bluuebunny/crossref_metadata_2025_split huggingface dataset:
8185 The diagnosis of primary aldosteronism: testing 2 screening approachesin a large reference laboratory population
Authors: Marcelli Marco , Bi Caixia , Funder John W , McPhaul Michael J 
Published: October 2024

Abstract
Disclosure: M. Marcelli: Employee; Self; Quest Diagnostics. Stock Owner; Self; Quest Diagnostics. C. Bi: Employee; Self; Quest Diagnostics. J.W. Funder: None. M.J. McPhaul: Employee; Self; Quest Diagnostics.
In many practices, the screening for primary aldosteronism (PA) relies on a single blood draw for plasma aldosterone concentration (PAC) and plasma renin activity (PRA) to establish an aldosterone-to-renin ratio (ARR). ARR cut-off levels vary between expert centers and between repeated assays in the same individual, emphasizing the potential variability of this screening approach. We conducted a study in 2 cohorts and used 2 screening approaches to identify probable PA (ARR ≥30 vs PRA suppressed to &lt;1 ng/mL/h). Methods: Cohort A consisted of 94,829 consecutive paired PRA and PAC samples submitted by clinicians to evaluate the presence of PA. Cohort B is a subgroup of cohort A consisting of 27,893 patients in whom serum K was measured on the same day as PRA and PAC. Results: Based on ARR, 13.9% of cohort A (95%CI 13.6-14.1) and 13.9% of cohort B (95%CI 13.4-14.3) tested positive; based on PRA, 45.9% of cohort A (95%CI 45.5-46.2) and 45.2% of cohort B (95%CI 44.6-45.8) tested positive. A range of aldosterone levels was observed in cohort A vs B samples that screened positive using ARR vs PRA. PAC &gt;15 ng/dL was present in a similar proportion of patients in both cohorts, regardless of the screening test used; however, PAC 5 to 15 and &lt;5 ng/dL were present in higher proportions of patients positive for PRA than ARR in both cohorts A (25.2% vs 8.4% and 15.1% vs 0.7%) and B (26% vs 8.6% and 13.3% vs 0.5%), respectively. Hypokalemia was tested in cohort B and was more frequent than in an equal number of random controls not tested for the ARR test code (5.4% vs 1.8%) and when examining specific age groups (eg, age 50-70) in both women (4.9% vs 1.3%) and men (7.5% vs 1.5%). Conclusions•In both cohorts screened for PA, more individuals were identified by focusing on PRA &lt; 1 than on ARR ≥ 30. This finding prompts a reassessment of the screening procedures for PA. •The proportion of positives for PA identified by the 2 screening tools was similar in cohort A vs B, suggesting that serum K should not be a routine test in the workup for PA.•Compared with the ARR test, Tthe PRA screening test identified more patients than the ARR test with PAC with 5 to 15 and &lt;5 ng/dL in both cohorts A and B, while thethe tests identified a similar proportion of patients with PAC &gt;15 ng/dL in both cohorts. This indicates that an ARR test of ≥30 is as effective as the PRA &lt;1 for identifying florid cases of PA, but unlike PRA, is unable to identify less florid (and more common) cases of PA. •Hypokalemia was more frequent in cohort B than random controls, even after controlling for age (50-70) and sex, indicating that this cohort is enriched with a classic biochemical marker of PA.
Presentation: 6/1/2024
7312 Tumor Size and Mutation Prevalence in Black Americans with Primary Aldosteronism
Authors: van Rooyen Desmaré , Nanba Kazutaka , Sapiro Dina R , Blinder Amy , Wachtel Heather , Cohen Debbie , Luther James M , Vaidya Anand , Giordano Thomas J , Turcu Adina , Udager Aaron , Rainey William E , Rege Juilee 
Published: October 2024

Abstract
Disclosure: D. van Rooyen: None. K. Nanba: Other; Self; AstraZeneca. D.R. Sapiro: None. A. Blinder: None. H. Wachtel: None. D. Cohen: None. J.M. Luther: Advisory Board Member; Self; consulted with Mineralys. A. Vaidya: None. T.J. Giordano: None. A. Turcu: None. A. Udager: None. W.E. Rainey: None. J. Rege: None.
