bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-168 Peri-Operative Glucocorticoids in Patients Having Total Joint Replacements: Help or Harm?
Authors: Chukir Tariq , Goodman Susan , Tornberg Haley , Do Huong , Thomas Charlene , Sigmund Alana , Russell Linda , Stein Emily Margaret 
Published: May 2020

Abstract
Introduction: There is limited evidence to guide peri-operative steroid regimen in patients receiving chronic glucocorticoid (GC) therapy. Many patients who undergo minor surgical procedures receive stress-dose steroids. While hemodynamic instability and hypotension are well-recognized risks of inadequate peri-operative GCs, there may be harms associated with using doses higher than necessary. Whether surgical outcomes differ according to peri-operative steroid dose is not known. We hypothesized that patients who had greater GC exposure have less hypotension, but higher rates of hyperglycemia and post-operative complications.
Methods: This retrospective study investigated the relationships between peri-operative GC use and post-operative complications following total hip/knee joint replacement (arthroplasty) in patients with rheumatoid arthritis (RA). All GCs were converted to prednisone equivalents; GC exposure was assessed by number of doses and total cumulative dose during the hospitalization. Complications (infection, thromboembolism and cardiovascular events) were determined by chart review.
Results: Of 432 patients with RA included, half (54%) underwent knee arthroplasty. Mean age was 64±12 years, 78% were women. Thirty percent of patients were on home GCs (mean dose 7±4mg/day). Median cumulative GC dose during hospitalization was 37mg [IQR 27, 57]. Compared to patients who only received one peri-operative dose of steroids, those who received multiple doses had a greater risk of post-operative complications (OR 3.319 (95% CI 1.03, 12.62; p&lt;0.05] and hyperglycemia, glucose &gt;180 mg/dl, [OR 1.812(0.99, 3.32; p&lt;0.05]. They did not have an increase in hypotension or need for pressors. Among patients who received steroids while in the hospital (90%), there was a small but significant dose response relationship with hyperglycemia (r=0.16; p&lt;0.01). Higher cumulative dose was also associated with higher risk of complications; for every 10 mg increase in cumulative dose, the risk of complications increased by 15% (p&lt;0.01).
Conclusions: Among RA patients undergoing arthroplasty, we did not find that lower doses of GCs were related to more hypotension. However, patients with higher GC exposure were more likely to have hyperglycemia and post-operative complications. Our results suggest that use of peri-operative GC is not without risk, and the lowest doses possible should be considered. Further studies are needed to confirm these findings and to define the optimal dosing strategies for patients receiving peri-operative GCs.
SUN-637 The Impact of Hyperandrogenemia and Western-Style Diet on Post-Pregnancy Metabolism in Nonhuman Primates
Authors: Takahashi Diana Lynn , Mishler Emily , Slayden Ov Daniel , Hennebold Jon D , Roberts Charles T , True Cadence 
Published: May 2020

Abstract
Polycystic ovary syndrome (PCOS) often is associated with hyperandrogenemia and an increased incidence of obesity and type 2 diabetes. To understand the separate and combined effects of androgens and obesity on reproductive and metabolic parameters, our group established a nonhuman primate model consisting of animals receiving either testosterone (T, mean value of 1.4 ng/mL), an obesogenic western-style diet (WSD, 36% of calories from fat compared to 16% in normal monkey chow), or a combination of T+WSD. T+WSD increased insulin resistance compared to WSD alone after three years of treatment and reduced fertility. Those T+WSD animals that became pregnant had a mild worsening of glucose homeostasis during pregnancy. The current study sought to determine how T+WSD affected post-pregnancy metabolic health and whether T+WSD led to the worsening of insulin resistance after pregnancy. Intravenous glucose tolerance tests (ivGTT) were performed 1) before pregnancy, 2) approximately 3-4 months after C-section, which occurred between gestational day 130-135 (3rd trimester), and 3) one year post C-section. All animal groups tended to show increases in weight, BMI, and body fat percentage after pregnancy. Both WSD groups (WSD and T+WSD) had higher overall weights, BMI, and body fat percentages. Measures of insulin sensitivity such as fasting insulin, glucose, and insulin area under the curves during an ivGTT and homeostatic model of insulin resistance (HOMA-IR) all increased over time, but there were no differences between groups. The lack of treatment effect on measures of insulin resistance may be due to the fact that animals that did not become pregnant had significantly higher indices of insulin resistance. Experimental animals underwent a second round of fertility trials thereby allowing for a comparison of glucose homeostasis for those animals that became pregnant in both the 1st and 2nd trial. The WSD group demonstrated increased fasting glucose and glucose AUC during an early third trimester ivGTT in the second pregnancy compared to the first. The control, T, and T+WSD groups did not show significant differences in glucose homeostasis between the first and second pregnancy. These findings indicate that WSD consumption may increase the risk of worsened glucose homeostasis after pregnancy and during subsequent pregnancies. Testosterone, either in isolation or in combination with WSD, did not appear to have a significant impact on post-pregnancy metabolism or worsen metabolic outcomes in a second pregnancy.
MON-695 Multiple Recurrent Lipomatoses with Thiazolidinedione Therapy in Familial Partial Lipodystrophy, Dunnigan Variety (FPLD2)
Authors: Patni Nivedita , Garg Abhimanyu 
Published: May 2020

