bluuebunny/crossref_metadata_2025_split huggingface dataset:
8637 Pituicytoma mimicking Craniopharyngioma
Authors: Araoye Olubusayo , Delibasi Tuncay , Chaugule Akshata Satish , Dhillon Shabnam Kaur , Fuller Christine 
Published: October 2024

Abstract
Disclosure: O. Araoye: None. T. Delibasi: None. A. Chaugule: None. S.K. Dhillon: None. C. Fuller: None.
Pituicytoma, a rare low-grade glial tumor originating from the neurohypophysis or infundibulum of the pituitary gland, poses diagnostic challenges due to its propensity to mimic other sellar or suprasellar lesions. We present a case of a 51-year-old male with a history of a suprasellar mass initially suggested to be a craniopharyngioma, incidentally discovered. Opting for elective surgery, the patient underwent transsphenoidal resection, revealing a highly vascular tumor adherent to the optic chiasm and pituitary stalk. While the tumor was successfully removed, sacrifice of the pituitary stalk led to postoperative complications, including cerebrospinal fluid (CSF) leak and central diabetes insipidus (DI).Histopathological examination characterized the tumor as oncocytic pituicytoma/spindle cell oncocytoma, a subtype of pituicytoma. The anti-mitochondrial antibody staining at an external laboratory displayed diffuse granular cytoplasmic staining supporting oncocystic pituicytoma/spindle cell oncocytoma.Postoperatively, the patient developed central DI treated initially with desmopressin (DDAVP), complicated by subsequent hyponatremia necessitating salt tablets and fluid restriction. Additionally, central adrenal insufficiency was managed with hydrocortisone, and central hypothyroidism with levothyroxine. A history of testosterone deficiency was addressed through testosterone injections every 10 weeks.Pituicytoma's diagnostic complexity arises from nonspecific radiological features, requiring reliance on histology and immunohistochemistry for definitive diagnosis. The expression of TTF1 emerges as a characteristic marker. Surgical resection, the primary treatment modality, proves curative in most cases, albeit with associated morbidity including CSF leak, DI, and panhypopituitarism. The role of adjuvant radiotherapy remains uncertain, potentially considered in cases of incomplete resection or recurrence.This case emphasizes three key aspects: first, the potential misdiagnosis of a lobulated suprasellar mass as craniopharyngioma when it could be pituicytoma; second, the development of postoperative DI due to pituitary stalk involvement; and third, the importance of considering pituicytoma in the differential diagnosis of sellar and suprasellar masses.In conclusion, pituicytoma, though rare, demands a nuanced diagnostic approach and comprehensive postoperative management to address potential complications and optimize patient outcomes.
Presentation: 6/2/2024
7102 Pituitary Apoplexy with Eventual Complete Tumour Involution
Authors: Ng Aaron , Lai Ray 
Published: October 2024

Abstract
Disclosure: A. Ng: None. R. Lai: None.
Pituitary apoplexy is an endocrinological emergency resulting from infarction or haemorrhage of the pituitary gland. We present a case of pituitary apoplexy from a non-functioning pituitary macroadenoma, complicated by pituitary insufficiency and subsequent tumour involution. An 80-year-old gentleman presented to the Emergency Department with sudden severe headaches and persistent vomiting and admitted for further evaluation. Computed tomography (CT) imaging of the brain showed a prominent pituitary gland and magnetic resonance imaging (MRI) confirmed a large sellar hyperintense lesion containing blood and proteinaceous material. It measured 1.6 cm by 1.2 cm by 1 cm and indented the optic chiasm. CT angiography did not reveal any aneurysms or intracranial haemorrhage. There were no neurological or visual field deficits at presentation. There was no indication for surgery upon neurosurgical consultation. Initial evaluation of the pituitary axis was consistent with central hypocortisolism (cortisol 75 nmol/L, adrenocorticotropic hormone 1.4 pmol/L [reference range (RR) 1.6-13.9]) and hypoprolactinaemia (prolactin 56 mIU/L, RR 73-351). Luteinising hormone levels were &lt; 1 IU/L (RR 1-9); follicle stimulating hormone levels were 3 IU/L (RR 1-19) and testosterone levels were &lt; 1 nmol/L (RR 5 to 30) as the patient was on androgen deprivation therapy for prostate cancer. Hydrocortisone was started and he was monitored for development of frank diabetes insipidus. He did not require regular desmopressin. He later developed anti-diuretic hormone mediated hyponatraemia (serum sodium nadir of 125 mmol/L, serum osmolality 275 mmol/kg, urine osmolality 390 mmol/kg) that was managed with fluid restriction and solute loading. He also developed central hypothyroidism on day 19 of admission (free thyroxine 11 pmol/L, thyroid stimulating hormone 0.49 mIU/L, RR 0.45-4.5) and oral levothyroxine was started. He was discharged with oral hydrocortisone and levothyroxine replacement. A repeat MRI of the pituitary 2 months later showed complete resolution of the mass and resolution of the mass effects. He was kept on oral hydrocortisone and levothyroxine replacement with regular follow-up.Most pituitary macroadenomas are non-functional, and can present with complications of apoplexy, mass effects or hormonal disturbances. However, the natural history of non-functional macroadenomas is not well known as most are operated on. Spontaneous regression of the tumour can rarely occur, notably in the setting of apoplexy and lymphocytic hypophysitis. Recovery of the pituitary axis may also accompany tumour regression. As spontaneous remission of pituitary macroadenomas may occur, close observation of tumours without visual field defects or significant mass effects may be an alternative to surgery.
