bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-415 Clinical Performance of Thyroid-Stimulating Immunoglobulin for Graves′ Disease Diagnosis
Authors: Marui Suemi , Lenczuk Aline , Rocha Nelisa Helena , Watanabe Tomoco , Brito Luciana Pinto 
Published: May 2020

Abstract
INTRODUCTION The diagnosis of Graves′disease (GD) is likely when patient presents hyperthyroidism, symmetrical goiter and orbitopathy and further evaluation is unnecessary. Nevertheless patient with nodular thyroid or in the absence of clinical orbitopathy, measurement of TSH receptor antibodies (TRAb) is recommended to distinguish GD from toxic multinodular goiter, toxic adenoma and other etiologies. Radioiodine uptake (RAIU) also helps to diagnosis when TRAb is unavailable. Third generation TRAb assays measure all types of TSH receptor antibodies: stimulating, blocking and neutral with an excellent sensitivity and specificity for GD diagnosis. Recently, an automated bioassay for the thyroid stimulating immunoglobulin (TSI) was introduced to improve GD diagnosis. OBJECTIVE To analyze clinical performance of TSI and compare with TRAb assay for GD diagnosis. MATERIAL AND METHODS Serum samples of 117 patients with thyrotoxicosis due to GD, toxic multinodular goiter and toxic adenoma were runned simultaneously in two analytical system commercially available. TRAb was analyzed by Elecsys Anti-TSHR assay (Roche Diagnostics, Germany) in a Cobase411 analyzer (Roche Diagnostics, Germany) and results, according to the manufacturer interval reference, were negative if &lt; 1.75 IU/L (analytical range: 0.3 to 40 IU/L). TSI was measured by Immulite TSI assay (Siemens Healthcare, UK) in Immulite XPi 2000 and results, according to the manufacturer interval reference, were negative if &lt; 0.55 IU/L (analytical range: 0.1 to 40 IU/L). Clinical diagnoses of thyrotoxicosis were determined according to ATA guideline (2016). Statistical analyses were performed using SPSS and MedCalc softwares. Comparison were evaluated by regression equations and were considered significant when p values were &lt; .05. RESULTS From 2017 to 2019 a total of 312 serum samples from 117 patients (96 females) were evaluated with mean age 49.5 ±15.8 years-old (18 to 90 yrs). We excluded 26 results above the analytical measurement range of both assays. A high degree correlation was observed with a slope of 0.647 and an intercept -.094 IU/L. Spearman correlation coefficient was 0.858 (p &lt; 0.0001, 95% CI 0.825 to 0.886). TSI assay had higher sensibility and negative predictive value compared to TRAb (95.6% vs 88.5% and 83.6% vs 54.8%, respectively) but lower specificity and positive predictive value (90.3% vs 100% and 97.5% vs 100%, respectively). The results of TSI assay showed good agreement with those of the TRAb assay (k=0.74). A total of 31 samples were discordant, favoring to TSI assay in all but one case of GD according to clinical diagnosis (TRAb positive and TSI negative). CONCLUSION TSI assay showed an excellent performance for GD diagnosis with a better sensibility than TRAb assay.
