bluuebunny/crossref_metadata_2025_split huggingface dataset:
9281 Menopause Has a Beneficial Influence on the Evolution of Prolactinomas: a Study in 95 Patients
Authors: Constantinescu Stefan Matei , Nava Caterina , Chasseloup Fanny , Chanson Philippe , Alexopoulou Orsalia , Maiter Dominique M 
Published: October 2024

Abstract
Disclosure: S. Constantinescu: None. C. Nava: None. F. Chasseloup: None. P. Chanson: Consulting Fee; Self; Eli Lilly & Company, Recordati, Ipsen, Novo Nordisk. O. Alexopoulou: None. D.M. Maiter: Consulting Fee; Self; Ipsen, Recordati, Pfizer, Inc.
The natural occurrence of menopause is considered to have beneficial effects in women with a prolactinoma and represents a window of opportunity for successful dopamine agonist (DA) withdrawal. Strong evidence for these effects remains however scarce. We retrospectively analyzed data from 95 women undergoing menopause (Mp) (FSH&gt;35 U/L) while still treated with DA (cabergoline (CAB) in 82) for a prolactinoma diagnosed at a mean age of 38.0 ± 8.0 years. The pituitary tumor was a microadenoma in 66 and a macroadenoma in 29 (invasive in 12). Our objectives were to identify the influence of menopause on the evolution of treated prolactinomas and on the risk of recurrence after DA withdrawal. In post-menopausal women still treated with DA (median dose of 0.50 mg CAB/week or equivalent), a significant decrease in median prolactin (PRL) was observed from a premenopausal value of 15.1 µg/L to 10.7 µg/L 3-6 months after Mp (n=64, P=0.05) and to 7.7 µg/L 24 months after Mp (n=43, P &lt; 0.001). There was also a significant reduction in median coronal tumor surface at 24 months, from 12.6 to 7.1 mm² (p &lt; 0. 01). DA treatment was withdrawn in 53 women (56%) after a median interval of 26 months after menopause (range: 3-262). Strict criteria for discontinuation were fulfilled in 52 of them: a normal PRL for at least 24 months under a cabergoline dose ≤ 0.50 mg/week and a more than 50%-reduction in tumor surface area for macroadenomas. Among them, 37 women (71%) remained in remission during a median follow-up period of 26 months (range: 6-176), while 15 (29%) had an asymptomatic biological recurrence after a median duration of 6 months (range: 2-47). Only one woman showed minimal tumor regrowth. 12/15 of the biological recurrences of hyperprolactinemia occurred within the first year after withdrawal and the estimated probability of remission at 5 years was 66%. Multivariate analysis showed that the only independent predictor of recurrence was the PRL value observed 3 to 6 months after DA discontinuation (p = 0.028). Estrogen-progestin replacement therapy, given in 21 women, did not influence these outcomes. In conclusion, we confirm that menopause has a beneficial effect on the evolution of treated and untreated prolactinomas. When using strict criteria for DA withdrawal in the post-menopausal period, a sustained clinical and biological remission can be expected in two-thirds of women, and when recurrence occurs, it is usually mild and asymptomatic.
Presentation: 6/2/2024
7220 Menopause Has a Beneficial Influence on the Evolution of Prolactinomas: a Study in 95 Patients
Authors: Constantinescu Stefan Matei , Nava Caterina , Chasseloup Fanny , Chanson Philippe , Alexopoulou Orsalia , Maiter Dominique M 
Published: October 2024