Background: Primary aldosteronism (PA) is the most common cause of endocrine hypertension. The prevalence of aldosterone-driver somatic mutations varies with sex and race. KCNJ5 mutations are commonly found in White Americans and female patients with PA. In contrast, CACNA1D mutations are dominant in Black American PA patients, but existing data are limited to small cohorts. Objective: To determine the impact of tumor size on aldosterone-driver mutation prevalence in Black Americans with PA. Methods: 113 formalin-fixed, paraffin-embedded adrenal tumors from Black American patients with PA were included. Histological classification was made based on aldosterone synthase (CYP11B2) immunohistochemistry and tumor diameter: aldosterone-producing adenomas (APA), ≥10 mm and aldosterone-producing nodules (APN), ≥3 - &lt;10 mm. Somatic mutations in CYP11B2-positive regions were analyzed using Sanger- and next generation sequencing. Results: Most aldosterone-driver somatic mutations in Black American tumors were seen in CACNA1D (48/113, 42%) followed by KCNJ5 (34%), ATP1A1 (11%), ATP2B3 (4%), and CADM1 (1%). 9% of tumors did not exhibit known mutations (mutation-negative; Mneg). Importantly, there was a correlation between mutation prevalence and tumor size. Adrenals from this Black American PA cohort exhibited APN in 59% (67/113) of patients, most of which harbored somatic mutations in CACNA1D (44/67, 66%), followed by ATP1A1 (12%), Mneg (10%), and KCNJ5 (7%). In contrast, most APAs (n=46) displayed mutations in KCNJ5 (33/46, 72%), and a lower detection rate for mutations in CACNA1D, ATP1A1, ATP2B3, and for Mneg samples (28%, collectively). Irrespective of size, KCNJ5 mutations were observed more frequently in tumors from females (50%; n=62) vs males (14%; n=51). However, CACNA1D was the dominant altered gene in APN, regardless of sex. Conclusion: Aldosterone-producing tumor size exhibited a higher correlation with mutation prevalence than sex. Smaller APN are the dominant histologic feature in Black Americans with PA, and most of these lesions harbor somatic CACNA1D mutations. In contrast, somatic KCNJ5 mutations are more common in APA, and particularly in women. Future studies are needed to determine if the combination of adrenal imaging and genotype-specific steroid profiles could assist with PA subtyping.
Presentation: 6/3/2024
12563 Very Severe Hypertriglyceridemia-Induced Pancreatitis
Authors: Abrams Jennifer , Fan Lena 
Published: October 2024

Abstract
Disclosure: J. Abrams: None. L. Fan: None.
Background: Very severe hypertriglyceridemia (HTG) (triglyceride (TG) &gt; 2000 mg/dl) occurs in 1.8 per 10,000 adults and portends a &gt;50% risk of pancreatitis. We present a rare case of HTG (TG &gt; 10,000) induced pancreatitis. Clinical Case: A 33-year-old man presented with acute onset abdominal pain, nausea, and vomiting for 12 hours. Clinical presentation was similar to a prior admission for acute pancreatitis 4 months ago, where TG level was 705 mg/dL. At that time, he was made NPO, treated with lactated ringers at 150 cc/hour, and discharged on gemfibrozil 600 mg twice daily. The patient was lost to follow up after discharge. On this admission, patient reported non-adherence to gemfibrozil, only resuming medication after abdominal pain began 12 hours prior to admission. Initial tests showed Lipase 198 U/L (reference range: 8-78 U/L), WBC 8.2K/uL (reference range: 4.5-11 K/uL), Cr 0.69 mg/dL (reference range: 0.7-1.3 mg/dL), Total cholesterol 477 mg/dL (reference range &lt;200 mg/dL), HDL 19 mg/dL (reference range: &gt;40 mg/dL), LDL “unable to calculate”(reference range &lt;130 mg/dL), A1c 6.3% (reference range: 4.0-5.6%), TG 11,772 mg/dL (reference range: &lt;150 mg/dL desirable, 150-199 mg/dL borderline, 200-499 mg/dL high risk, &gt;500 mg/dL very high risk), repeat TG 8,151 mg/dL. CT abdomen scan