bluuebunny/crossref_metadata_2025_split huggingface dataset:
7498 Pituitary Apoplexy Associated With COVID 19 Infection in a 55 Year Old Filipino Male: A Case Report
Authors: Macrohon Calvin Lontoc , Mercado Joseph Aljen Y , Gan Robert Michael Go 
Published: October 2024

Abstract
Disclosure: C.L. Macrohon: None. J.Y. Mercado: None. R.G. Gan: None.
Introduction: Pituitary apoplexy is a rare fatal disorder resulting from acute ischemia or hemorrhage of the pituitary gland. Major predisposing factors include patients with anti-thrombotic drugs. However, there has been an increasing number of cases reported associating COVID- 19 and pituitary apoplexy. Case: This is a case of a 55-year-old Filipino male, who came in with right eye ptosis and blurring of vision associated with headache and dizziness. Significantly, 2 weeks prior the patient had developed cough and colds. On admission, he was noted to be febrile and presented with a visual acuity of light perception on the right eye and hand movements on the left. Plain MRI of the brain revealed a well-circumscribed hemorrhagic sellar-suprasellar mass with mass effect on adjacent structures worrisome for pituitary apoplexy. Incidentally, patient tested positive for COVID- 19. Hormonal work- up revealed hypopituitarism presenting with central hypothyroidism and hypogonadism. Patient was then started on Hydrocortisone 100mg intravenously as loading dose then 50mg intravenously every 6 hours to cover for adrenal insufficiency. At this point, thyroid hormone replacement was also started at 100mcg/day. Initially, patient was scheduled for endoscopic endonasal transsphenoidal surgery. However, due to euvolemic hyponatremia with a serum sodium of 119mmol/L secondary to SIADH, surgery was delayed and was performed on the fourth day of admission. Post- operatively, patient had improvement of vision and was eventually discharged stable without any complications. He was sent home on thyroid hormone replacement and steroids were discontinued since adrenal insufficiency was ruled out with a post operative serum Cortisol of 27.27ug/dL taken 24 hours after last dose of hydrocortisone. Discussion: COVID- 19 with associated hypophysitis or pituitary apoplexy has been reported in literature. The pituitary gland was proposed as possible targets of SAR- CoV-2 due to the presence of ACE- 2 receptors on the surface of their cells. Hazzi et al. discussed that infection by COVID-19 could play a role in the disruption of the equilibrium between the high energy demand and limited blood supply of underlying adenomas. They also discussed on possible routes of entry of COVID 19 particularly thru the nasopharyngeal epithelium via olfactory nerve or pass through blood brain barrier or thru the median eminence. Other possible contributing factors may be due to coagulopathy, endothelial dysfunction and hypercoagulative state seen in COVID- 19. Conclusion: With increasing reports of pituitary apoplexy in the setting of SARS-COV-2 infection there is a possibility that COVID 19 may be a risk factor for pituitary apoplexy. Hence, the prevalence of COVID- 19 may increase risk of patients with underlying pituitary tumors to develop pituitary apoplexy.
Presentation: 6/2/2024
8188 Pituitary hyperplasia resulting from primary hypothyroidism: A case report
Authors: Aziz Mohammad , Manolas Melina Ileana , Tabatabaie Vafa , Rincon Laura 
Published: October 2024

Abstract
Disclosure: M. Aziz: None. M.I. Manolas: None. V. Tabatabaie: None. L. Rincon: None.
