bluuebunny/crossref_metadata_2025_split huggingface dataset:
6665 A Case of Exogenous Cushing Syndrome and Acute Adrenal Insufficiency from Usage and Subsequent Withdrawal of Unregulated Glucocorticoid Supplement Ardosons
Authors: Rao Angela , Faidat Ishola Adeola , Desai Dimpi , Sellmeyer Deborah E 
Published: October 2024

Abstract
Disclosure: A. Rao: None. A.F. Ishola: None. D. Desai: None. D.E. Sellmeyer: None.
Introduction: Exogenous Cushing’s syndrome is a frequent complication of therapeutic glucocorticoids. Rare cases of exogenous hypercortisolism from supplements have been reported. We report the first case of exogenous Cushing’s syndrome due to an unregulated anti-inflammatory supplement called Ardosons. Clinical Case: A 47-year-old male with medical history of ankylosing spondylitis, obstructive sleep apnea, and hypertension presented to the hospital with several weeks of generalized weakness. Five weeks prior to his admission, he was evaluated by Rheumatology and started on adalimumab for ankylosing spondylitis, and all previous medications were stopped.His medication history was notable for Ardosons, an unregulated supplement he obtained in Mexico for ankylosing spondylitis that contains 25 mg of indomethacin, 0.75 mg of oral betamethasone, and 215 mg of methocarbamol. He had been taking two tablets of Ardosons daily for the past ten years, and throughout this time had noted 160 lb weight gain, worsening hypertension, and development of obstructive sleep apnea.His symptoms on hospital presentation since stopping Ardosons included weakness, nausea, vomiting, and hypotension. Clinically, he appeared Cushingoid with violaceous striae, abdominal adiposity, prominent dorsoclavicular and supraclavicular fat pads, and scattered ecchymoses. Due to these exam findings, the medical team obtained a 1 mg dexamethasone suppression test which showed morning cortisol of 1.1 ug/dL [reference range post-suppression &lt;1.8 ug/dL]. Endocrinology was consulted and due to clinical features of acute adrenal insufficiency, in the setting of abrupt withdrawal from systemic glucocorticoids, he was started on physiologic hydrocortisone with symptomatic improvement. At his subsequent endocrinology clinic visit five weeks later, he had lost 20 lbs, and striae were less prominent. His hypothalamic-pituitary-adrenal axis has been serially reassessed and shows continued impaired adrenal function, most recently with morning cortisol of 2.9 ug/dL [reference range 6-18 ug/dL], and ACTH of 49.9 [reference range 7-63 pg/mL]. Clinical Lesson: This is the first case of exogenous Cushing syndrome resulting from usage of a medication called Ardosons, which contains a potent glucocorticoid. Abrupt withdrawal of agents like these can cause acute adrenal insufficiency and can present as a diagnostic challenge, as physical findings may paradoxically show evidence of cortisol excess. Thorough medication reconciliation and supplementation history is essential to identify potential hidden corticosteroids which can have severe and lasting systemic effects.
Presentation: 6/2/2024
6552 A soft case of Pheochromocytoma
Authors: Lai William , Delsignore Valentina , Steven Scott 
Published: October 2024

Abstract
Disclosure: W. Lai: None. V. Delsignore: None. S. Steven: None.