Abstract
Background: FPLD2, a rare autosomal dominant disorder due to heterozygous missense mutations in LMNA, is characterized by gradual loss of subcutaneous (sc) fat from the limbs starting during late childhood and predisposition to metabolic complications, such as diabetes, dyslipidemia and hepatic steatosis. Some patients, especially females, accumulate excess sc fat in the chin, neck, supraclavicular and perineal regions. We report disfiguring and disabling lipomatoses in unusual locations with thiazolidinedione therapy in two women with FPLD2.
Clinical Cases: A 57-year-old white female with FPLD2, due to heterozygous p.R482Q LMNA mutation, developed recurrent large lipomatoses in the axillae at age 33 years, and later in the posterior neck (buffalo hump), mons pubis and above sacrum. She developed diabetes at age 30 and was started on pioglitazone 45 mg daily, which was switched to rosiglitazone 8 mg daily at age 43 years. Supra-sacral lipomatoses were approximately 40 cm X 20 cm bilaterally and continued to grow despite lipectomy and multiple liposuctions. Rosiglitazone was stopped at age 56 years, and she reported no further increase in the size of lipomatoses. Her other medications included colesevelam, atorvastatin, metformin, glimepiride, lisinopril, losartan, hydrochlorothiazide, aspirin, insulin and dulaglutide. Her 54-year-old younger sister with FPLD2 (heterozygous p.R482Q LMNA mutation) was treated with lisinopril, metoprolol, atorvastatin, liraglutide, and insulin glargine and aspart, but no history of taking thiazolidinediones, and she never developed any lipomatoses. Another 43-year-old white female with FPLD2, due to heterozygous p.S583L LMNA mutation, was noticed to have lipomatous deposits in the axillae, medial gluteal region, labia and perineal regions. She developed diabetes mellitus at age 36 years and took metformin for 6 years and pioglitazone 30 mg daily for one year before she noticed the lipomatoses. Her other medications included atorvastatin, aldactone and vitamin D3. Pioglitazone was stopped and after one year, she reported reduction in the size of lipomatoses.
Conclusion: Thiazolidinediones are selective peroxisomal proliferator-activated receptor-γ agonists and induce weight gain by increasing fat mass, especially subcutaneous depots. Our cases suggest that thiazolidinediones can cause undesired growth of non-lipodystrophic adipose tissue in patients with FPLD2 and thus should be avoided.
MON-253 A Rare Case of Pituitary Aspergillosis Diagnosed by CSF PCR in an Immunocompetent Patient with Headaches and Photophobia
Authors: Popli Rakesh , Nikoomanesh Tina , Jackson Gavin 
Published: May 2020