confirmed peripancreatic edema and fat stranding, consistent with acute pancreatitis. Pertinent exam revealed temperature 98.2⁰F, pulse 61 beats/min, respirations 16 breaths/min, blood pressure 166/110 mmHg, oxygen saturation 97%, BMI 29.69 kg/m2; skin negative for xanthomas; abdomen tender to palpation in epigastrium, no guarding or rebound, bowel sounds present. He was made NPO, treated with normal saline, and admitted to intensive care, and started on an insulin drip with a rate of 0.1 unit/kg/hour with D5 1/2NS initially at 100 cc/hr titrated to maintain glucose 150-200. The subsequent TG level drawn 37 hours after admission was 531 mg/dL, 427 mg/dL at 43 hours, 428 mg/dL at 51 hours, 532 mg/dL at 72 hours, and 419 mg/dL at 96 hours. The insulin drip was stopped after 16 hours and low fat (&lt;20%) diet was started. Compliance with low fat diet and fibrate therapy (atorvastatin 40mg daily, fenofibrate 245mg daily) was emphasized to the patient at discharge. Conclusion: This patient is one of the few reported cases of severe (TG&gt;10,000) hypertriglyceridemia induced pancreatitis.
Presentation: 6/3/2024
8784 Cold Fingers, False Numbers: A Case Report on Fingerstick Artefactual Hypoglycemia
Authors: Acharya Madhav P , Sharma Sapna , Bajgain Anjana , Leu James Ping-Hsun 
Published: October 2024

Abstract
Disclosure: M.P. Acharya: None. S. Sharma: None. A. Bajgain: None.
Artifactual hypoglycemia, characterized by discrepancies between capillary and plasma glucose levels, can lead to unnecessary testing and interventions. Fingerstick testing, a common method for blood glucose monitoring, may yield misleading results. We report a case highlighting the clinical implications of fingerstick artefactual hypoglycemia. A 93-year-old female, with multiple comorbidities, including severe malnutrition and cool digital extremities, was admitted after a motor vehicle accident. Subsequent diagnosis revealed sepsis due to acute cystitis. Throughout her hospitalization, the patient consistently displayed low blood sugar readings exclusively in fingerstick tests. Despite a lack of prior history of diabetes or hypoglycemia, clinical examination uncovered cold and cyanosed fingertips. At bedside, point-of-care testing (POCT) for glucose from the patient's index finger yielded a concerning reading of 47 mg/dL. Surprisingly, multiple episodes of apparent hypoglycemia were measured via glucometer, with no accompanying symptoms. Simultaneous testing from the antecubital fossa yielded a contrasting reading of 84 mg/dL, aligning with plasma blood sugar. Remarkably, when POCT was performed on the heel and antecubital fossa sites, normoglycemia consistently prevailed. A 48-hour fasting test, with POCT on the patient's heel instead of fingers, revealed no hypoglycemia. Recognition of pseudo hypoglycemia in this patient was crucial, considering the septic state and cold extremities. The case underscores the importance of accurate glucose measurement sites, especially in conditions affecting micro perfusion. Healthcare providers should interpret low glucose levels measured by fingerstick with caution, considering potential limitations in patients with impaired micro perfusion. Simultaneous alternative-site testing and confirmation with venous measurements are essential for accurate diagnosis and appropriate clinical management.
Presentation: 6/3/2024
8362 3 cases with Hyperosmolar Hyperglycemic Syndrome and Atypical Diabetic Ketoacidosis
Authors: Nakamura C , Ishimaru M , Tanimoto E , Fukui S , Ujita N , Miyagi H , Igarashi M , Kashima T , Doi H , Yoshii K , Naiki Y , Horikawa R 
Published: October 2024

Abstract
Disclosure: C. Nakamura: None. M. Ishimaru: None. E. Tanimoto: None. S. Fukui: None. N. Ujita: None. H. Miyagi: None. M. Igarashi: None. T. Kashima: None. H. Doi: None. K. Yoshii: None. Y. Naiki: None. R. Horikawa: None.