Presentation: 6/1/2024 12:15:00 PM
6374 Prevalence and risk factor of complications in patients with adult growth hormone deficiency: A retrospective database study
Authors: Fukuoka Hidenori , Fujio Shingo , Endo Takaaki , Tsuboi Satoshi 
Published: October 2024

Abstract
Disclosure: H. Fukuoka: None. S. Fujio: None. T. Endo: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. S. Tsuboi: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk.
Though adult growth hormone deficiency (AGHD) is known to lead to increased prevalence of complications, large database studies on AGHD have not been conducted. We investigated the clinical characteristics and prevalence of AGHD-related complications in Japanese patients. We identified 8,809 GH-untreated patients with AGHD from Medical Data Vision claims database between April 2008 and September 2022. In 2020, 3,420 AGHD patients were identified, and their prevalence of complications adjusted for sex and age was higher than that of Japanese general population, 9.3% vs 3.6% for diabetes mellitus (DM), 4.8% vs 1.3% for osteoporosis, and especially 22.0% vs 3.9% for dyslipidemia. We explored the risk factors for the onset of complications using Cox proportional hazard model. Age was significant risk factor for most complications and being female was significant risk factor for osteoporosis. DM was a significant risk factor for dyslipidemia, ischemic heart disease, cerebrovascular disease, and all cause death. AGHD increases the overall risk of metabolic complications, risk factors of these complications were similar to those in general population. Comprehensive treatment approach needs to be considered to alleviate the risk of complications.
Presentation: 6/3/2024
6705 Sheehan syndrome: a case report
Authors: Rodrigues Fernanda S , Silva Camila C , Da Silva Wilson , Caldas Talita M , Rocha Luis Klaus 
Published: October 2024

Abstract
Disclosure: F.S. Rodrigues: None. C.C. Silva: None. W. Da Silva: None. T.M. Caldas: None. L. Rocha: None.
Introduction: Sheehan's Syndrome, or postpartum hypopituitarism, is characterized by hyperplasia and an increase in the number of prolactin-secreting cells, secondary to a major hemorrhagic event occurring during or after childbirth. In this situation, the anterior pituitary gland can increase in size and suffer ischemia due to vascular hypoflow. Consequently, there is low production of one or more of the hormones produced by the gland, which can generate heterogeneous clinical presentations. As a preventive treatment, polytransfusion is recommended in cases of large hemorrhage. OBJECTIVE: To present a case of Sheehan’s Syndrome, which developed after a birth complicated by a major hemorrhagic event, even after receiving polytransfusion. CASE REPORT: A woman, 45 years old, being monitored at the endocrinology outpatient clinic for 2 years. As a history, there was a severe hemorrhage during her cesarean section, which occurred 30 years ago, in which she received a blood transfusion of a total of 1.2 liters of packed red blood cells. 7 years ago, she was diagnosed with hypothyroidism and 2 years ago with hyperprolactinemia. In 2022, she was also diagnosed with adrenal insufficiency. At that time, she underwent a magnetic resonance imaging (MRI) scan of the sellaturcica region, which was found to be partially empty. The patient's recent exams showed TSH: 3.15 μUI/mL (0.4-4.0); Free T4: 0.88 ng/dL (0.93-1.7); Cortisol 8h: 8 μg/dL (5-25); LH: 15 mIU/mL (1.1-14.7); FSH: 43 mIU/mL (2.8-9); Estradiol: 8 ng/dL (12.4-398); Prolactin: 28 ng/mL (1.9-25), basal GH 0’ 0.054/30’ 2.51/60’ 2.48/90’ 3.74 ng/mL (up to 10), ACTH 17 pg/mL (up to 46). Since then, she has been undergoing endocrinological monitoring for hormone replacement therapy to treat the hormonal changes caused by late-diagnosed Sheehan Syndrome. DISCUSSION: Sheehan's Syndrome is a rare disease, characterized by low blood flow and necrosis of the pituitary gland due to postpartum hemorrhage. The diagnosis results from