Introduction: Pheochromocytoma is a rare condition estimated to occur in less than 0.2% of patients with hypertension [1]. Symptomatology is critical in prompting suspicion for testing for pheochromocytoma with patients going undiagnosed up to 50% of the time based on one post mortem study [2]. The following is an atypical case of pheochromocytoma in which the initial presenting symptom was erectile dysfunction. Case: The patient is a 37 year old male who had been complaining of difficulty obtaining and maintaining erections as well as fatigue over the past year prior to presentation. He subsequently began experiencing frequent episodes of nausea, vomiting, headaches, sweating, palpitations, and pallor which resulted in several visits to local emergency departments. Despite having no known prior history of tachycardia or hypertension, he was found to be both tachycardic and hypertensive. Abdominal computed tomography (CT) demonstrated a septated right adrenal mass measuring 8.0x7.7x7.4cm. The lesion measured 44 Hounsfield units (HU) on pre-contrast imaging, 57 HU one minute following contrast administration, and 58 HU ten minutes following contrast administration on dedicated adrenal CT. Laboratory studies revealed serum metanephrines of 3,919pg/mL and serum normetanephrines of 3,184pg/mL as well as 24 hour urinary metanephrines of 22,154ug and 24 hour urinary normetanephrines of 8,702ug. His symptomatic episodes resolved after starting a low dose of doxazosin. He underwent laparoscopic resection of the adrenal mass with surgical pathology revealing pheochromocytoma with a Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) of 8. Serum metanephrine and normetanephrine levels and 24 hour urinary metanephrine and normetanephrine levels became undetectable following surgical intervention. His erectile dysfunction and other symptoms completely resolved. Conclusion: Pheochromocytomas can pose a diagnostic challenge and therefore require a high level of clinical suspicion based on symptoms. The classic triad for pheochromocytoma which includes headaches, sweating, and tachycardia is relatively uncommon with paroxysmal findings occurring more often. There has been only one other documented case in which the initial presenting symptom of pheochromocytoma was erectile dysfunction, but this case illustrates that erectile dysfunction should certainly be considered as one of the possible symptoms that raises suspicion for pheochromocytomas [3].
Presentation: 6/3/2024
7321 A Mixture Of PCBs Induces Sex-Specific Disruptions To Cognitive And Neuromolecular Endpoints In Grandchildren Of Exposed Rats
Authors: Hilz E N , Morales-Ledesma E , Deka J , Bhamidipati S , Thompson L , Wiley D C , Gore A C 
Published: October 2024

Abstract
Disclosure: E.N. Hilz: None. E. Morales-Ledesma: None. J. Deka: None. S. Bhamidipati: None. L. Thompson: None. D.C. Wiley: None. A.C. Gore: None.
Polychlorinated biphenyls (PCBs) are a weakly estrogenic class of ubiquitous environmental endocrine-disrupting chemicals that affect a range of sex-specific neuroendocrine and reproductive outcomes. Furthermore, these effects can extend intergenerationally via epigenetic changes carried down the germline. In humans, PCBs are associated with sexually dimorphic and hormone sensitive neurobehavioral disorders including attention deficit hyperactivity disorder (ADHD) and depression; however, little preclinical work has modeled these cognitive changes in rats and none has determined if they extend intergenerationally via endocrine-mediated changes to the brain. In the current work, pregnant and nursing Sprague-Dawley rats were exposed to the PCB mixture Aroclor 1221 (A1221). Male and female grandchildren of these rats, exposed preconceptionally to A1221 via the germline, underwent a battery of behavioral tasks to assess attentional phenotype, cognitive flexibility, and reward preference followed by targeted 3’ RNA sequencing (TAGseq) to assess neuromolecular changes in brain regions that support these behaviors. Results revealed that A1221 exposure had sex-specific effects. In germline-exposed females, A1221 decreased conditioned orienting suggestive of a hyporesponsive attentional phenotype and impaired attentional set-shifting suggestive of reduced cognitive flexibility; in both males and females, germline exposure to A1221 increased preference for sucrose solution indicating potential hypersensitivity to rewarding substances. From these animals, dopamine (DA) cell numbers in the midbrain significantly and negatively correlated with behavioral changes. TAGseq in regions of the brain DA system (including the prelimbic region of the prefrontal cortex, core of the nucleus accumbens, and substantia nigra and ventral tegmental area of the midbrain), revealed that molecular disruptions of A1221 were most apparent along the male germline: in the core of the nucleus accumbens, A1221 downregulated genes involved in myelination and upregulated genes involved in synaptic signaling compared to controls. Using gene ontology (GO), it was determined that GO sets involved in these processes were differentially affected throughout regions of the DA system of exposed animals in both males and females. These data show that the PCB mixture A1221 impairs different aspects of cognitive behavior between the sexes in a manner that emerges over generations, and may be mediated by both structural and molecular changes in the brain DA system. Supported by 1F32-ES034257-01A1 and R01 ES028464.
Presentation: 6/3/2024
8214 Adrenocortical Oncocytic Neoplasm Presenting As Cushing's Syndrome: A Case Report
Authors: Chu Lee Ainee Krystelle , ROSARIO M I C H A E L D 
Published: October 2024

Abstract
Disclosure: A.C. Lee: None. M.D. Rosario: None.