Introduction: Diabetic ketoacidosis (DKA) and hyperosmotic hyperglycemia syndrome (HHS) are severe hyperglycemic emergencies as the spectrum of insulin deficiency and dehydration. HHS is known as a complication with type 2 diabetes mellitus(T2DM), likely to develop in elderly patients with hypertension and cardiac disease triggered by infections in Japan. In children and adolescents, as the incidence of T2DM rises, HHS is increasing. HHS and/or DKA cases in type 1 diabetes mellitus (T1DM) also have been reported, but it is not yet clear in which cases are more likely to develop. Clinical Cases Case 1&gt; An 18-year-old girl with central diabetes insipidus and T2DM after operation for suprasellar germ cell tumor. She tended to neglect medication of desmopressin. She presented to the emergency department with fatigue, and had 6.6% weight loss in 1 week. Lab: Blood glucose 669 mg/dl, pH 7.306, b-hydroxybutyrate 1.3 mmol/L, Na 153 mEq/L, plasma osmolality 359 mOsm/kgH2O. She was diagnosed as HHS and needed enough hydration. &gt; She was receiving artificial respiration and gastric tube feeding. She was brought to the emergency room with fever and hypoxemia, and she had lost 9.6% of weight in 2 weeks. Lab: Blood glucose 1322 mg/dl, pH 7.13, b-hydroxybutyrate 6.2 mmol/L, Na 160 mEq/L, plasma osmolality 446 mOsm/kgH2O. She was diagnosed as DKA and HHS combined with T1DM. She required enough hydration than usual treatment of DKA. Case 3&gt; A 17-year-old boy with Prader-Willi syndrome. He presented to the emergency department with persistent low-grade fever and had 9.4% weight loss in 1 week. Lab: Blood glucose 519 mg/dl, pH 7.24, b-hydroxybutyrate 6.0 mmol/L, Na 136 mEq/L, plasma osmolality 334 mOsm/kgH2O. In addition to initial DKA treatment, he required aggressive dehydration correction with consideration of HHS. Clinical Lesson Three cases had underlying diseases that made it difficult for them to hydrate appropriately. They were easily dehydrated, and were high risk of developing/complicating HHS. In emergency hyperglycemia cases in children and young adults with those underlying diseases, we have to consider the possibility of the pathophysiology of both DKA and HHS at an early stage of treatment. Some symptoms which are not typical for DKA, like hypernatremia or abnormally high serum osmolality, the possibility of HHS should be considered.
Presentation: 6/1/2024
6957 5-Year Follow-Up of Acute, micro, and Macrovascular Complications of Patients With Type 2 Diabetes Managed by a Multi-Disciplinary Team In A Hospital in Northeastern Mexico
Authors: Romero Ibarguengoitia Maria Elena , Morales Rodríguez Devany Paola , Garza-Silva Arnulfo , Rivera-Cavazos Andrea , Francisco Fernández-Chau Iván , Cepeda-Medina Andrea Belinda , González-Cantú Arnulfo 
Published: October 2024

Abstract
Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales Rodríguez: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. A. González-Cantú: None.
