bluuebunny/crossref_metadata_2025_split huggingface dataset:
8562 Mineralocorticoid Receptor Antagonist Do Not Prevent Primary Aldosteronism Subtyping by Adrenal Vein Sampling
Authors: Pintus Giovanni , Seccia Teresa M , Rossitto Giacomo , Caroccia Brasilina , Ceolotto Giulio , Lenzini Livia , Rossi Gian Paolo 
Published: October 2024

Abstract
Disclosure: G. Pintus: None. T.M. Seccia: None. G. Rossitto: None. B. Caroccia: None. G. Ceolotto: None. L. Lenzini: None. G. Rossi: None.
Background. Current guidelines suggest withdrawal of mineralocorticoid receptor antagonists (MRA) before subtyping primary aldosteronism (PA) by adrenal venous sampling (AVS), but this practice can cause severe hypokalemia and/or uncontrolled high blood pressure (BP) values. Aims. To investigate the feasibility of unilateral PA (uPA) identification by AVS in patients on MRA treatment. Methods. We compared the rate of uPA identification between patients with and without MRA treatment, using two large datasets of patients who were submitted to AVS from 2000 to 2023 in absence of interfering drugs. The rate of uPA identification was also compared between patients with suppressed renin levels (DRC &lt; 2 mUI/L) and unsuppressed renin levels (DRC &gt; 2 mUI/L or DRC &gt; 8.2 mUI/L). Results. Compared to non-MRA PA patients (n = 779), those with MRA (n = 61) showed a higher daily drug dose (2.25 vs 1.5, p = 0.001), a higher rate of adrenal nodules at imaging (82 vs 67, p = 0.022) and of adrenalectomy (72 vs 54%, p = 0.01). The AUROC of lateralization index (LI) did not show significant differences between groups, neither under unstimulated conditions (0.960 vs 0.937, p = 0.590) nor after cosyntropin (0.923 vs 0.917, p = 0.938). Sensitivity analyses confirmed these results 1) after propensity score matching in several adjusted models and 2) in patients with undetectable, suppressed or unsuppressed renin levels. Conclusions. MRAs, at doses that controlled blood pressure and potassium levels in PA patients, did not preclude the identification of uPA at AVS. Moreover, unsuppressed renin levels were not associated with lower rate of uPA identification.
Presentation: 6/3/2024
9307 Significance of Assessing QTc Interval in Chronic Hypoparathyroidism and its Clinical and Biochemical Correlates
Authors: Namjoshi Preeti Vijay , Saha Soma , Sharma Vibhav , Goswami Ravinder , Narang Rajiv , Mani Kalaivani 
Published: October 2024

Abstract
Disclosure: P.V. Namjoshi: None. S. Saha: None. V. Sharma: None. R. Goswami: None. R. Narang: None. K. Mani: None.
Background: Patients with chronic hypoparathyroidism (cHypoPT) and hypocalcemia are at risk of QTc prolongation and life-threatening arrhythmias. Information on clinical and biochemical correlates of QTc in cHypoPT is limited. Design: Observational study in cHypoPT cohort, tertiary-care-center.Materials and methods: Eighty-eight nonsurgical cHypoPT patients (age 44.1±15.4 years, 45 males) were assessed for QTc interval and its possible correlates including arrhythmic symptoms (palpitations/giddiness/syncope), and serum total calcium, phosphorus, 25(OH)D, and iPTH. Results: The mean QTc was 428±34 ms and showed a significant inverse correlation with serum total calcium measured on the same day (r=-0.43, p&lt;0.001). 13.6% of cHypoPT had prolonged QTc. The mean serum total calcium (7.05±1.94 vs. 8.49±1.01 mg/dL, p=0.02) was significantly lower in patients with prolonged QTc. Patients with arrhythmic symptoms had significantly higher mean QTc (p=0.02) and tended to have lower average serum total calcium during follow-up (p=0.06). Multivariable regression showed female gender, higher current age, BMI, and low serum calcium as the significant independent determinants of QTc. For every mg/dL decrease in serum total calcium, QTc increased by 13 ms. Receiver operating characteristic (ROC) analysis revealed serum total calcium at cut-off 8.27 mg/dL discriminated prolonged QTc with area-under-curve being 0.72 [95% CI: 0.51, 0.93]. Conclusion: cHypoPT patients have an increased risk of QTc prolongation which was associated with arrhythmic symptoms, female sex, higher age, BMI, and low serum total calcium. ROC analysis indicated maintaining serum total calcium level of at least 8.27 mg/dL to minimize the risk of prolonged QTc. The study indicates the need for close monitoring of arrhythmic symptoms as well as ECG in cHypoPT patients.