Pituitary hyperplasia resulting from primary hypothyroidism: A case report.Background: Primary hypothyroidism is a common endocrine condition seen in 4.6% of USpopulation (1). We describe an uncommon presentation of prolonged severe primaryhypothyroidism leading to significant hyperplasia of the pituitary gland resembling a pituitarymacroadenoma. Clinical Case: A 34-year male with schizophrenia and Hashimoto’s hypothyroidism diagnosedat the age of 17 presented with hallucinations, chest pain, fatigue, and dyspnea. The patient hada 15-year history of uncontrolled hypothyroidism with persistently elevated TSH with values ashigh as 2,299 (n 0.30-4.20 uU/mL) due to poor adherence to levothyroxine. Initial laboratorystudies revealed hyponatremia (Na 130, n135-145 mEq/L), elevated TSH (&gt;100, n0.30-4.20 uU/mL), undetectable FT4 (&lt;0.4, n0.6-1.5 ng/dL) and elevated CK (5671, n&lt;200 U/L).Levothyroxine was restarted at dose of 150 mcg daily. Head CT performed for evaluation ofaltered mental status and hallucinations revealed hyperdensity within the pituitary gland,concerning for underlying hemorrhage and apoplexy. Neurosurgical consultation was requested,and a pituitary MRI was obtained in preparation for potential surgical intervention. MRI showeda prominent anterior pituitary gland measuring up to 14 mm with homogeneous enhancementwithout evidence of hemorrhage. In the absence of any hemorrhage or definitive mass, thepituitary enlargement was considered secondary to the long-standing history of uncontrolledprimary hypothyroidism leading to pituitary hyperplasia, and surgical intervention was deemedunnecessary. Repeat labs 1 week later showed TSH &gt;100uU/mL, FT4 0.6 ng/dL, CK 2799 andrepeat MRI showed slight decrease in size of the pituitary gland, confirming hyperplasiasecondary to severe, prolonged hypothyroidism. Conclusion: Prolonged primary hypothyroidism can lead to pituitary hyperplasia which can bemistaken as pituitary macroadenoma, leading to unnecessary surgical intervention. Carefulreview of history and TSH trends can help elucidate this diagnosis. References: (1) Wyne KL, Nair L, Schneiderman CP, et al. Hypothyroidism Prevalence in theUnited States: A Retrospective Study Combining National Health and Nutrition ExaminationSurvey and Claims Data, 2009-2019. J Endocr Soc. 2022;7(1):bvac172. Published 2022 Nov10. doi:10.1210/jendso/bvac172
Presentation: 6/3/2024
9183 Pituitary Metastasis Of Lung Adenocarcinoma Presenting As Anterior Pituitary Dysfunction
Authors: Faour Omar , Kinaan Mustafa , Suryanarayanan Sowmya K 
Published: October 2024

Abstract
Disclosure: O. faour: None. M. Kinaan: None. S.K. Suryanarayanan: None.
Introduction: The pituitary should not be overlooked as a site for metastasis and can be the first presentation of neoplastic disease in some patients. Most common presenting symptoms: headache, ophthalmoplegia, visual field defect and Arginine Vasopressin Deficiency (AVP-D). We present a case of pituitary metastasis of lung adenocarcinoma presenting as anterior Pituitary dysfunction that also showed partial AVP-D unmasked after starting steroids. Case Description: A 63-year-old male with history of tobacco use, COPD, and hypertension presented with syncope. He reported a 30lbs weight loss within prior 2 months, low energy, increased thirst, and polyuria. Physical exam was significant for cachexia, normal visual field on confrontation, and vital signs of BP 100/61, HR 83, and Weighing 180 lbs. Since he had syncope, Cortisol checked was undetectable and Free T4 was low, He was started on hydrocortisone and levothyroxine. CTA chest revealed a right hilar mass measuring 2.7 x 3 cm. Endobronchial biopsy was consistent with lung adenocarcinoma. MRI of pituitary gland revealed solid hypointense lesion with glandular thickening and diffuse heterogeneity involving most of the pituitary gland measuring up to 16 mm. No cavernous sinus invasion. Pituitary infundibulum showed diffuse thickening and enhancement of the pituitary stalk throughout with Intact posterior pituitary bright spot. Labs showed low LH, cortisol, ACTH, GH, TSH, and ADH. Initially, the patient was able to maintain a euvolemic status through increased water intake; however, he was later found to have partial central AVP-D when steroids were introduced. He responded to the use of Desmopressin, developed hyponatremia after 3 doses. He was started on a combination of carboplatin/pemetrexed/pembrolizumab but had no response and was transferred to palliative care/hospice and passed away within 7months after diagnosis.Discussion:Pituitary metastasis is rare and most commonly occurs in lung and breast cancers. Unfortunately, they are associated with poor prognosis. MRI findings of loss of posterior pituitary bright spot, thickening of the stalk, and dumbbell shape can be helpful in distinguishing between primary pituitary tumors and metastases. PET-FDG scan has limited value. Pituitary metastasis commonly presents with posterior pituitary dysfunction due to direct blood supply. Unmasking or worsening of AVP-D can happen with steroid replacement in patients requiring initiation or intensification of Desmopressin therapy. Treatment involves combination of surgery, radiation therapy, and systemic treatment for the primary cancer which can improve symptoms only but does not improve mortality.