Abstract
Disclosure: S. Constantinescu: None. C. Nava: None. F. Chasseloup: None. P. Chanson: Consulting Fee; Self; Eli Lilly & Company, Recordati, Ipsen, Novo Nordisk. O. Alexopoulou: None. D.M. Maiter: Consulting Fee; Self; Ipsen, Recordati, Pfizer, Inc.
The natural occurrence of menopause is considered to have beneficial effects in women with a prolactinoma and represents a window of opportunity for successful dopamine agonist (DA) withdrawal. Strong evidence for these effects remains however scarce. We retrospectively analyzed data from 95 women undergoing menopause (Mp) (FSH&gt;35 U/L) while still treated with DA (cabergoline (CAB) in 82) for a prolactinoma diagnosed at a mean age of 38.0 ± 8.0 years. The pituitary tumor was a microadenoma in 66 and a macroadenoma in 29 (invasive in 12). Our objectives were to identify the influence of menopause on the evolution of treated prolactinomas and on the risk of recurrence after DA withdrawal. In post-menopausal women still treated with DA (median dose of 0.50 mg CAB/week or equivalent), a significant decrease in median prolactin (PRL) was observed from a premenopausal value of 15.1 µg/L to 10.7 µg/L 3-6 months after Mp (n=64, P=0.05) and to 7.7 µg/L 24 months after Mp (n=43, P &lt; 0.001). There was also a significant reduction in median coronal tumor surface at 24 months, from 12.6 to 7.1 mm² (p &lt; 0. 01). DA treatment was withdrawn in 53 women (56%) after a median interval of 26 months after menopause (range: 3-262). Strict criteria for discontinuation were fulfilled in 52 of them: a normal PRL for at least 24 months under a cabergoline dose ≤ 0.50 mg/week and a more than 50%-reduction in tumor surface area for macroadenomas. Among them, 37 women (71%) remained in remission during a median follow-up period of 26 months (range: 6-176), while 15 (29%) had an asymptomatic biological recurrence after a median duration of 6 months (range: 2-47). Only one woman showed minimal tumor regrowth. 12/15 of the biological recurrences of hyperprolactinemia occurred within the first year after withdrawal and the estimated probability of remission at 5 years was 66%. Multivariate analysis showed that the only independent predictor of recurrence was the PRL value observed 3 to 6 months after DA discontinuation (p = 0.028). Estrogen-progestin replacement therapy, given in 21 women, did not influence these outcomes. In conclusion, we confirm that menopause has a beneficial effect on the evolution of treated and untreated prolactinomas. When using strict criteria for DA withdrawal in the post-menopausal period, a sustained clinical and biological remission can be expected in two-thirds of women, and when recurrence occurs, it is usually mild and asymptomatic.
Presentation: 6/2/2024
6579 Neuroendocrine Signatures of Social-Defeated Stress Expressed by Adrenal Hormones in Mice
Authors: Noh Jongsung , Choi Jeongyoon , Myung Seung-Woon , Kim Min Soo , Choi Man-Ho 
Published: October 2024

Abstract
Disclosure: J. Noh: None. J. Choi: None. S. Myung: None. M. Kim: None. M. Choi: None.
While psychological stress is one of the prevalent contributors to depression, the precise role of metabolic phenotypes in the development of depression remains elusive. Abnormality in hypothalamus-pituitary-adrenal (HPA) axis is a classical feature of depression. Here, an animal model of social defeat stress (SDS) was established with five-week-old C57BL/6J mice to repeated episodes of social defeat for a period of 10 days, facilitated by an aggressive CD-1 mouse. Liquid chromatography-mass spectrometry-based profiling of 29 adrenocortical steroids and 6 medullary amines was employed for serum samples collected at 3, 5, 7, and 10 days during the modeling from both control (n = 28) and SDS (n = 32) group. In response to initial stress, corticosterone (B) and its two precursors were significantly increased (p &lt; 0.03 for all) during 3 days, while 18-hydroxyB was remarkably elevated (p &lt; 0.003 for 3 days and p &lt; 0.005) in SDS mice. In contrast, dopamine (p &lt; 0.03) and metanephrine (p &lt; 0.008) were significantly increased during 5 days in SDS mice, while remarkably higher levels of norepinephrine were also observed during 7 days (p &lt; 0.01). The SDS mice showed the increased levels of normetanephrine for all days of repeated stress exposure (p &lt; 0.002 for all, except 10 days of p &lt; 0.02). In this study, the HPA regulated negative feedback in short period, whereas sympathetic nervous system was continuously stimulated during repeated stress exposure. The present study may provide insight into the neuroendocrine effects of social stress on allostatic overload.
Presentation: 6/2/2024
12583 Nutrient Intake And Physical Performance In Patients With Acromegaly
Authors: Hupalowski Natália N , Rocha Claudia P S , Fidalski Solena Z K , Boguszewski Cesar Luiz , Borba Victoria Z C 
Published: October 2024