Abstract
Background: Pituitary aspergillosis is a rare infection usually found in the immunocompromised population. It is oftentimes mistaken for a pituitary adenoma based on similar clinical presentation and characteristic findings on MRI. Most cases require removal of the pituitary mass in order to make a diagnosis. Here we present the case of an immunocompetent patient with headaches and photophobia diagnosed with pituitary aspergillosis by CSF PCR and treated medically with voriconazole.
Clinical Case: A 40-year-old woman with a questionable history of Brucellosis presented with a 3 month history of headaches along with 2 days of nausea and vomiting. Vital signs were notable for intermittent hypotension but were otherwise within normal limits. Physical exam was notable for tenderness at the left temporal region, diaphoresis and photophobia. Patient was otherwise alert and oriented and had no visual field deficits or extraocular muscle dysfunction.
Patient was found to have central adrenal insufficiency with undetectable AM cortisol (&lt;0.5 mcg/dL, n 3.7-19.4 mcg/dL), inappropriately normal ACTH (7 pg/mL, n 6-58 pg/mL) and central hypothyroidism with low TSH (0.057 mcIU/mL, n 0.358-3.8 mcIU/mL) and low free T4 (0.48 ng/dL, n 0.76-1.46 ng/dL). Patient initially presented with hyponatremia (Na 119 mmol/L, n 137-145 mmol/L) likely secondary to central adrenal insufficiency and central hypothyroidism. Gadolinium-enhanced pituitary MRI showed a heterogeneous 1.8 cm pituitary mass with rim enhancement concerning for hypophysitis.
Patient was started on stress-dose steroids with IV hydrocortisone 100 mg IV q8h, levothyroxine 50 mcg PO daily and empiric antibiotic therapy with ceftriaxone, doxycycline and rifampin due to suspicion for neurobrucellosis. Lumbar puncture was obtained showing low glucose (39 mg/dL, n 40-70 mg/dL), normal protein (47 mg/dL, n 12-60 mg/dL) and an elevated white count (WBC 9/mcL, n 0-5/mcL) with lymphocyte predominance (97% lymphocytes, n 40-80%). Blood and CSF cultures showed no growth at 2 weeks. CSF was sent for multiplex PCR which came back positive for Aspergillus.
Patient was discharged with voriconazole 300 mg PO BID for 1 year, levothyroxine 75 mcg PO daily and hydrocortisone 10 mg PO Qam and 5 mg PO Qpm. Three months later, repeat MRI showed resolution of the pituitary mass and patient felt well without headaches, nausea or vomiting.
Conclusion: This case demonstrates an atypical example of pituitary aspergillosis diagnosed without pituitary mass biopsy and treated medically with voriconazole. It demonstrates the possible role of CSF PCR to diagnose the condition and guide antifungal treatment.
SUN-725 Clinical and Genetic Features of Families with Maternally Inherited Central Precocious Puberty
Authors: Tinano Flávia Rezende , Canton Ana Pinheiro Machado , Montenegro Luciana Ribeiro , Leal Andrea de Castro , Ramos Carolina , Piovesan Maiara Ribeiro , Seraphim Carlos Eduardo , de Faria Aline Guimarães , Mendonca Berenice Bilharinho , Brito Vinicius Nahime , Latronico Ana Claudia 
Published: May 2020

Abstract
Context: The clinical recognition of familial central precocious puberty (CPP) has significantly increased in the last years. This fact can be related to the recent descriptions of genetic causes associated with this pediatric condition, such as loss-of-function mutations of two imprinted genes (MKRN3 and DLK1). Inherited defects in both genes cause paternally inherited CPP. However, no genetic abnormality has been described in families with maternally inherited CPP so far.
Objectives: To characterize the clinical and genetic features of several families with maternally inherited CPP.
Setting and Participants: We analyzed clinical and genetic features of children with familial CPP. No brain MRI alterations were detected in the selected patients with CPP. MKRN3 and DLK1 pathogenic mutations were excluded. Whole-exome sequencing was performed in selected cases.
Results: We studied 177 children from 141 families with familial CPP. Paternal inheritance was evidenced in 44 families (31%), whereas 58 (41%) had maternally inheritance. Indeterminate inheritance was detected in the remaining families. Maternally inherited CPP affected mainly female patients (69 girls and two boys). Thelarche occurred at mean age of 6.1 ± 1.9 years in this female group. Most of girls had Tanner 3 (41%) and Tanner 4 (35%) breast development at first evaluation. One boy had additional syndromic features (macrosomia, autism, bilateral eyelid ptosis, high arcade palate, irregular teeth and abnormal gait). The pedigree analysis of patients with maternally inherited CPP revealed the following affected family members: 42 mothers, 10 grandmothers, 11 sisters, 12 aunts, and 11 female cousins. Most of the families (41) had two affected consecutive generations, while eight families had three affected generations. No consanguinity was referred. Ongoing molecular analysis revealed two rare heterozygous variants in the boy with syndromic CPP and three affected family members with precocious menarche (mother, maternally half-sister, and maternally aunt): a frameshift deletion (p.F144fs) in MKKS; and a missense variant (p.P267L) in UGT2B4, which encodes a protein involved in estrogen hydroxylation and it was related to menarche timing in genome-wide association studies.
Conclusions: Maternally inherited CPP was diagnosed mainly in girls, who had thelarche at mean age of 6 years old. Dominant pattern of inheritance was more prevalent, with direct maternal transmission in 72% of the studied families. New candidate genes might be implicated with maternally inherited CPP.
OR23-01 Intrapatient ACTH Variability in Cushing’s Disease: Prognostic Significance
Authors: Alvarez Reinier , Hogan Elizabeth , Wu Tianxia , Stratakis Constantine A , Nieman Lynnette K , Chittiboina Prashant 
Published: May 2020