Presentation: 6/1/2024
8652 Real World Impact of Cushing’s Syndrome: A Shared Global Story
Authors: Edwin Leslie , Jordan Gretchen 
Published: October 2024

Abstract
Disclosure: L. Edwin: None. G. Jordan: None.
Introduction: Cushing's Syndrome creates short- and long-term challenges to physical and mental health. Clinical and surgical outcome statistics have improved over time, but patients continue to report diagnosis delays, confusion about treatments, and the feeling of being “dropped” once cortisol is normalized. White matter is damaged by persistent high cortisol, and a return to eucortisol often unmasks new or worsened autoimmune, neuropsychological, physical, and other conditions. Hypothesis: Patients have been sharing best practices and supporting each other through patient networks for decades on topics that are misunderstood, dismissed, and under-treated in the clinical setting. Improvements to care will come faster if this kind of patient-created data is made widely available, and advocacy groups must establish an acceptable method to accomplish this. Methodology: A committee of patients reviewed the design and content of two large Quality of Life surveys conducted in recent years, then built a new survey for a larger international patient cohort. SurveyMonkey was used for layout and response collection. Spanish and French translations were done with DeepL then cleaned up by native speakers. The survey was then promoted within global patient advocacy organizations and on social media. The survey comprised over 150 questions and received 438 responses from 38 countries. Results: Respondents answered questions about their daily lives including physical, emotional, mental and social well-being. Examples: •75% of respondents are still trying to determine their “new normal”.•Over 80% report memory problems that did not exist before.•Almost 90% took much longer than six weeks to return to work in any capacity.•A third of male patients and a fifth of female patients report that their marriage or long-term relationship ended because of Cushing’s.•Almost half of respondents felt that their medical team was unable to support them beyond cortisol issues.•More than 50% who answered this survey have experienced suicidal thoughts due to the overwhelming nature of Cushing’s. Conclusion: Dr. Harvey Cushing, namesake of the disease, identified the most underrated element of the patient experience when he made his famous statement: “A physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world.”The man in his world. The results of our study paint a picture of the ongoing burden of hypercortisolism that often starts seven or more years before an official diagnosis is made and continues indefinitely. Patients can help fast-track the identification of areas where more work needs to be done. It is therefore incumbent on a group of well-organized advocates to develop a structure that translates the patient voice into datasets that are useable by all doctors, researchers, and stakeholders in the Cushing’s community.
Presentation: 6/3/2024
6534 Schwannoma-Induced Hyperprolactinemia: A Rare Presentation Unveiled
Authors: Naronowicz Gabriela , Foo Francine Fane , Cheng Jennifer , Ong Raquel Kristin , Holland Soemiwati Weidris , Chalasani Krishna 
Published: October 2024

Abstract
Disclosure: G. Naronowicz: None. F.F. Foo: None. J. Cheng: None. R. Ong: None. S.W. Holland: None. K. Chalasani: None.
