabetic ketoacidosis (euDKA), in the setting of sodium-glucose cotransporter-2 (SGLT2) inhibitor use, complicated by non-anion gap metabolic acidosis and low-carbohydrate diet leading to admission.
Presentation: A 43-year-old woman with a history of type 2 diabetes mellitus treated with Metformin, with no prior history of DKA, was admitted with progressive dizziness, nausea, vomiting, malaise, palpitations, and dyspnea starting 3 days prior to admission. Her other history includes anemia due to uterine fibroids, hypertension, and hyperlipidemia. Hemoglobin A1C was 6.7%, however in the setting of anemia. She denied polyuria and polydipsia, and alcohol and drug use. She was started on a low-dose SGLT2i and pioglitazone 1 week prior to admission.
Labs revealed mild hyperglycemia (blood glucose 145 mg/dL), with mixed anion-gap and non-anion-gap metabolic acidosis, and respiratory alkalosis [arterial pH 6.97 (rr7.35-7.45), PCO2 &lt;13.0 mmHg (rr 32-45 mmHg), bicarbonate 5mm/dL (rr 24-33 mg/dL), anion gap 22, B-hydroxybutyrate 12.52 mmol/L (rr 0-0.3 mmol/L), and chloride 108 mEq/L (rr 98-109 mEq/L)], with normal renal function, hepatic function, and lactate. Infectious work-up was negative, including chest x-ray and urinalysis.
She was diagnosed with euDKA due to SGLT2i. The SGLT2i was stopped and she was treated with insulin drip, intravenous fluids, and temporary bicarbonate drip given combined acidoses and severely low bicarbonate level, until her acidosis cleared. The patient noted that she had lately been eating a very low-carbohydrate diet in order to improve her glycemic control and promote weight loss.
Discussion: In this case, DKA was likely precipitated by ketogenesis from low-carbohydrate diet for 1 week while taking a low-dose SGLT2i. Additionally, the dual anti-hyperglycemic therapy with Metformin and SGLT2i contributed to high anion-gap metabolic acidosis, along with the presence of a non-anion-gap metabolic acidosis. The patient was successfully transitioned to Metformin and pioglitazone upon discharge. As the use of SGLT2i is becoming widespread across multiple disciplines, recognizing euDKA in the setting of profound acidemia and very low carbohydrate diet in patients who are overall lower risk is particularly important.
SAT-LB94 An Unusual Case of Acute Myocardial Infarction Revealing Underlying Polycythemia Secondary to Exogenous Bioidentical Testosterone Therapy
Authors: Fox Marissa , Epps Michelle , Jafari Jasmine , Roy Simi , Rahman Maisara 
Published: May 2020

Abstract
BACKGROUND: Many patients seeking testosterone therapy are turning to compound pharmacies for customized bioidentical testosterone replacement. These pharmacies market “bioidentical” hormone therapies as more effective and superior to traditional FDA-approved synthetic therapies. Bioidentical formulations are available as injections, creams, and subcutaneous pellet implants. Exogenous testosterone replacement is associated with polycythemia complicated by increased blood pressure, blood viscosity, and platelet aggregation (1). The ensuing hypercoagulable and prothrombotic changes predispose individuals to adverse cardiac events, including myocardial infarction.
CLINICAL CASE: A 66-year-old male with hypertension, type 2 diabetes, and hyperlipidemia presented with chest pain and dizziness. Initial EKG was unremarkable but troponin levels were elevated and the patient was admitted to telemetry. Lexiscan indicated anterior territory ischemia and coronary angiography revealed 95% stenosis of the left anterior descending artery (LAD). He underwent percutaneous coronary intervention (PCI) with stenting of the LAD. During the patient’s workup, he was noted to have elevated hemoglobin (20) and hematocrit (60) levels and was treated with 1g hydroxyurea as phlebotomy was unavailable. JAK2 mutation and EPO level screenings were ordered and unremarkable. The patient was noted to have multiple subcutaneous testosterone pellets in his buttocks which he stated were implanted three weeks prior. Serum total testosterone was elevated at 1226 ng/dL. Hematology was consulted and the patient continued daily 1g hydroxyurea. After discharge, the patient continued outpatient follow up with hematology and received plasmapheresis for management of polycythemia.
CONCLUSION: Considering polycythemia can arise secondary to exogenous testosterone use and is a known risk factor for cardiovascular events, it is likely this patient’s myocardial infarction was complicated by his use of exogenous bioidentical testosterone. Compound pharmacies providing bioidentical testosterone are not required to report adverse events, provide black box warnings, or show evidence-based safety and efficacy profiles for their products. The increasing availability and use of non-FDA-approved testosterone therapies warrants increased physician vigilance, particularly for patients with existing cardiac conditions or predisposition to hypercoagulable and prothrombotic states. The lack of regulation and research in the realm of compound pharmacy hormone products calls for further studies and reforms to protect patients from the risk of developing detrimental complications.
REFERENCE: (1) Xu, L., Freeman, G., Cowling, B. et al. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med11, 108 (2013).