Abstract
Introduction: In patients with Cushing’s Disease (CD), intrapatient variability of hormone measurements creates significant clinical challenges, therefore multiple measurements are recommended.1 Urinary and salivary cortisol variation has been well described. However, intrapatient variation of adrenocorticotropic hormone (ACTH) in CD remains unknown. In CD patients, ACTH levels are inherently elevated from baseline but the coefficient of diurnal variation is reduced.2Additionally, at each diurnal time point, these exists a significant variation around the mean for the ACTH levels. In this study, we first analyzed the intrapatient variablility of ACTH at each diurnal timepoint in patients with CD. CD is primarily a disorder of ACTH excess, and treatment directed at pituitary adenomas would presumably perturb ACTH levels prior to affecting serum or urine cortisol. We hypothesized that the coefficient of variation at each diurnal time-point can help predict remission from CD following surgery.
Methods: We conducted a retrospective review of patients (n = 645) who had histopathologically confirmed diagnosis of CD from 2005-2019 (NCT NCT00060541). We selected patients that had ≥ 3 plasma ACTH values over a 7 day span prior to surgical or medical intervention. We grouped the ACTH measurements into morning (AM) and midnight (PM) values to account for diurnal variation in ACTH secretion. We then analyzed post-operative hormone measurements performed every 6 hours prior to administration of replacement corticosteroids. Remission was assigned to patients with nadir serum cortisol level ≤5 mcg/dL within ten days post-operatively3,4.
Results: We found 54 patients with multiple PM (n = 27) and AM (n = 41) ACTH measurements within a 7 day span. We found that the median coefficient of variation (CV) of intra-patient variability was 19.7% (N=41) (95% CI:12.5-27.5) for the AM and was 24% (N=27) (95% CI: 9.6-31.8) for the PM. Age, the number of tests, or the length of test period were not correlated with CV or absolute levels of ACTH. The intraclass correlation coefficient (ICC) of the AM data set was 0.59 and the PM data set was 0.79 which demonstrates a good and excellent reliability respectively. We found that that, in general, 30-60% decrease from pre-operative ACTH levels predicted remission from CD. ACTH decrease &gt;50% on POD2 and 3 had 100% specificity and sensitivity in predicting remission. The decrease in ACTH preceded cortisol nadir in 3/10 patients by 24 hours.
Conclusion: We found significant intra-patient variability in plasma levels of ACTH at individual diurnal timepoints in CD patients. We also found that the change in ACTH &gt;50% on POD2 or 3 is an excellent predictor of remission from CD.
SAT-136 Hypoxia Effect on Cytokine Production by Breast Cancer Cells
Authors: Avtanski Dimiter , Chen Karin , Satlof Leo , Stoffels Guillaume , Kothapalli Udithi , Ziluck Noah , Lema Maribel , Poretsky Leonid 
Published: May 2020

Abstract
Inflammation is a critical component of tumor initiation and progression. Chronic inflammation triggers molecular events that can promote carcinogenesis, tumor vascularization and metastasis. As inflammatory mediators, cytokines play an important role in the interplay between the tumor cells and tumor microenvironment. Cytokines released by the tumor-associated macrophages modulate cancer cell survival, stemness, invasiveness, and tumor vascularization. Breast cancer cells, however, also produce a variety of cytokines, whose role in cancer development is poorly understood. The aim of our study was to characterize the basal cytokine secretory activity in commonly used human breast cancer cell lines (MDA-MB-231, MCF-7, BT-474, and T-47D). Using MILLIPLEX assay, we measured the expression of 41 cytokines, including interleukins, monokines, interferons and growth factors. We also compared cytokine expression profile of breast cancer cells with those of non-tumorigenic human breast epithelial MCF-10A cells. Further, we investigated whether hypoxia modulates cytokine secretion of breast cancer cells. Using cobalt(II) chloride (CoCl2) to mimic hypoxia, we compared the effect of various treatment doses and intervals on cytokine production in the breast cancer cells. Results demonstrated that CoCl2 affects the release of multiple cytokines in a dose- and concentration-dependent manner, thus highlighting the role of cancer cell-derived cytokines on breast tumor progression. Understanding the molecular actions of cytokines in the tumor microenvironment is important for understanding the mechanism of cancer initiation and progression.
SAT-270 Priapism Secondary to Cabergoline
Authors: Amir Maryam , Flores Monica , Calles-Escandon Jorge 
Published: May 2020