obtaining a good clinical history associated with hormonal levels. This patient presented significant bleeding after cesarean section requiring transfusions. However, despite transfusions, the patient developed hypothyroidism, hyperprolactinemia, and adrenal insufficiency. The MRI confirmed the suspected diagnosis, showing the partially empty sellaturcica. Conclusion: The diagnosis of Sheehan Syndrome is based on very broad clinical manifestations, with MRI of the sellaturcica contributing to confirming the diagnosis. Although the preventive treatment is blood transfusion, the patient developed the disease, highlighting the need for continued monitoring of pregnant women with a history of significant bleeding during childbirth. Therefore, outpatient monitoring of the patient is necessary with a focus on hormonal levels so that clinical complications are avoided.
Presentation: 6/2/2024
6520 Stimulated Copeptin Measurement in the Evaluation of a Patient Presenting Hypernatremia and Adipsia
Authors: Assunção Beatriz R , Freire Magda M , De Castro Margaret , Moreira Ayrton Custodio , Elias Paula C L 
Published: October 2024

Abstract
Disclosure: B.R. Assunção: None. M.M. Freire: None. M. De Castro: None. A.C. Moreira: None. P.C. Elias: None.
Introduction: Hypernatremia (hyperNA) in patients submitted to neurosurgery involving the hypothalamic region prompts the diagnosis of vasopressin deficiency (AVP-D), typically accompanied by increased thirst, polydipsia and polyuria. Classic adipsic AVP-D is characterized by hypotonic polyuria and no thirst in response to hyperNA. Clinical Case: A 21 yo male patient, followed since he had a surgery for a pilocytic astrocytoma of the third ventricle at 12 yo, presented hyperNA (154 mEq/L) with mild dehydration. He denied increased thirst, polyuria or polydipsia. Further evaluation showed elevated plasma and urinary osmolalities (pOsm: 317 mOsm/Kg; uOsm: 878 mOsm/Kg). The patient was admitted for hydration and fluid balance. Oral water intake (2500-3000L/day) was prescribed. Serum sodium (Na+) decreased from 158 to 133 mEq/L within 72h, and no polyuria was detected at hyper or normonatremic states. A 3% saline infusion test (SIT) was performed with thirst visual scale and plasma copeptin (CP) assessment. Na+ rose from 139 to 150 mEq/L and pOsm from 295 to 321 mOsm/kg, with no rise in thirst scale (4,2 to 4,8 cm). Basal and maximal 3% SIT CP levels were 3.1 and 3.2 pmol/L, respectively, also displaying subnormal values. CP assessed under hypovolemic hyperNA (Na+: 158 mEq/L) was 4.1 pmol/L, suggesting that this patient might have an adispic disorder with subnormal thirst and AVP osmotic responses, explaining the lack of polyuria. Patient was treated with fixed daily fluid intake with a last follow-up Na+ of 141 mEq/L.Discussion: Adipsic AVP-D is characterized by hypotonic polyuria and no thirst in response to hyperNA. However, polyuria, a hallmark of clinical presentation, was not observed in the present case. Other adipsic disorders include upward resetting of the osmotic thresholds for both thirst and AVP release (Type A); sub-normal thirst and AVP responses to osmotic stimuli (Type B); and intact osmoregulation of AVP release with absent thirst response (Type D). The lack of polyuria even in normovolemic conditions and the subnormal thirst and CP responses to normovolemic hyperNA and dehydrate states suggest the present case to be a Type B adipsic disorder. In those patients, the secretion of small amounts of AVP in response to osmotic stimulation explains why they retain the ability to concentrate urine, limiting free water excretion. Treatment is based on a fixed fluid intake of around 2 liters per day. Conclusions: Adipsic AVP-D and other adipsic disorders are extremely rare, presenting a great challenge in the diagnosis and management. To our knowledge, this is the first description of CP assessment in a patient with hyperNA and adipsia. CP might be an important diagnostic approach to adipsic disorders.