SAT-417 Personalized Treatment Planning for Radioiodine Therapy of Graves’ Disease;The Collar Therapy Indicator(CoTI)
Authors: Santhanam Prasanna , Simons Zachary , Ganji Suneeta , Sgouros George , Ladenson Paul W 
Published: May 2020

Abstract
Introduction Since its introduction 80 years ago, the therapeutic I-131 dosage has usually been tailored to individual patient requirements based on the uptake of a tracer radio-iodine(RAI) dose. Estimated exposure has typically been extrapolated from the results of activity measurements at one or two time points, e.g., at 4 and 24 hours. We now know that treatment of hyperthyroid Graves disease with these methods lead to a 13–25% rate of failure to cure hyperthyroidism and a 46–80% rate of long-term hypothyroidism in cured patients. There is a need for a much more personalized approach to RAI dosing based on individual RAI tissue uptake, kinetics. This can be achieved only after including multiple data points during the evaluation of tissue uptake. The Collar Therapy Indicator (CoTI), a device placed in cloth collar around the neck resembling a turtle neck sweater collar with a connecting wire and recording box, has been shown in small feasibility studies to provide data regarding radioiodine exposure that correlates with conventional methods of measuring I-123 and I-131 uptakes after diagnostic dose administration and/or therapy for thyroid disorders Methods; We hypothesized that the device’s continuous measurement capability will permit more accurate estimates of radiation exposure to thyroid tissue than conventionally employed methods assessing fractional uptake at one or a few time points. It may also provide information about the extent of variability in the absorbed radiation dose among patients with hyperthyroidism. We performed a feasibility study in a patient with graves’ disease to see the difference between tradition methods of I-123 uptake and the CoTI; (1) We compared the conventional quantitative uptake-derived thyroid time activity curve (TAC) as well as the Area Under the Curve (AUC)(based on percent uptake at 6 hour and 24 hour time points) to that obtained using the CoTI.(2) We evaluated the uptake and clearance kinetics of diagnostic I-123 administered.(3) We also evaluated patient experience in using the CoTI device with a survey instrument. Results; The CoTI plotted TAC and AUC offered a different approach from the conventional methods of calculation (6 hr and 24 hr % uptake) of I-123 TAC and AUC. The patient reported no difficulty in using the device and the device itself was not inconvenient. Conclusions; The calculation of % uptake as well as rate of uptake within the thyroid by CoTI might help us, in achieving a more personalized approach to I-131 RAI dose calculation for treatment of Graves’ disease. The preliminary research findings that we have generated will help us investigate different aspects of RAI uptake within the thyroid and will hopefully lead to solutions, for some of the common issues and problems arising out of random dosing of RAI.
SAT-343 Diagnosis and Management of Pseudohypoparathyroidism Type 1B
Authors: Tahata Shawn , Kohlenberg Jacob , Clarke Bart Lyman 
Published: May 2020

Abstract
Background: Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterized by end-organ resistance to PTH. Most subtypes are caused by pathogenic variants or epigenetic alterations in GNAS, which encodes the alpha subunit of the G protein regulating end-organ response to PTH. PHP type 1B (PHP1B) is caused by methylation defects in GNAS and presents with isolated renal PTH resistance. Clinical Case: A 29-year-old gentleman presented with intermittent muscle spasms, perioral and digital paresthesias, fatigue, and anxiety. Family history was notable for similar symptoms in his sister and nephew. Physical examination revealed normal stature, non-dysmorphic facies, and no soft tissue ossifications or skeletal anomalies. Chvostek sign was positive. Laboratory studies showed total calcium 6.0 mg/dL (n 8.6–10.0 mg/dL), phosphorus 6.8 mg/dL (n 2.5–3.5 mg/dL), creatinine 0.8 mg/dL (n 0.8–1.3 mg/dL), albumin 5.0 (n 3.5–5.0 mg/dL), PTH 231 pg/mL (n 15–65 pg/mL), total 25-hydroxyvitamin D 19 mg/mL (n 20–50 ng/mL), and 1,25-dihydroxyvitamin D 45 pg/mL (n 18–64 pg/mL). Additional endocrine testing showed TSH 6.4 mIU/L (n 0.3–4.2 mIU/L), free T4 1.1 ng/dL (n 0.9–1.7 ng/dL), and TPO antibody &lt;0.3 IU/mL (n &lt;9.0 IU/mL). Renal ultrasound was normal. CT head showed diffuse intracranial calcifications. He was diagnosed with PHP1B and started on calcitriol, cholecalciferol, and calcium carbonate. He declined genetic testing. Repeat laboratory studies were improved with total calcium 8.5 mg/dL, phosphorus 3.9 mg/dL, total 25-hydroxyvitamin D 49 mg/mL, PTH 124 pg/mL, and 24-hour urinary calcium 269 mg (n &lt;250 mg). Conclusion: International consensus guidelines for the diagnosis and management of PHP and related disorders were recently published by Mantovani et al. in 2018. Proposed clinical and biochemical major criteria include PTH resistance, ectopic ossifications, early-onset obesity, TSH resistance, and Albright hereditary osteodystrophy (AHO; round facies, short stature, brachydactyly, developmental delay). Unlike PHP type 1A, PHP1B often presents later in life and features of AHO are usually absent, so diagnosis requires a high degree of clinical suspicion. It is recommended that patients with suspected PHP have molecular confirmation with sequencing, methylation, and/or copy number variant analysis of GNAS. Routine monitoring of calcium, phosphorus, and PTH levels and treatment with active vitamin D analogues with or without calcium supplements are advised to maintain normal calcium and phosphorus and PTH &lt;2 times the upper limit of normal. Other recommendations include renal imaging for nephrocalcinosis, eye exam for cataracts, CT head imaging (in patients with neurological findings) for calcifications, regular dental care, and management of comorbid endocrinopathies. A multidisciplinary approach is needed in this complex, heterogeneous group of disorders.