Type 2 Diabetes Mellitus (T2DM) is a condition associated with various acute and chronic complications, which constitute the leading cause of disability, morbidity and mortality globally. During the SARS-CoV-2 pandemic, vulnerable individuals such as those with T2DM faced a restriction in access to primary healthcare services. Therefore, we decided to compare the presence of micro and macrovascular complications before and during the SARS-CoV-2 pandemic, as well as the incidence of acute complications. A retrospective observational cohort study from 2018 to 2022 was conducted in a hospital in northeastern Mexico on patients with T2DM who were treated by a multidisciplinary team composed of an internist or geriatrician based on the patient's age, endocrinologist, nutritionist, and other diabetes-related specialties. Levels of HbA1C, fasting serum glucose (FSG), low-density lipoprotein cholesterol (LDLc), blood pressure (BP), and microalbuminuria were analyzed. Consequently, presence of micro and macrovascular complications and incidence of acute complications was described. A total of 999 subjects were analyzed, 516 (51.7%) males, with an average age (SD) of 60.1 (12.7) years. There was an increase in the proportion of patients with adequate glycemic control based on HbA1C of 15.2% between 2018 and 2022 (p&lt;0.001) and a 42.3% increase in FSG control during the same period (p&lt;0.001). LDLc showed a decrease in the control proportion of 5.1% between 2018 and 2022 (p&lt;0.001). Systolic BP control in 2018 was 82.7% and 80.1% in 2022 (p&lt;0.001). Diastolic BP control in 2018 was 89.6%, with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria control increased from 80.5% in 2018 to 89% in 2022 (p=0.002). There were 78 (7.8%) cases of microvascular complications, with diabetic neuropathy being the most prevalent (n=35, 3.6%), and a higher incidence in 2021 with 15 (1.6%) cases. A total of 15 (1.5%) patients presented a macrovascular complication, with ischemic heart disease being the most frequent with 11 (1.1%) subjects, and a higher incidence of cases in 2021 (n=4, 0.4%). Hypoglycemia was found to be the most frequent acute complication with 14 (1.4%) cases, with a higher incidence in 2020 (n=5, 0.5%). The low incidence of complications in our population, emphasizes the importance of coordinating patient’s care between a multidisciplinary team to maintain an overall disease control, optimize T2DM treatment and enhance patient’s quality of life.
Presentation: 6/1/2024
8197 A Captivating Case Report of Teprotumumab Induced Hyperglycemic Hyperosmolar State
Authors: Tuna K M , Perdomo Rodriguez J P 
Published: October 2024

Abstract
Disclosure: K.M. Tuna: None. J.P. Perdomo Rodriguez: None.
Introduction: Teprotumumab, a monoclonal antibody targeting the IGF-1 receptor, is increasingly utilized for moderate to severe thyroid eye disease. Initial trials noted mild hyperglycemia in patients with diabetes, while recent trials revealed a significant elevation in Hemoglobin A1c (HbA1c) among those with diabetes or pre-diabetes post-infusion. Here, we discuss a case of a patient with diet-controlled diabetes who developed hyperglycemic hyperosmolar state (HHS) two months after Teprotumumab infusion. Case Presentation: A 43-year-old male, with class III obesity, obstructive sleep apnea, dyslipidemia, coronary artery disease, and diet-controlled diabetes (HbA1c 6.5%) presented with worsening proptosis, decreased color vision, severe visual field depression. Laboratory evaluation revealed elevated TSH (6.3 mIU/ml), normal free T4 (0.67 ng/dl, ref: 0.60-1.2 ng/dl), and undetectable Thyroid Stimulating Immunoglobulin (&lt;0.1 IU/L). Blood cell count, renal and liver function tests were normal. Due to high clinical suspicion of thyroid eye disease, he was treated with timolol, dorzolamide, brimonidine, and methylprednisolone 1g daily for 3 days. Glycemic control was achieved with 30 units of daily insulin while on pulse steroids. On outpatient ophthalmology follow-up, Teprotumumab was initiated and he received 2 doses. Eight weeks later, the patient was hospitalized with altered mental status caused by HHS (glucose 617 mg/dl, serum osmolality 316 osm). HbA1c was found to be significantly increased to 12% and the patient required 150 units total daily insulin and metformin upon discharge. Of note, the patient did not have significant weight changes during this time. GAD, IA2, and Zinc Transporter-8 antibodies were obtained prior to discharge and results are pending. Discussion: The IGF-1 receptor, a partial homologue of the insulin receptor, plays a pivotal role in glucose homeostasis. Inhibiting this receptor can lead to hyperglycemia. Initial randomized controlled trials (RCTs) reported a 10% incidence of mild hyperglycemia. A recent RCT from a cohort of 42 patients demonstrated a 50% incidence of hyperglycemia, in which two-thirds of the patients remained in a dysglycemic state with one patient with pre-existing prediabetes developing diabetic ketoacidosis (DKA). Our patient mirrored this scenario with no identifiable confounding factors. Conclusion: Teprotumumab-induced hyperglycemia, though rare, can lead to life-threatening complications. Baseline glycemic assessment, identification of high-risk patients, and comprehensive discussions on risks and benefits are crucial before initiating therapy. Close monitoring, especially in those with prediabetes, is recommended. Patient education plays a pivotal role in early symptom recognition, averting delayed diagnoses, and subsequent hospitalization.