Presentation: 6/2/2024
7722 Temporal mineralocorticoid receptor activation regulates the molecular clock and transcription of cardiovascular disease modulators in myeloid cells
Authors: Young M J , Heanue S , Kanki M , Ray D W , Morgan J , Cole T J 
Published: October 2024

Abstract
Disclosure: M.J. Young: None. S. Heanue: None. M. Kanki: None. D.W. Ray: None. J. Morgan: None. T.J. Cole: None.
The mineralocorticoid receptor (MR) is an established target in the treatment of heart failure, as a mediator of cardiac inflammation and fibrosis. We recently identified a bidirectional regulatory role for the MR and the peripheral molecular clock in cardiac cells. We have also demonstrated a novel role for the MR in macrophages/monocytes in the progression of cardiac inflammation and fibrosis. Given that immune cells are implicated in cardiac pathology, we investigated whether the MR modulates temporal transcription of the molecular circadian clock and inflammatory mediators in the spleen from myeloid MR null mice (MyMRKO), and in immortalised bone marrow derived cells (BMDCs) RNAseq and RT-qPCR analysis of whole spleen from wild type (WT) or MyMRKO revealed differential expression of the clock genes Per2, Cry1, REV-ERBα, and Dbp predominantly at ZT0 and ZT4 compared to ZT12 and ZT16. 10nM aldosterone or corticosterone modulated the 24hr pattern of expression of Per2, REV-ERBα and other clock components in cultured BMDCs, supporting a direct role of MR in timekeeping. MR modulation of genes involved in the proinflammatory response in macrophages such as iNOS, IL-1β, Arg-1, IL-10, CCL2 and Spp1 was more evident at the start of the ‘lights on’ phase in mice, suggesting that low circulating corticosterone at these times allows for a more dominant MR response as a result of preferential binding. Genes related to PPARγ signalling, a key pathway in the development of cardiovascular disease, also demonstrated MR-dependent regulation in a temporal manner. Significant differences in temporal MR modulation were evident between males and females, implying a role for sex hormones in the modulation of circadian signalling and myeloid inflammatory responses in the context of MR-regulated transcription. Our findings underscore the dynamic influence of MR signalling on circadian rhythms and inflammatory pathways in myeloid cells, highlighting potential sex-based differences and offering insights into its pivotal role in cardiovascular disease pathogenesis.
Presentation: 6/3/2024
12517 The Condition Of The Heart And Myocardial Changes In Patients With Type 2 Diabetes
Authors: Alieva Anna , Li Victoria 
Published: October 2024

Abstract
Disclosure: A. Alieva: None. V. Li: None.