SAT-102 Height Improvement with Recombinant Human Growth Hormone Therapy at Terminal Stage of Growth
Authors: Kim Dae Hyun , Choi Ju-hee 
Published: May 2020

Abstract
Recombinant growth hormone therapy (rhGH) is known to improve the final adult height in various conditions. The effectiveness of treatment depends on the status of patients, but it is generally known that the younger age the treatment starts, the better effects obtained. The authors experienced that final adult height was dramatically improved with rhGH at the very end stage of deceleration period of growth, so we would like to share our unusual experience. A boy of 13 years and 11 months visited our clinic with cessation of growth. He was 163cm (54%) tall and 62.6kg (78%), and showed Tanner stage IV-V development. There have been no unusual findings in past history and family history. His Mid Parental Height was calculated as 170.5cm (Father: 172cm, Mother: 156cm). After experiencing an acute growth acceleration around 20cm over the past two years, growth rate was abruptly decreased, with 1cm growth in the last nine months. Bone age was 17 years by TW3 method, and pelvic AP x-ray showed Risser stage 4, which is compatible to 17 years in boy. As a result of the above findings, additional height gain was expected to less than 1-2cm and medical intervention for more height gain was expected to impossible. However, the patient and his parents strongly requested rhGH treatment. So, we decided to try rhGH treatment for only three months and then discuss whether or not to extend the treatment after checking up the result. Follow up was conducted every three months, and the height of the patient continued to grow and the closure of the remaining growth plates was confirmed to be delayed. During the one-and-a-half year treatment, no side effects appeared in patient, reaching 173 centimeters, the equivalent of the Korean male standard height. In this case, we experience that the use of Growth hormone can improve the final adult height significantly, even in the end stage of growth, without any other intervention. So, we may consider attempting limitedly to treat growth hormones for height gain, if caregivers or patient strongly request the medical intervention in end stage of the puberty or growth.
MON-622 Rapid Improvement in Glycated Albumin Before Educational Admission Predicts Fair Glycemic Control One Year After the Discharge of Patients with Type 2 Diabetes Mellitus
Authors: Katsuragawa Sho , Tsurutani Yuya , Takiguchi Tomoko , Saito Jun , Nishikawa Tetsuo 
Published: May 2020

Abstract
Background and Aim: Glycated albumin (GA) reflects a short-term glycemic control (about 2 weeks) in comparison to glycated hemoglobin (HbA1c) which reflects a long-term glycemic control. Thus, if the dietary, exercise, or medication therapy before the educational admission is effective, a rapid improvement in GA can be observed. However, the impact of the improvement in GA on the subsequent glycemic control is not well understood. This retrospective study analyzed the association between the change of GA before educational admission and glycemic control one year after the discharge of patients with type 2 diabetes mellitus (T2DM). Method: We analyzed data from 114 T2DM patients who were admitted to our hospital from 2011 to 2016. The GA data within 30 days before admission and on the day of admission were available for all patients. The change of GA per day (ΔGA/day) was calculated as [(GA on admission) - (GA before admission)/number of days between the two measurements of GA]. Patients with renal dysfunction (eGFR &lt; 30 mL/min/1.73 m2) or insulin deficiency [fasting C-peptide (CPR) &lt; 0.5 ng/mL or two-hour postprandial CPR &lt; 1.0 ng/mL] were excluded. Patients achieving an HbA1c of &lt; 7.0 % at one year after discharge were defined as achievers, and the rest were defined as non-achievers. Multiple baseline factors including the ΔGA/day between the two groups were compared. Results: Of the 114 patients, 68 were achievers and 46 were non-achievers. GA significantly declined during before and just after the admission to hospital (median [interquartile range]: 26.0 [22.2 - 32.7] to 25.0 [21.4 - 29.8] %, p &lt; 0.001). The range of the ΔGA/day was between -1.14 and 0.28, with a median value of -0.08 [-0.26 - 0.002]. The age, body mass index, and HbA1c levels at admission were not significantly different between the two groups. The increase in CPR after the glucagon loading test was higher in the achievers than in the non-achievers (1.85 [1.32 - 2.87] vs 1.21 [0.53 - 1.92] ng/ml, p = 0.004). The ΔGA/day was lower in the achievers than in the non-achievers (-0.14 [-0.39 - -0.006] vs -0.04 [-0.13 - 0.03], p = 0.002). A logistic regression analysis demonstrated that the ΔGA/day was the factor associated with achieving an HbA1c of &lt; 7.0% at one year after discharge (Odds ratio: 0.037, 95 % confidence interval: 0.004 - 0.267, p &lt; 0.001). In the receiver operating characteristic curve analysis, the ΔGA/day had an area under the curve of 0.67 in the achievement group and the cutoff value was set as -0.146 for predicting the achievement, with a sensitivity of 0.50 and a specificity of 0.85.