Adrenocortical oncocytoma is often non-functioning and detected incidentally. We report a case of a functioning adrenal oncocytic neoplasm referred for adrenal incidentaloma. She is a 33-year-old female hypertensive and diabetic, had 10-kilogram weight gain in a span of one year, with easy bruisability, and irregular menses for the last 10 months. Physical examination showed moon facies, buffalo hump, purple-colored violaceous striae measuring 1.2-1.4 cm in diameter, thin skin and hirsutism. There was an incidental finding of a left adrenal mass measuring 3.0 x 2.9 x 3.0 cm on CT scan. Work-up done: 1-mg dexamethasone suppression test (DST) with unsuppressed 8am cortisol at 948 nmol/L (reference range (RR) 172- 303), ACTH &lt;1.00 pg/ml (RR 3.0 – 30.0); Total 24-hour urine metanephrine 136 mcg/24 hours (RR 115-695); Normal Plasma Aldosterone Concentration 169pg/ml (RR 57-335), and Plasma Renin Activity 21.4pg/mL (RR 5.4-34.5). She was referred for further evaluation and definitive management. CT scan with adrenal protocol showed an enhancing isodense mass in the lateral limb of the left adrenal (3.2 x 3.1 x 2.9 cm). Plain, venous and delayed Hounsfield Unit respectively as follows: +47, +84, +72 with absolute and relative wash out at 32.4 % and 14.3% respectively, worrisome for neoplasm versus metastasis. The right adrenal is unremarkable. Repeat work up showed unsuppressed 1-mg DST at 17.90 ug/dL (RR &lt;1.8) with low 4pm ACTH 2.14 pg/ml (RR: 3.00 - 30.00). Dehydroepiandrosterone Sulfate low 3.40 ug/dL (RR: 95.80 - 511.70) with normal plasma free metanephrine 10.31pg/ml (RR: &lt;65pg/ml). She was assessed to have ACTH-independent Cushing syndrome secondary to adrenal mass to consider malignancy and underwent left laparoscopic adrenalectomy. Pre-operatively, hydrocortisone 50 mg intravenously was given and continued every 6 hours intra-operatively. Histopathology revealed ﻿﻿adrenal cortical adenoma with oncocytic features , tumor size 3.3 cm in widest dimension, with low mitotic tumor grade (&lt;20 mitoses per 10 millimeter square). Lymphatic and vascular invasion was not identified and all surgical margins were negative for tumor. Postoperatively, hydrocortisone was shifted to prednisone and tapered. Six months post operatively, 8 am serum cortisol (24-hour post steroid discontinuation) was adequate at 20 ug/dL with gradual improvement in the patients Cushing’s features. Nine months post-adrenalectomy, there was resumption of her regular menses and twelve months thereafter total weight loss was at 13 kilograms. Physical examination showed a remarkedly lighter violaceous striae with decreased hirsutism. Whole abdominal CT scan twelve months post operation was unremarkable. Recurrence and metastases have been described in patients with an adrenal oncocytic carcinoma post-surgery hence our patient will be closely followed-up to check for any recurrence or metastases.
Presentation: 6/1/2024
6983 Pembrolizimab Induced Hypophysitis: Uncommon Side Effect Leading To Late Diagnosis
Authors: Chaudhary Taibah , Syed Omar , Shridar Archana , Kaur Ravleen , Chaudhary Omaima , Zubair Muhammad Saad 
Published: October 2024

Abstract
Disclosure: T. Chaudhary: None. O. Syed: None. A. Shridar: None. R. Kaur: None. O. Chaudhary: None. M.S. Zubair: None.