Relevance: Type 2 diabetes is associated with serious complications, including cardiovascular diseases, among which is diabetic autonomic cardiomyopathy (DAC), significantly increasing the risk of heart failure and cardiovascular mortality. The mechanisms of myocardial changes in type 2 diabetes (T2D) are not fully understood, which limits the possibilities for prevention and treatment of DAC in such patients. A deeper understanding of myocardial changes in type 2 diabetes may help improve the prognosis and treatment outcomes in patients with this condition. Research objective: To study the condition of the heart muscle in patients with T2D without concomitant arterial hypertension and signs of DAC. Materials and methods: Evaluation of the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV) based on echocardiography examination of the heart. Results: Two groups of 5 patients each were examined. Diabetes duration of more than 5 years, without concomitant arterial hypertension (AH), without significant changes on the electrocardiogram, without complaints from the cardiovascular system, aged 35-42 years. In the first group, glycated hemoglobin ≤ 8.5%, no significant myocardial changes were observed on echocardiography; in the second group with uncontrolled T2D, hypertrophy of the IVS and PWLV was detected. Also, a disturbance of the diastolic function of the left ventricle, directly proportional to the duration of T2D in the group with uncontrolled glycemia, was noted. Conclusions: Analysis of the data obtained shows that an elevated level of glucose in the blood, regardless of the presence of AH, leads to myocardial hypertrophy and remodeling.
Presentation: 6/2/2024
8727 Treatment of Hypertriglyceridemia Induced Pancreatitis
Authors: KC Shreeyanta , Tan Marie , Salim Anzi , Goyal Aakash , Maan Ramanpreet K , Mahat Sanjeev , Kattel Trishna , Wendell Gary D 
Published: October 2024

Abstract
Disclosure: S. Kc: None. M. Tan: None. A. Salim, MD: None. A. Goyal, MD: None. R.K. Maan, MD: None. S. Mahat, MD: None. T. Kattel,MD: None. G.D. Wendell, MD: None.
Introduction : Hypertriglyceridemia less commonly causes acute pancreatitis compared to gallstones or alcohol consumption, estimated to be almost 10% of all cases of acute pancreatitis. Hypertriglyceridemia induced pancreatitis is most often caused by primary hyperlipidemia, pregnancy, uncontrolled diabetes, or alcohol consumption. Diagnosis of HTGP includes evaluation of risk factors, physical examination findings and lipid panels. Treatment and management includes diet restriction, plasmapheresis, insulin, and fibrates. Case Report : We present a 39 year old male with a past medical history of hyperlipidemia, alcohol use disorder, depression who presented to the emergency room with left sided abdominal pain and flank pain for the past 2 days. He had nausea but no vomiting and had been off of hypertriglyceridemia treatment for over a year. He smoked half a pack of cigarettes for 15 years and drinks 3-4 alcoholic beverages a day. Physical examination was notable for soft, left lower quadrant tenderness. His triglyceride levels on admission were over 10,000 (normal: &lt;150 mg/dL). LFTs were slightly elevated (AST: 77, ALT: 64, ALP: 150, normal ranges: 5-30 IU/L, 4-46 IU/L, 30-120 IU/L, respectively). He was afebrile with no leukocytosis. Abdominal CT scan showed acute edematous interstitial pancreatitis. The patient was admitted to the ICU. He was made NPO, placed on saline infusions, started Insulin drip, Dextrose drip for recurrent hypoglycemia from the insulin drip, and fenofibrate. Hydromorphone and ketorolac used for pain. On hospital day 2, the patient’s triglyceride level was below 800, and insulin and dextrose drips were discontinued. The patient started on a clear diet. He was transferred over to the floors, where his triglycerides continued to downtrend and abdominal pain improved. Patient was discharged back home on hospital day 5 with fenofibrate, atorvastatin, thiamine, and folic acid. Conclusion : This case report serves as a valuable learning experience by showcasing the interplay of risk factors, the importance of diligent treatment, and the effectiveness of prompt and multi-faceted management of triglyceride-induced pancreatitis. This case also highlights the importance of adhering to treatment to prevent recurrence of HTGP. Finally, aggressive lipid lowering therapy like insulin and fenofibrate reduced the patient’s triglyceride levels in a short time frame.