Abstract
Disclosure: N.N. Hupalowski: None. C.P. Rocha: None. S.Z. Fidalski: None. C.L. Boguszewski: Consulting Fee; Self; Recordati. Research Investigator; Self; Crinetics. Speaker; Self; Ipsen, Novo Nordisk. V.Z. Borba: None.
Acromegaly is a chronic disease characterized by increased levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). These patients exhibit increased skeletal muscle mass but poorer performance in functional physical assessments. Certain nutrients are important for both muscle mass and strength, as well as for maintaining an anti-inflammatory state in the body. Objective: To assess the correlation between nutrient intake and physical performance in patients with acromegaly. Patients and Methods: An observational, cross-sectional study of patients with acromegaly matched 1:1 by sex and age with a control group. Patients underwent analysis of dietary patterns using the validated Food Frequency Questionnaire (FFQ), and physical performance and strength were measured using Hand Grip Strength (HGS), 5 Times Seat to Stand Test (STST), Time Up and Go (TUG), and Short Physical Performance Battery (SPPB) tests. Results: It was evaluated 47 patients (54.1% women; mean age 56.3 ± 11.6 years), which were compared with 36 controls (53.9% women; mean age 56.7 ± 13.4). There was no difference between groups in HGS evaluation. The performance of patients with acromegaly were poorer in the STST, SPPB and TUG. Better performance was associated with selenium (p=0.045), vitamin E (p=0.034), flavonol (p=0.02) and vitamin A (0.024) intake. Conclusion: Physical performance is compromised in patients with acromegaly, especially in lower limbs, and it was associated with lower consumption of selenium, vitamin E, flavonol and vitamin A.
Presentation: 6/2/2024
7427 Cellular Senescence As A Pro-Tumorigenic Process And Therapeutic Target In Adrenocortical Carcinoma
Authors: Smith Lorenzo , Warde Kate , Haston Scott , Martinez-Barbera Juan Pedro , Basham Kaitlin 
Published: October 2024

Abstract
Disclosure: L. Smith: None. K. Warde: None. S. Haston: None. J. Martinez-Barbera: None. K. Basham: None.
Adrenocortical carcinoma (ACC) is a rare, yet highly aggressive malignancy that arises in the adrenal cortex. Advanced age is a major risk factor for ACC, with the peak age incidence between 50 and 60 years old. Older individuals above age 50 also have significantly worse survival outcomes. A better understanding of how aging contributes to the development and progression of ACC will uncover new treatment strategies. A major hallmark of aging is the systemic accumulation of senescent cells. While senescent cells have been implicated in various age-related diseases, including cancer, their role in ACC remains poorly understood. ACC tumors from older patients have an enrichment of senescence-associated gene signatures. Moreover, advanced ACC patients are treated with etoposide, doxorubicin, and cisplatin (EDP), which are chemotherapies that induce senescence. While EDP offers short-term benefit in some patients, more than half will progress within 6-months. We hypothesize that the accumulation of senescent cells that arise after EDP treatment are ultimately tumor-supportive long-term. As a result, we postulate that the use of senolytic compounds that clear away senescent cells after EDP treatment will lead to improved survival outcomes for ACC patients. We developed a new ACC mouse model that provides a window to study the role of senescence in ACC tumor progression and treatment. Our model is based on adrenal specific loss of ZNRF3, which is a Wnt inhibitor that is frequently inactivated in human ACC tumors. Despite early adrenal hyperplasia, we showed that Znrf3 conditional knockout (cKO) mice do not develop adrenal tumors until 18-months of age, which corresponds to the peak age incidence in humans. Additionally, the adrenals of Znrf3 cKO mice show a robust senescence activation phenotype that precedes adrenal tumorigenesis. We hypothesize that the accumulation of senescent cells is pro-tumorigenic long-term. To test our hypothesis, we combined Znrf3 cKO mice with a newly established mouse model that enables selective ablation of senescent cells (ZKO-FDR mice). Ongoing aging studies will determine whether the removal of early and late senescent cells in ZKO-FDR mice reduces adrenal tumorigenesis. Further, we established new primary tumor cell lines from aged ZKO-FDR mice. These cell lines will facilitate testing of the pro-tumor mechanisms of senescence. Additionally, they will permit the removal of senescent cells, both genetically and pharmacologically with senolytics, as a new treatment strategy in ACC. Overall, this project aims to investigate the pro-tumor biology of age- and therapy-induced senescence in ACC. Results from these studies will advance our understanding of senescence in cancer and aid in the development of new therapeutic strategies for ACC, including senolytics.
Presentation: 6/2/2024
7068 Paraganglioma in Cyanotic Congenital Heart Disease
Authors: Lis Rita , Hamidi Vala 
Published: October 2024