Conclusion: Our results suggest that the change in GA before the educational admission can predict the glycemic control one year after the discharge of T2DM patients.
SUN-302 Incidence Trends in Lung and Gastroenteropancreatic Neuroendocrine Neoplasms
Authors: Alwan Heba , Rosa Stefano La , Kopp Peter , Germann Simon , Maspoli-Conconi Manuela , Sempoux Christine , Bulliard Jean-Luc 
Published: May 2020

Abstract
Abstract
Introduction
The incidence of neuroendocrine neoplasms (NENs) seems to increase worldwide. However, long-term, population-based data that consider differentiation levels are sparse.
Objective
To evaluate the incidence trend of lung and gastroenteropancreatic (GEP) NENs according to the latest International Agency for Research on Cancer/World Health Organization classification over a 41-year time period in two Swiss regions.
Methods
All cases of lung and GEP NENs recorded in the Vaud and Neuchâtel Cancer Registries from 1976–2016 were included. NENs were stratified into well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). Changes in annual age-standardized incidence rates were calculated for lung and GEP NETs and NECs by sex.
Results
There were 4141 patients diagnosed with NENs, of which 65% were men. The incidence of lung NETs did not reveal any statistically significant trend in men, but increased in women by 4.9%/year between 1976–2016. The incidence of lung NECs in men decreased significantly by 2.6%/year from 1985–2016 whereas the incidence of lung NECs in women increased significantly between 1976–1998 by 6%/year. For GEP NETs, a steady annual increase in incidence occurred between 1976–2016 with a magnitude of 1.7% in men and 1.3% in women. No trend in incidence of GEP NECs was found for both sexes.
Conclusions
The incidence trends of lung NECs in men and women parallel changes in smoking prevalence in the population whereas causes of the increase in incidence of GEP NETs are not fully understood. Our study supports the importance of evaluating the epidemiology of NENs by their differentiation level.
SUN-065 Bone Health Outcomes in a Large, Diverse Pediatric Cohort Undergoing Hematopoietic Stem Cell Transplant
Authors: Swauger Sarah , Sabulski Anthony , Hornung Lindsey , Myers Kasiani , Wasserman Halley , Howell Jonathan Christian 
Published: May 2020

Abstract
Background:
Impaired bone mineral density (BMD) is a known complication of hematopoietic stem cell transplantation (HSCT) in adults and may lead to increased fracture risk. Little is known in pediatrics about the risks for impaired BMD and fragility (low trauma) fractures after HSCT. Factors that may influence the risk of bone disease include underlying diagnosis, glucocorticoid exposure, and HSCT complications (e.g. graft versus host disease (GVHD)). Our study aims to describe the incidence of fragility fractures in a large diverse pediatric HSCT population and to identify risk factors of both fracture and impaired BMD.
Methods:
We reviewed the records of 237 patients (age ≤ 21 years at time of transplant) who underwent HSCT at our institution between January 2015 and March 2018. The primary endpoint was incidence of fragility fractures and the secondary endpoint was assessment of BMD on dual-energy X-ray absorptiometry (DXA). We analyzed DXA results at one-year post-HSCT in 72 out of 206 patients alive at 1 year.