Background: Pembrolizumab, an immune checkpoint inhibitor, has shown efficacy inducing remission in various malignancies. Associated immune-related adverse effects (irAEs) have been recorded but cases of concomitant hypophysitis and thyroiditis are rare. Clinical case: The patient is a 41-year-old male with a past medical history significant for metastatic melanoma of the left calf, status post sentinel lymph node biopsy and left inguinal lymph node dissection, treated with pembrolizumab for one year. He initially presented with a severe headache that was preceded by two months of fatigue and impaired concentration. CT and MRI head were both unremarkable while lab work was significant for cortisol 0.2 ug/dL and adrenocorticotropic hormone (ACTH) 1.1 pmol/L. A full hormone panel was ordered which showed normal insulin-like growth factor-1 (IGF-1), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Free testosterone was at the lower end of normal. Prolactin was elevated at 27.3 ng/mL. The thyroid function tests showed primary hypothyroidism with elevated thyroid stimulating hormone (TSH) at 109 uIU/mL, low T4 at 1.5 ug/dL, and low free T4 at 0.4 ng/dL. There were no signs or symptoms of posterior pituitary dysfunction. The patient was diagnosed with hypophysitis and started on hydrocortisone 20 mg once daily along with levothyroxine 175 mcg once daily. DEXA scan showed normal bone mineral density. Subsequently, the patient presented to our care and reported symptom improvement after taking the prescribed medication however he continued to develop fatigue by the end of the day. Therefore, hydrocortisone prescription was switched to 15 mg in the morning and 10 mg at noon. A repeat thyroid function panel, sex hormone binding globulin, and LH were ordered, to be followed up at the patient's next visit. The patient was also advised to wear a medical alert bracelet at all times moving forward. Conclusion: Due to non-specific symptoms at onset, hypophysitis can be undiagnosed or misdiagnosed therefore it is important to have a high clinical suspicion with patients on PD-1 inhibitors presenting with such symptoms. It is also imperative to order a full set of hormones as this patient had concomitant primary hypothyroidism.
Presentation: 6/1/2024
8513 Toxic Metals Are Associated With Increased Diabetes And Obesity Through Gut Microbiota Changes In Five African-Origin Populations
Authors: Jorgensen Julianne , Choo-Kang Candice , Issa Lina , Gilbert Jack A , Ecklu-Mensah Gertrude , Luke Amy , Bedu-Addo Kweku , Forrester Terrence , Bovet Pascal , Lambert Estelle V , Rae Dale , Argos Maria , Dai Yang , Sargis Robert Michael , Dugas Lara R , Layden Brian T 
Published: October 2024

Abstract
Disclosure: J. Jorgensen: None. C. Choo-Kang: None. L. Issa: None. J.A. Gilbert: None. G. Ecklu-Mensah: None. A. Luke: None. K. Bedu-Addo: None. T. Forrester: None. P. Bovet: None. E.V. Lambert: None. D. Rae: None. M. Argos: None. Y. Dai: None. R.M. Sargis: None. L.R. Dugas: None. B.T. Layden: None.
Obesity is associated with an increased risk for cardiometabolic diseases, such as type 2 diabetes mellitus (T2D). Prior research has shown an association between toxic metals/metalloid (hereafter, “metals”) exposures, including arsenic (As), lead (Pb), mercury (Hg), and cadmium (Cd), and increased T2D risk. Importantly, metal exposure has been suggested to impact the gut microbiome. Gut microbiome composition and metabolism are key to the development and progression of obesity and diabetes, thus we propose a potential novel interaction via the gut microbiota between metals and T2D, although the exact pathway remains unclear. We studied a large African-origin cohort from Ghana, South Africa, Jamaica, Seychelles, and the US (n=188, 51% female, mean age=43.0±6.5 yr). Analyzing 16S rRNA Amplicon sequencing, anthropometrics, and creatinine-adjusted urinary metal levels, we observed metal levels were significantly associated with country of origin and in most countries were significantly associated with decreased microbial diversity. Metal levels were highest in Ghana and lowest in the US, and were significantly different between Ghana and the US for As and Pb (p-value &lt; 2.2e-16). Individually, Pb levels were significantly associated with fasting blood glucose and BMI, As levels were associated with T2D diagnosis, and Hg levels were associated with obesity diagnosis. Pb levels were significantly associated with a lower proportion of potential acetate- and butyrate-producing microbial strains. Similarly, As levels were associated with decreased proportion of potential butyrate-producing genera. Microbial strains in individuals with high Pb levels showed significant association with obesity and T2D risk and strains in individuals with significant high As levels were associated with only T2D risk. Hg and Cd were not significantly associated with microbes and clinical status. These taxa are significantly associated with increased heme metabolism. With this study, we aimed to begin to describe the effect of metals and the risks for obesity and diabetes through its action within the gut microbiome. We demonstrate that toxic metal exposures were associated with differences in the gut microbiome and predicted metabolism that may also be associated with increased obesity and T2D risk.