Presentation: 6/3/2024
7368 Triglyceride Tales: Two Cases Unveiling Pegaspargase-Induced Hypertriglyceridemia
Authors: Noguchi S , Singh A , Rajpal A 
Published: October 2024

Abstract
Disclosure: S. Noguchi: None. A. Singh: None. A. Rajpal: None.
Introduction: Acute lymphoblastic leukemia (ALL) is a hematologic malignancy that has seen dramatic improvements in survival, owing to the development of multi-agent chemotherapy regimens. Pegaspargase (PEG), an enzyme that depletes serum asparagine and leads to apoptosis of leukemic cells, has long been a cornerstone of ALL chemotherapy regimens. While many toxicities have been recognized including hypersensitivity, thrombosis and hepatotoxicity, hypertriglyceridemia (HTG) is a much less documented complication. We present two patients who developed severe hypertriglyceridemia (sHTG) secondary to PEG, with differing outcomes. Both patients were re-challenged with PEG and again developed sHTG. Case description: A 31-year-old male presented with leukocytosis and blastemia and was diagnosed with Philadelphia chromosome negative B-cell ALL. He underwent chemotherapy induction via pediatric-inspired protocol CALBG 10403 which included PEG. Three weeks later triglyceride (TG) levels rose to 3,728 mg/dl, but normalized with gemfibrozil over the next month. He received two more doses of PEG, separated by four weeks, as part of consolidation chemotherapy. Eleven days following the third dose he presented with abdominal pain, lipase of 702 units/L, TG of 3,999 mg/dl and imaging consistent with necrotizing pancreatitis. With intravenous insulin and meropenem he eventually made a full recovery, however he had a persistent pancreatic pseudocyst. Thereafter, he was transitioned to HyperCVAD followed by POMP maintenance chemotherapy.Another patient, a 35-year-old female presented with cytopenia and was also diagnosed with Philadelphia chromosome negative B-cell ALL. She was also induced with CALBG 10403 protocol including PEG. One month later her TG levels rose to 1,295 mg/dl and was started on fenofibrate. Following resolution of the lipemia, she underwent consolidation chemotherapy which included two doses of PEG administered four weeks apart. Despite a 50% dose reduction, ten days after the third dose TGs rose to a peak of 3,363 mg/dl, however she did not develop pancreatitis. She was treated with intravenous insulin, gemfibrozil and omega-3-acid ethyl esters for sHTG. Given complications with CALGB, she is planned to transition to blinatumomab consolidation. Discussion: Albeit a rare complication of PEG, the presented cases highlight the severity of HTG that can result from this commonly used chemotherapy agent. There are currently no guidelines for the baseline assessment of TG levels in ALL patients receiving PEG. Awareness of this potential complication should prompt regular monitoring of TG levels in patients undergoing regimens involving PEG. There is a need for future studies to identify patients at higher risk of developing sHTG and evaluate the appropriate dose and frequency of PEG administration in patients who develop sHTG after initial exposure.
Presentation: 6/3/2024
9326 A Case Of Diabetic Ketoacidosis Obscured By Metabolic Alkalosis In An Individual With End-stage Renal Disease
Authors: Messersmith Andrew L , Bayrakdar Keenan , Killeen David 
Published: October 2024

Abstract
Disclosure: A.L. Messersmith: None. K. Bayrakdar: None. D. Killeen: None.