Results:
There were 25/237 (10.5%) patients with evidence of fragility fracture on x-ray. Of those, 18/25 (72%) were spine fractures. For patients who had fractures, median time to fracture was 5.9 months after BMT. Mortality at one-year was proportionally higher, though not significant (p=0.11) in patients who had at least one fragility fracture (24%; 6/25) compared to patients without fragility fracture (12%; 25/212). Vitamin D status at one-year post transplant was sufficient (&gt;20ng/mL) in 94% (160/171) of patients measured. There was no difference in incidence of fracture between vitamin D sufficient and insufficient patients. The median height-for-age adjusted Z-score (HAZ) for spine BMD at one-year post transplant was 0.13 in all patients. The median HAZ spine BMD Z-score in patients with fragility fracture was -1.64, though data was available for only 5 patients.
Conclusions:
The incidence of fragility fractures, especially vertebral compression fractures, after pediatric HSCT is striking and is higher than in adult populations. Furthermore, there are likely additional asymptomatic patients with occult fractures not detected in out cohort. Additional analysis will assess the associations between underlying medical diagnosis, GVHD, and chronic glucocorticoid exposure on fragility fracture risk. The high incidence of fragility fractures seen in this study advocates for establishing bone health screening protocols with attention toward spinal imaging in pediatric patients undergoing HSCT.
OR34-03 Variable and Pulsatile Circulating Aldosterone Levels in Primary Aldosteronism: Implications for Diagnosis and Sub-Type Differentiation
Authors: Yozamp Nicholas , Sacks Barry , Underhill Jonathan , Fudim Tali , Vaidya Anand 
Published: May 2020

Abstract
Introduction: Considerable intra-individual variability in circulating aldosterone levels has been observed in patients with primary aldosteronism (PA). The magnitude and implications of this phenomenon are not well characterized.
Objective: To evaluate the acute variability in aldosterone in patients with confirmed PA.
Methods: 373 patients with confirmed PA underwent adrenal venous sampling (AVS) after appropriate catheterization of bilateral adrenal veins. Peripheral venous aldosterone levels were measured 2 hours prior to AVS while in supine posture. After anesthesia induction with fentanyl and midazolam, AVS was performed while in the same supine posture, and aldosterone levels were drawn from the inferior vena cava (IVC) and in triplicate from the bilateral adrenal veins over 10 minutes. Differences between the pre-AVS and intra-AVS IVC aldosterone levels were analyzed, and regression models used to identify independent predictors of change. Coefficients of variation (COV) between triplicate aldosterone levels in each adrenal vein were calculated.
Results: 81% of patients demonstrated a decrease in aldosterone concentration from pre-AVS to the intra-AVS IVC measurement. The mean decrease in aldosterone was 10.5 ng/dL (95% CI: 7.6–13.3) and the mean relative decrease in aldosterone was 39% (95% CI: 27–51%, P&lt;0.0001). The absolute decrease in aldosterone was striking, with 48% of patients who had a decrease in aldosterone exhibiting an IVC aldosterone of less than or equal to 5 ng/dL. The absolute decrease in aldosterone was significantly associated with a higher aldosterone level (p&lt;0.001) and lower systolic blood pressure at diagnosis (p=0.02). A wide variation in triplicate aldosterone values was seen in the span of 10-minute sampling, ranging from 1–300%, with COV of 21.0% in the left adrenal vein and 25.0% in the right adrenal vein. If the lowest of three aldosterone-to-cortisol (A/C) ratios on the dominant side and highest of three A/C ratios on the contralateral side were used instead of the average of the three values, the interpretation of the AVS would have changed from unilateral PA to bilateral PA in 15.9% of cases.
Conclusions: These findings underscore the pulsatile and variable nature of circulating aldosterone levels in patients with bona fide PA. Aldosterone levels substantially declined in 81% of patients within a period of 2 hours while maintaining a fixed and supine posture. In half of these patients, aldosterone levels declined to 5 ng/dL or below, a threshold typically considered incompatible with PA. Further, adrenal venous aldosterone levels exhibited large variations on repeated sampling within a 10-minute span that could have influenced the interpretation of sub-type differentiation in nearly 16% of cases. Single circulating aldosterone values lack precision and reproducibility and may result in incorrect diagnosis and sub-type differentiation.