Presentation: 6/2/2024
7483 The Pharmacokinetic Profile of Lanreotide Autogel® Improved Long-Term Arrhythmia Fluctuations in Acromegalic Cardiomyopathy
Authors: Iwabuchi Masayasu 
Published: October 2024

Abstract
Disclosure: M. Iwabuchi: None.
Background: The prognosis of acromegaly is related to the status of cardiac complications. Ventricular premature contractions (VPC) are frequently observed in acromegaly, and it is very important to suppress fatal arrhythmias to improve long-term prognosis. Somatostatin analogs are widely used as pharmacotherapy for acromegaly, and they have been reported to improve cardiac prognosis. In comparison to LAR, lanreotide Autogel® has a unique property of self-aggregation under favorable conditions, leading to a stable structure of highly organized nanotubules and has a long half-life after subcutaneous injection determined by pseudo-first order kinetics. CASE: 55-year-old man visited a cardiologist for the treatment of PVCs and heart failure. Because of his acromegalic features, endocrinological and image examinations were performed, and diagnosis of acromegaly was confirmed. His GH was 7.17 ng/mL, IGF-1 566 ng/mL (Normal range: 59-215). Concerning excess of GH may cause nonischemic cardiomyopathy, administration of 20 mg of LAR once a month was started. GH and IGF-1 improved to1.52 ng/mL and 217 ng/mL respectively. The dose of LAR was increased to 30mg because of a remaining fluctuation of VPCs. Considering a possibility of the problem of bioavailability due to method of injection and the pharmacokinetics of LAR, administration of lanreotide Autogel® was started instead of LAR, with the result that an improvement of the fluctuation of the symptom was observed without remarkable change in GH and IGF-1. Arrhythmia status was assessed over time using Holter electrocardiography. Pretreatment Holter electrocardiogram showed 18% of total heart rates in PVCs. After LAR injection, the frequency of PVCs decreased to 3%, and 6 years after changing LAR to lanreotide, the frequency of PVCs decreased to 2%. Clinical Lessons: Simulated steady state pharmacokinetic profiles of LAR and lanreotide Autogel® differ significantly. During LAR treatment, serum concentrations of the drug are approximately stable, whereas the characteristic first-order kinetics of lanreotide Autogel® is superimposed on levels just before the next administration. The pharmacokinetic differences indicate that LAR can be better tailored to therapeutic levels, whereas serum levels of lanreotide must be high for part of the interval between injections to be effective in the period before the next administration. Lanreotide Autogel® has similar clinical effects compared to LAR for the treatment of cardiomyopathy of acromegaly and has the advantage of being available in a convenient pre-filled syringe and no necessity of injection by healthcare professionals. It is suggested that the pharmacokinetic profile of Lanreotide Autogel® resulted in decreased arrhythmia fluctuation in acromegalic hearts, which has been maintained for the past 6 years.
Presentation: 6/3/2024
5132 Unraveling the Enigma: A COVID-19 Triggered Revelation of Adult Idiopathic ACTH Deficiency
Authors: Arao Kevin A , Gadbois Alexander E 
Published: October 2024

Abstract
Disclosure: K.A. Arao: None. A.E. Gadbois: None.