Presentation: 6/3/2024
8494 A Case of Diabetic Ketoacidosis in Setting of COVID-19 Infection and SGLT-2 Inhibitor Use
Authors: Abrahimi Nora , Bajpay Shreya , Abrahimi Aryan 
Published: October 2024

Abstract
Disclosure: N. Abrahimi: None. S. Bajpay: None. A. Abrahimi: None.
Background: COVID-19 infection can cause endocrine system disruptions leading to the development of diabetic ketoacidosis (DKA) in patients with type 1, 2 or new onset diabetes mellitus. (1) DKA is a side effect of SGLT-2 inhibitor use and its development on the medication can lead to discontinuation of SGLT-2 inhibitor. (2) SGLT-2 inhibitors are part of guideline directed medical therapy for management of heart failure with reduced ejection fraction (HFrEF). (3) Case: 67-year-old female history of non-insulin dependent diabetes mellitus type 2 on Empagliflozin presented with shortness of breath and hypoxia. Initial BMP: Glucose 141 mg/dL, bicarb 24 mmol/L, anion gap of 10 mmol/L. Patient test positive for COVID-19 and was admitted for acute hypoxic respiratory failure in setting of COVID-19 infection. Six hours after patient received first dose of dexamethasone, labs showed BMP: Glucose 582 mg/dL, bicarb 14 mmol/L, anion gap of 20 mmol/L. ABG: pH 7.09, bicarb 13.2 mmol/L, glucose 509 mg/dL, lactate 9.6, beta-hydroxybutyrate 1.15 mmol/L. Patient was diagnosed and treated for DKA. Patient had an echocardiogram which showed new HFrEF. There was initial hesitation to restart patient on home Empagliflozin due to recent development of DKA. Literature review showed cases of DKA associated with COVID-19 infection. Etiology of DKA remained unclear. Ultimately, it was decided to restart patient on home Empagliflozin for management of diabetes and HFrEF. Conclusion: An abundance of evidence support the benefits of SGLT-2 inhibitors for patients with and without type 2 diabetes mellitus. (4) It is important to consider other causes of DKA for patients who develop DKA on SGLT-2 Inhibitors. Furthermore, additional research into endocrinopathies related to COVID-19 infections should be considered. References: (1) Alamuri TT, Mahesh S, Dell'Aquila K, Leong TJ, Jennings R, Duong TQ. RCOVID-19 associated ketosis and diabetic ketoacidosis: A rapid review. Diabetes Obes Metab. 2023 Jul;25(7):1785-1793. doi: 10.1111/dom.15036. Epub 2023 Mar 17. PMID: 36855317. (2) Goldenberg RM, Berard LD, Cheng AYY, Gilbert JD, Verma S, Woo VC, Yale JF. SGLT2 Inhibitor-associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis. Clin Ther. 2016 Dec;38(12):2654-2664.e1. doi: 10.1016/j.clinthera.2016.11.002. PMID: 28003053. (3) Patel J, Rassekh N, Fonarow GC, Deedwania P, Sheikh FH, Ahmed A, Lam PH. Guideline-Directed Medical Therapy for the Treatment of Heart Failure with Reduced Ejection Fraction. Drugs. 2023 Jun;83(9):747-759. doi: 10.1007/s40265-023-01887-4. Epub 2023 May 31. PMID: 37254024. (4) Brown E, Heerspink HJL, Cuthbertson DJ, Wilding JPH. SGLT2 inhibitors and GLP-1 receptor agonists: established and emerging indications. Lancet. 2021 Jul 17;398(10296):262-276. doi: 10.1016/S0140-6736(21)00536-5. Epub 2021 Jun 30.PMID: 34216571.
Presentation: 6/3/2024