Abstract
Background: Cabergoline and Bromocriptine are ergot derivative long-acting dopamine agonist that are very effective and well tolerated in patients with hyperprolactinemia. A rare and unwanted side effect of Bromocriptine is priapism, which has hardly ever been report in literature and it’s not cited under the medication insert. The underlying mechanism is not totally clear, but it is well known that dopaminergic pathways in the central nervous system are of importance for male sexual behavior and penile erection. Lesser is known about Cabergoline and priapism with only one case report in the literature (1).
Clinical Case: A 65 yr old African American male with a past medical history significant for obesity, essential hypertension, and recent history of frontal headaches was found to have a pituitary macroadenoma. Brain MRI demonstrated 11 x 12 x 9 mm enhancing lesion within the right lateral sella turcica. The lesion extended laterally to abut the right cavernous ICA without vascular encasement or extension into the right temporal skull base. Prolactin level was 276.3 ng/mL (2.1-15.0 ng/mL). He was started on Cabergoline 0.5 mg weekly. 60 days after starting Cabergoline he presented to the ED with a painful penile erection lasting &gt;12 hours. He did not take any Phosphodiesterase (PDE) inhibitors and had no other recent change in medications. He denied any history of sickle cell disease. His most recent dose of Carbergoline was the day prior to the ED visit. He was seen by a Urologist in the ED and confirmed to have a low flow Priapism and underwent aspiration of intracorporal bodies. He was discharged home on pseudoephedrine and pain medications. Carbergoline was discontinued. He has had no further episodes of Priapism since discontinuation of Cabergoline.
Conclusion: The time between drug use and occurrence, absence of other offending medications or precipitating factors and no further priapism episodes once treatment was discontinued suggests a priapism as a rarely reported side effect of Cabergoline. (1)
References:
1.E.de la Pena Zarzuelo, V. Hernandez Canas and C. Llorente Abarca, Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
MON-460 An Extremely Rare Case of Urothelial Carcinoma Metastasizing to the Thyroid Gland
Authors: German Massiell , Singh Abhilasha , Lin Yu Kuei , Sundaresh Vishnu 
Published: May 2020

Abstract
BACKGROUND Metastasis of primary malignancies to the thyroid gland is uncommon, with an overall incidence of 2%. The most common malignancy to metastasize to the thyroid is lung neoplasm (22%) as reported in an autopsy series and renal cell carcinoma (25%) in a clinical series.
CLINICAL CASE A 78 year-old-white male was found to have a thyroid nodule on CT neck performed for surveillance of urothelial carcinoma diagnosed 3 years prior. On retrospective review of CT chest from the previous year, the thyroid nodule had increased in size but didn’t meet criteria for FNAC. Neck/Thyroid US demonstrated a right lobe solid hypoechoic nodule measuring 1.1 x 0.7 x 1.1 cm (longitudinal x anterior-posterior, lateral respectively). Nodule margin was well defined, with no internal vascularity, microcalcifications or abnormal cervical lymph nodes. Seven months later, US reported the nodule to have increased in size to 2.1 x 2.1 x 4.7 cm at which point FNAC was performed. Cytology revealed malignant cells compatible with metastasis from the urothelial carcinoma. Three years prior, his high-grade papillary urothelial carcinoma with extensive infiltration into the muscularis propria had been treated with a partial cystectomy and radiation therapy. Surgical margins and all tested lymph nodes had been negative for neoplasm. The patient underwent right thyroid lobectomy and pathology confirmed high-grade malignant neoplasm consistent with metastatic tumor from the patient’s known urothelial carcinoma.
CONCLUSION We present a rare case of urothelial carcinoma with metastasis to the thyroid gland. While evaluating thyroid nodules in patients with other known malignancies, clinicians should have a lower threshold for FNAC. This will assist with earlier diagnosis of potential metastatic disease and improve clinical outcomes.