Diabetic ketoalkalosis (DKALK) is a term coined in the literature by Bleicher in 1967, characterized by diabetic ketoacidosis (DKA) with concomitant metabolic alkalosis. Patients with DKALK may present with normal to elevated bicarbonate and an alkalotic pH secondary to recurrent vomiting, ingestion of alkali, contraction alkalosis from hyperglycemia-induced osmotic diuresis, or diuretics. Here we discuss a 33-year-old female who presented to the hospital with non-bloody, nonbilious vomiting for two days and unremitting abdominal pain that started the day of arrival to the emergency department (ED) along with two ulcers localized to the lateral aspect of her foot with purulent discharge. Her past medical history was significant for insulin dependent diabetes mellitus complicated by recurrent DKA, diabetic peripheral neuropathy and retinopathy, amputation of the left fifth toe at the mid metatarsal secondary to osteomyelitis, hypertension, and end-stage renal disease (ESRD) on hemodialysis (HD). Blood glucose was 302 mg/dL, bicarbonate 30 mmol/L, chloride 96 mmol/L without an anion gap, lactic acid 3.6 mmol/L, and urinalysis positive for glucose and ketones. Blood cultures grew Staphylococcus hominis and epidermidis, and Actinetobacter lwoffii. Magnetic resonance imaging was compatible with chronic osteomyelitis of the fifth metatarsal stump. On the third day of hospitalization, after worsening abdominal pain, nausea, and vomiting, repeat laboratory results showed a blood glucose 580 mg/dL, chloride 95 mmol/L, beta-hydroxybutyrate 4.23 mmol/L; and a pH of 7.609 and bicarbonate of 23 mmol/L on ABG with an anion gap of 23 mmol/L. The patient was treated with insulin, intravenous fluids, potassium, and antibiotics with resolution of symptoms. Diabetic ketoalkalosis is a condition rarely reported in the literature. Case reports have included association with type I diabetes in patients with underlying gastroparesis presenting for abdominal discomfort and vomiting. Loss of hydrochloric acid from vomiting increases bicarbonate in the body. Volume contraction activates the renin-angiotensin-aldosterone system (RAAS), which acts on the kidneys to reabsorb sodium and bicarbonate, generate new bicarbonate, and excrete hydrogen ions into the urine. The delta ratio can be used to identify DKALK, along with the presence of serum or urine ketones, and an elevated anion gap. In DKALK the delta ratio (increase in anion gap/decrease in bicarbonate) is greater than 1.2; Our patient had a delta ratio of 11. This case highlights the importance of identifying DKALK, a mixed metabolic acidosis and alkalosis disorder, to prevent morbidity and mortality associated with misdiagnosis.
Presentation: 6/2/2024
8337 A Case Report of Polypharmacy With Combined Adverse Effects of SGLT-2 Related Euglycemic DKA and Lithium Induced Nephrogenic DI
Authors: Gupta Uma Datta , Subedi Saphal Nath , Kunwar Kalendra , Ghimire Brijesh , Dhakal Govind , Bagain Jay B , Ishrat Syeda R 
Published: October 2024

Abstract
Disclosure: U.D. Gupta: None. S.N. Subedi: None. K. Kunwar: None. B. Ghimire: None. G. Dhakal: None. J.B. Bagain: None. S.R. Ishrat: None.
Polypharmacy, typically defined as the use of 5 to 10 medications, is linked to an elevated risk of adverse drug events (ADEs) and hospital admissions, independent of age. In the USA, 67 percent of hospitalizations are linked to four medications or classes: warfarin, insulins, oral antiplatelet agents, and oral hypoglycemic agents. A higher number of medications increases the likelihood of "prescribing cascades," where an ADE is mistaken for a new medical condition, leading to additional drug therapy. In our case report we are presenting a 41 years old female with a medical history of Hypertension, Diabetes Mellitus Type 2, Schizoaffective disorder, presented to the emergency department with left gluteal pain with subsequent CT scan shows Fournier's gangrene or perforated perirectal abscess and she received IV antibiotics, pain management, and fluids. Patient has been taking Lantus, Glipizide (sulfonylurea), and Empagliflozin, Bupropion and Aripiprazole at home. During her treatment of sepsis she was diagnosed with euglycemic DKA (A1c - 10.3, Blood glucose 240-180s, anion gap metabolic acidosis, glucosuria &gt;1000, Ketone bodies of 40, beta hydroxybutyrate 3.18, serum osmolality 303, urine osmolality 140, urine output 13 liters/24 hrs). Furthermore Lithium Level reported 0.1(mild toxicity 1.5 mEq/L or 1.5 mmol/L). In literature, Sodium-glucose cotransporter 2 (SGLT2) inhibitors can reduce lithium levels. Polyuria and polydipsia are common in lithium-treated patients (70% cases), with potential risk factors including longer treatment duration, episodes of toxicity, and concurrent use of other psychotropic medications. In some cases, the lack of significant hyperglycemia (plasma glucose &lt;250 mg/dL ) can lead to a delayed identification of issues by both patients and clinicians (risk is 2 times higher than other therapies), it is recommended to check for serum ketones. The patient received treatment for other comorbidities; however, Lithium and Empagliflozin were withheld during her hospital stay, leading to gradual improvement. This case report will enforce the importance of ensuring appropriate drug prescribing involves factors such as avoiding inappropriate medications, monitoring for side effects and drug levels, preventing drug interactions, and incorporating patient values through active involvement. This case is an unique opportunity to learn ADEs, contributing to diagnostic challenges which can increase mortality across various age groups without proper vigilance.