Introduction: Adult idiopathic ACTH deficiency (AIAD) is a rare and potentially life-threatening condition that is frequently misdiagnosed or even missed. We present a case of AIAD in a patient who exhibited altered mental status alongside a COVID-19 infection and was fortunately diagnosed after responding to empiric treatment with oral steroids for another condition. Case Presentation: A 76-year-old man was admitted to the hospital for bilateral leg weakness. His hospital stay was complicated by the development of febrile episodes and delirium. He tested positive for COVID-19, and the rest of infectious work-up yielded negative results. He then received a course of remdesivir. In the evaluation of his delirium, a CT scan of the brain, MRI of the brain, and lumbar puncture with CSF analysis were done, all of which were unremarkable. Initially, the delirium was attributed solely to COVID-19 infection. After consultation with neurology and rheumatology, the patient received empiric treatment with prednisone 5 mg twice daily for possible polymyalgia rheumatica as a cause of his bilateral leg weakness. His mental status significantly improved following steroid administration. With the improvement in symptoms, an AM cortisol test was added on his morning blood tests, revealing a cortisol level of 2.56 mcg/dL with an albumin level of 2.3 g/dL, raising concerns for adrenal insufficiency. An outpatient endocrinology evaluation recommended transitioning from prednisone to physiologic twice-daily dosing of hydrocortisone. An ACTH stimulation test was performed, which peaked at an AM cortisol of 6.1 mcg/dL, with a baseline ACTH level of 4.1 pg/mL. A review of the recent brain MRI showed no pituitary pathology. Other pituitary hormones were normal, and he was eventually diagnosed with AIAD. He was subsequently maintained on physiologic dosing of hydrocortisone, resulting in clinical stability. Discussion: AIAD is characterized by secondary adrenal insufficiency, normal production of other pituitary hormones, and the absence of structural pituitary pathology. The etiology of AIAD remains unknown, with most cases attributed to an autoimmune process. AIAD can have diverse clinical manifestations and may only become more apparent with triggers like infections or illnesses. As in our case, the COVID-19 infection likely unmasked the underlying AIAD, presenting with altered mental status. Identifying AIAD can be challenging, leading to high rates of misdiagnosis and clinical omission. Physicians should consider AIAD when dealing with unexplained altered mental status, as the administration of a simple treatment with steroids can be life-changing.
Presentation: 6/3/2024
5147 Use of hypertonic saline in severe symptomatic hyponatraemia; results from a national survey from United Kingdom
Authors: Arshad M , Iqbal A 
Published: October 2024

Abstract
Disclosure: M. Arshad: None. A. Iqbal: None.
Background: Acute severe symptomatic hyponatraemia is potentially life-threatening. Irrespective of the underlying aetiology, hypertonic saline (HTS) is effective at rapidly correcting serum sodium. Several clinical treatment guidelines have aimed to standardise the administration of HTS. The European Society of Endocrinology (ESE) guidelines (2014) recommend two boluses of 150 mL 3% HTS with an aim to raise serum sodium concentration by 5 mmol/L([1]). It is important to note that the evidence supporting this approach is limited, and concerns have been raised regarding the potential for overcorrection using this protocol(2). Aim: To assess the practices and perceptions surrounding hypertonic saline (HTS) use in severe symptomatic hyponatraemia among United Kingdom (UK) endocrinologists and specialty trainees (fellows). Methods: An anonymous online survey was disseminated to all clinical members of the Society for Endocrinology (UK) between 24/10/2023 and 30/11/2023 using Survey Monkey ®, a web-based multiple-choice questionnaire. Results: Of 133 respondents (60.1% consultants, 33.1% specialty trainees, 6.8% other), 85% employed bolus treatment with HTS only, with 9.8% using both bolus and continuous infusions. Most (50.4%) preferred 150 mL boluses, followed by 100 mL boluses (18.8%). Commonly used HTS strengths were 2.7% (45.1%), followed by 1.8% (31.6%), while the 3% HTS strength recommended by ESE guidance was used by 21.8%. Only 7 (5.3%) respondents used weight-based HTS dosage. Contrary to guidelines, 74.4% did not administer a second bolus without waiting for sodium result from the first bolus. Also, 86% have experience using venous blood gas sodium readings for monitoring, even though this has not been mentioned or recommended in the guidelines. HTS was always administered in high-dependency settings by 16.5% and mostly administered in this setting by 49.6%. Overcorrection targets defined by 10 and 8 mmol/24 hours cut-offs were used by 48.9% and 39.9%, respectively. For definite or expected overcorrection, 75.9% preferred 5% dextrose, while 40.6% had experience with desmopressin (DDAVP). Conclusion: Significant variation exists in HTS use for severe symptomatic hyponatraemia in the UK, deviating from guidelines, especially regarding a second bolus without assessing the first bolus's biochemical impact. European guidelines warrant an evidence-based revision to harmonize clinical practice. References: (1) Spasovski et al. Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014 Feb 25;170(3):G1-47. doi: 10.1530/EJE-13-1020(2) Arshad et al. Letter to Editor: Call for review of European Society of Endocrinology guidelines for symptomatic hyponatraemia. Endocrine. 2023 Apr;80(1): 234-235. doi: 10.1007/s12020-023-03322-w
Presentation: 6/1/2024