Background: This case describes a rare presentation of a schwannoma manifesting with hyperprolactinemia. Case Description: A 37 year-old female with a past medical history including prolactinoma presented to our endocrine office to establish care. Prior to presentation, this patient had been diagnosed with a prolactinoma in 2015 via MRI. She was started on Cabergoline 0.5mg twice a week for treatment and continued this medication without any bothersome side effects. However, she began experiencing progressive dizziness, tinnitus, bilateral galactorrhea, and vision changes, prompting her to seek further intervention. The patient presented to our endocrine office in October 2017 for her initial visit. Due to ongoing symptoms, an MRI was done which revealed an adenoma vs hyperplasia of the pituitary gland. During this time her prolactin level was within normal limits, thus she continued her Cabergoline regimen. Soon thereafter, the patient was seen again in April 2018 with evidence of stable prolactin levels on Cabergoline treatment, although a repeat MRI showed a concern for a 1.2 cm mass in the left cerebellopontine angle extending to the right auditory canal. The patient underwent a follow-up consultation with a neurosurgeon; However given the unavailability of surgery at that time owing to insurance-related matters, a subsequent MRI was performed in August 2019 which revealed a vestibular schwannoma with no pituitary mass, and she ultimately underwent resection of this mass in February 2020. Throughout this period, the patient presented with a rise in prolactin levels (23.7 to 41.9 ng/mL). However, due to an asymptomatic state and the absence of concerning pituitary mass, the decision to be observed off Cabergoline therapy appeared to be the appropriate clinical course of action. Following the surgery, she was seen again in June 2020 with normalization of her prolactin levels without ongoing cabergoline treatment. We continue to follow this patient to present day for annual appointments and she continues to have normal prolactin levels. Conclusion: This report underlines the importance of a thorough and multidisciplinary approach in the assessment of elevated prolactin levels in light of a schwannoma. This also highlights the significance of continued surveillance and the value of repeat imaging. Exploring alternative diagnoses, such as Schwannoma, broadens the scope of etiologies, thus allowing a comprehensive approach for accurate diagnosis.
Presentation: 6/1/2024
8663 Sex differences in delayed fear incubation in mice
Authors: Littlepage-Saunders Mydirah , Rusnak Milan , Tsuda Mumeko , John Wu T 
Published: October 2024

Abstract
Disclosure: M. Littlepage-Saunders: None. M. Rusnak: None. M. Tsuda: None. T. Wu: None.
Post-traumatic stress disorder (PTSD) has a lifetime prevalence of 1 in 13 people. It is not fully understood why some are more vulnerable to developing PTSD whereas others are more resilient. Among those who develop PTSD, about a quarter have delayed-onset PTSD where onset of symptoms occur at 6 months or later after experiencing a traumatic event. While there is recognition of this type of PTSD, the underlying mechanism is poorly understood. The development of PTSD is more prevalent in women than men. However, previous preclinical and clinical studies have focused mainly on males. Thus, there lacks an understanding of this sex difference. To enhance our understanding of the causal mechanisms, we designed a study with mice to compare the effect of sex on delayed fear incubation. We expected the female mice to show increased fear responses that would suggest more chronic delayed fear incubation than the male mice. To test this, we evaluated distance travelled, freezing, and latency until the first freezing episode in adult male and female C57Bl/6J mice (7-8 weeks of age; n=8/group) using a delayed fear incubation behavioral assay. Animals were placed in a fear conditioning chamber for a 198 s acclimation period and then administered a single 2 s scrambled footshock of 1.5 mA via the metal grid floor. After an additional 60 s, animals were returned to their home cage. At specific time after shock application, animals underwent a fear recall test where the animals were placed back in the shock chamber for a total of 180 s without any additional footshocks and then returned to their home cage. The study was based on a 2X2 factorial design comprising of sex (male vs female) and recall time (1 day and 14 days post shock). The data showed an increasing freezing trend (p=0.08) at d 14 compared to their recall d 1 counterparts. There was no effect of time or sex on distance travelled or latency until the first freezing episode. Interestingly, female mice showed less freezing when compared to the male mice. Ongoing experiments will look more into circuitry-level changes by comparing neuronal activation through cFos expression in different brain regions that are a part of the limbic system and/or have been associated with fear: the amygdala, hippocampus, prefrontal cortex, and paraventricular nucleus.