Presentation: 6/3/2024
8002 A Dose Beyond Limits: Semaglutide and Insulin Overdose - A Novel Approach to Management
Authors: Foo Francine Fane , Amin Tasnuva , Farhat Farah , Gonzalez Paula , Hu Katherine , Chalasani Krishna , Cheng Jennifer , Ong Raquel Kristin , Akula Monika Soujanya , Philip Rosily , Holland Soemiwati Weidris 
Published: October 2024

Abstract
Disclosure: F.F. Foo: None. T. Amin: None. F. Farhat: None. P. Gonzalez: None. K. Hu: None. K. Chalasani: None. J. Cheng: None. R. Ong: None. M.S. Akula: None. R. Philip: None. S.W. Holland: None.
Background: In the past decade, treatment of diabetes has expanded to include multiple classes of medication including GLP-1 agonists. Although newer medications offer better safety profiles, overdosing on these agents can have potentially fatal complications. Several cases of insulin overdose have been reported to date however, only a few cases of GLP-1 receptor agonist overdoses have been recorded and to our knowledge none have been reported on semaglutide specifically. We present a unique case of a patient who intentionally overdosed with massive amounts of both the injectable GLP-1 receptor agonist and multiple types of insulin and our approach to management. Case Presentation: This is a case of a 61 year old female with past medical history including depression, hypertension, stage 3 chronic kidney disease, and insulin dependent type 2 diabetes. She was brought by EMS to the emergency room after injecting herself with Toujeo Max 1800 units, Lantus 300 units, Humalog 300 units, and a pen of Ozempic (3mL). On initial EMS contact, the patient's blood glucose was 27 and she was given 50cc of D10W which improved her blood glucose to 110. Her admission was complicated by persistent hypoglycemia despite ongoing intravenous dextrose infusions, injections of octreotide and glucagon, and IV steroids. Given the long half life and massive dose of Toujeo, a decision was made to initiate hemodialysis to expedite insulin metabolism and removal. Insulin levels were monitored before and after dialysis to determine the efficacy of dialysis. After 1 session of dialysis insulin levels improved from 286.37 to 124.66 miU/mL and due to patient’s preference dialysis was discontinued. Following dialysis, the patient was able to be tapered off steroids and no longer required glucagon and octreotide injections. Her insulin levels continued to trend down daily and eventually she was resumed on her home basal - bolus insulin regimen. On day 10 of admission, she was deemed both medically and psychiatrically clear for discharge. She was sent home with a basal - bolus regimen, she was seen at our office for follow up and continues to do well. Conclusion: Newer diabetes medications and insulin formulations have become increasingly popular and physicians must remain vigilant in identifying potential complications that can arise from intentional overdose. Although hypoglycemia treatment has been well established, it is crucial to consider other methods and protocols.
Presentation: 6/3/2024