Presentation: 6/1/2024
6479 Acute Estradiol and Progesterone Therapy In Hospitalized Adults With Moderate COVID-19: A Randomized Control Trial
Authors: Lovre Dragana , Bateman Kristin M , Saltzman Leia Y , Fahd Qadir Mirza Muhammad , Mauvais-Jarvis Franck 
Published: October 2024

Abstract
Disclosure: D. Lovre: Research Investigator; Self; Novo Nordisk, Corcept Therapeutics. K.M. Bateman: None. L.Y. Saltzman,: None. M. Qadir: None. F. Mauvais-Jarvis: None.
Background and Objective: COVID-19 outcomes are less severe in women vs men. Experimental studies show that estradiol (E2) and progesterone (P4) produce anti-inflammatory immune responses and immune tolerance and enhance antibody production. The effect of E2 and P4 combination on COVID-19 severity is unknown. The aim of the study was to evaluate the efficacy of a short systemic E2/P4 combination in mitigating COVID-19 severity in hospitalized men and women. Methods: Phase 2, double blind, placebo-equivalent controlled, single center trial of ten participants (men and women) who were hospitalized for COVID-19, with scores 3 to 5 on the 9-point World Health Organization (WHO) ordinal scale for clinical improvement. Participants were randomized into two arms and treated for five days: 1) E2 Cypionate (5 mg IM once) and micronized P4 (200mg, PO daily); and 2) Placebo-equivalent (normal saline (1ml, IM once) and folate (400mcgs, PO daily), in addition to standard of care (SOC). The primary outcome was the proportion of patients improving to scores 1 or 2 on the WHO scale on the day of discharge. Secondary outcomes included length of hospital stay (LOS), days on oxygen therapy (DOT), readmission rates (RR), adverse events (AEs) and change in inflammatory biomarkers assessed by untargeted proteomics. Findings: There were no significant differences between the treatment groups in COVID-19 severity by WHO score, LOS, DOT, RR or AEs. Patients in the E2/P4 arm exhibited a decrease in inflammatory biomarkers of respiratory and gastrointestinal disease (GI) and significant change in immune and inflammatory responses. Conclusions: Use of short-term systemic E2/P4 is associated with decrease in biomarkers of respiratory and GI disease inflammation and change in biomarkers of immune and inflammatory response.
Presentation: 6/3/2024
6790 High IGF-1: What Else Could It Be?
Authors: Pinson-Hilkemeyer Amber , Ghalib Luma 
Published: October 2024

Abstract
Disclosure: A. Pinson-Hilkemeyer: None. L. Ghalib: None.
A 28-year-old transgender male was referred to the pituitary clinic to evaluate an incidentally found small pituitary cyst. The initial MRI was ordered as part of a workup of recurrent headaches and possible Multiple Sclerosis (MS). He has been on a stable dose of testosterone cypionate 120mg every two weeks since 2020. The pituitary endocrine workup showed an elevated insulin like growth factor-1 (IGF-1) at 385.1 ng/ml (Reference range 96 – 262 ng/ml), however further hormonal workup was unremarkable with the most recent testosterone level of 309 ng/mL. He did not have any acromegalic features on examination. He underwent growth hormone suppression testing with an oral glucose tolerance test and GH suppressed to 0.12 ng/mL in 120 min, which was not consistent with the diagnosis of acromegaly. He has continued to have an elevated IGF-1 on repeat testing for 18 months.There are not many cases reporting elevated IGF-1 in the setting of hormonal therapy in the trans community. But it has been reported that administration of testosterone to hypogonadal and non-hypogonadal men can lead to increased levels of IGF-1. It has also been reported that cross-sex hormone treatment (HT) in the transgender population with either testosterone for a transgender male or estradiol for a transgender female has been related to increased levels of IGF-1 after starting treatment. It is well documented in patients with acromegaly, there are increased risk of cardiovascular and musculoskeletal disease, systemic inflammation, and insulin resistance. However, it is not well studied in the transgender population. More research is needed to determine the incidence and clinical significance of the isolated elevation in IGF-1 in this population. Also, if there is any benefit to screening transgender individuals who are on HT for elevated IGF-1 and if they are considered to be at increased risk for developing other potential side effects?
Presentation: 6/3/2024