Presentation: 6/2/2024
8603 Sex Steroids Have Opposing Impacts on Female Gonadotrope Metabolism and LH Secretion via GLUT1
Authors: Garcia Christopher , Nguyen Christy , Wang Sizhe , Trinh Davina , Le Uyen-Vy , Kapadia Rubina , De La Torre Jamie-Jean , De La Cruz Chantal K , Nicholas Dequina 
Published: October 2024

Abstract
Disclosure: C. Garcia: None. C. Nguyen: None. S. Wang: None. D. Trinh: None. U. Le: None. R. Kapadia: None. J. De La Torre: None. C.K. De La Cruz: None. D. Nicholas: None.
Gonadotropes of the anterior pituitary regulate reproductive hormone synthesis and secretion not only through GnRH signaling from the hypothalamus, but by also determining if glucose availability, via GLUT1, meets the current requirements to support reproduction. GLUT1 facilitates glucose uptake and in gonadotropes its expression increases during the LH surge which indicates its necessity in the maximal secretion of LH through glycolysis. However, the mechanisms underlying the feedback from sex steroids that also mediate female reproduction have not been completely elucidated. By manipulating GLUT1 expression and sex steroid levels using cell lines and a conditional knockout of GLUT1 in mouse gonadotrope we show that sex steroids alter GLUT1 expression and translocation effecting gonadotrope glycolysis and subsequent gonadotropin secretion. Tamoxifen treated iGricCre +/+ GLUT1 fl/fl mice display disrupted estrous cycles and changes in serum gonadotropins. Dihydrotestosterone (DHT) or estradiol (E2) replacement in gonadectomized male and female, respectively, surprisingly result in increased (by DHT) or reduced (by E2) pituitary GLUT1 protein as measured by western blot despite both inhibiting serum LH. Using extracellular flux analysis and imaging flow cytometry, we show that LβT2 cells treated with DHT increase while E2 decreases glycolysis and translocation of GLUT1 to the cellular surface. We conclude that sex steroids regulate gonadotropin secretion and reproduction through direct impacts on gonadotrope metabolism through GLUT1.
Presentation: 6/1/2024
9363 Spontaneous Cushing Disease Remission Induced By Pituitary Apoplexy
Authors: Vargas Jose Edmond Esquivel , Salazar Francis Ruiz , Santos Rojo Ana B 
Published: October 2024

Abstract
Disclosure: J.E. Esquivel Vargas: None. F. Ruiz Salazar: None. A.B. Santos Rojo: None.
Background: Spontaneous remission of Cushing disease is rare, and it is mainly due to apoplexy of a pituitary tumor. Clinical case: 14-year-old female presented with clinical features of Cushing syndrome. Initial tests were consistent with Cushing disease (CD): elevated 24h urinary cortisol (235µg/24h, n&lt;90µg/24h), abnormal 1 mg dexamethasone overnight test (cortisol after 1 mg dex 3.4µg/dL, n&lt;1.8µg/dL), and elevated ACTH-concentrations (83.5 pg/mL, n 10-60pg/mL). Pituitary adenoma was suspected, and the patient was referred for a transsphenoidal resection of the adenoma. While waiting for surgery the patient presented to the Emergency department with a headache and clinical signs of meningism. Computed axial tomography of the central nervous system was performed, and no structural alterations were found. The symptoms subsided with analgesia. One month later she presented again to the Emergency department with clinical findings of acute adrenal insufficiency (cortisol level of 4.06 µg/dL), and she was noted to have spontaneous biochemical remission associated with resolution of her symptoms of hypercortisolism. Nuclear magnetic resonance imaging was performed describing a 2.6 x 1.8mm hypointense pituitary lesion, suggestive of cerebrospinal fluid, which could be a remnant of a pituitary microadenoma. For that reason, spontaneous CD remission induced by pituitary apoplexy (PA) was diagnosed. The patient has been managed conservatively since the diagnosis and remains in clinical and biochemical remission until the present time after 10 months of follow up. Conclusion: There are 3 unique aspects of our case: the early age of onset of symptoms, the spontaneous remission of CD due to PA which has been rarely reported in the medical literature, and the patient presented a microadenoma because there are less than 10 clinical case reports of PA associated with microadenoma.
Presentation: 6/1/2024