Abstract
Disclosure: R. Lis: None. V. Hamidi: None.
Paragangliomas arise from the non-chromaffin cells of the parasympathetic nervous system, which are composed of glomus cells. These function as chemoreceptors in response to hypoxia. Carotid body paragangliomas have been linked to conditions with chronic hypoxia. This was first seen in residents of high altitude locations in a case report presented by Saldana et. al and regression of a paraganglioma with resolution of hypoxia was reported by Gruber et. al. There have been few additional case reports of Paraganglioma in other hypoxic states. We present a rare case of a functional Paraganglioma in a patient with Cyanotic Congenital Heart Disease (CCHD).This is a 19 year old female with a history of CCHD due to double inlet left ventricle and transposition of the great arteries. Soon after birth, she had a fontan procedure. She subsequently developed fontan associated liver disease as well as chronic kidney disease, hypertension, sinus node dysfunction, and complete heart block. Her baseline oxygen saturation was 78-85%. Her heart rate was 40-49 beats per minute with upcoming plans for pacemaker placement. Her blood pressure ranged 90/50 to 150/80 mmHg on Amlodipine 5 mg and Lisinopril 2.5 mg. She routinely received abdominal imaging to monitor her liver disease. A liver MRI incidentally revealed a retroperitoneal mass concerning for a paraganglioma. Serum Normetanephrines were found to be 26.60 nmol/L (reference range less than 0.89). 24 hr Urine Norepinephrine was 1,187 ug/d (reference range 14-20). Further imaging was negative for additional sites of disease. Given her complete heart block, she was started on alpha blockade only prior to pacemaker placement. After the pacemaker was placed, she was started on beta blockade and underwent surgical resection of her paraganglioma. The pathology confirmed paraganglioma and mutation testing was negative for germline mutations including SDH, VHL, RET, NF1 mutations. Paragangliomas in patients with CCHD have been scarcely described in the literature given the rarity of both of these conditions. However, there is a relatively increased incidence of paragangliomas in the CCHD population due to chronic hypoxia triggering the hypoxia pathway. EPAS1 mutated HIF2alpha is often found to be the culprit in these patients. In addition, case reports have often described these patients to either be asymptomatic or have potential symptoms masked by their cardiac disease. Therefore, CCHD patients are at increased risk for paragangliomas and warrant additional awareness and regular screening. Screening has been proposed to start after 10 years of hypoxia in a case review by Agarwal et. al. as paraganglioma incidence in CCHD populations has not been seen before age 11. Incidence of recurrence is not yet widely studied, but significant concern for recurrence is warranted if the etiology of hypoxia is not reversed.
Presentation: 6/3/2024
8452 Paraganglioma Masquerading as Neurological Symptoms: A Rare Case Presentation
Authors: Basnet Arjun , Sharma Sapna , Acharya Madhav , Basnet Sijan , Brenan-Rothschild Kelly , Sherpa Chheki 
Published: October 2024

Abstract
Disclosure: A. Basnet: None. S. Sharma: None. M. Acharya: None. S. Basnet: None. K. Brenan-Rothschild: None. C. Sherpa: None.
Introduction: Paragangliomas (PG) are rare tumors of neural crest origin. We report an unusual case of a PG wherein the patient presented to the hospital with complaints of bilateral numbness, tingling, and intermittent difficulty in grasping objects. Case presentation: A 51-year-old female with a prior history of Guillain-Barre Syndrome and hypertension presented to the hospital due to bilateral numbness, tingling, and intermittent difficulty grasping objects in her hands for four weeks. At presentation, her vitals were stable, and her physical examination was positive, only for diminished sensation in her upper extremities. Lab work, including TSH, B12/Folic Acid/ANA, was unremarkable at presentation. CT head and MRI brain were negative for acute intracranial pathology. MRI of the cervical spine showed multilevel degenerative changes (C5-6) and a 1.9 cm soft tissue mass just above the left carotid bifurcation. CTA of the neck revealed a 2.7 x 1.6 x 1.7 cm enhancing mass at the left carotid bifurcation and a contralateral 5 x 3 mm lesion at the right carotid bifurcation. EMG/NCS was performed, which did not meet the diagnostic criteria for Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP/GBS) or cervical radiculopathy. Biochemical workup with plasma metanephrine, 24-hour urine catecholamines/metanephrine/normetanephrine, and 24-hour vanillylmandelic acid was normal. She underwent resection of the left carotid body tumor. The histopathology was consistent with PG. Following the diagnosis, blood tests with PTH, calcium, and calcitonin were performed and were normal. The thyroid ultrasound did not show any thyroid nodules. The patient is scheduled to follow up with Endocrinology as an outpatient to complete genetic testing. Discussion: PG of the head and neck are rare. PG are benign in most cases, but 10% are reported to be malignant. PG may occur sporadically or as inherited familial tumors. Classic tumor syndromes associated with PG include MEN 2A and 2B, von Hippel-Lindau disease, Neurofibromatosis type 1 (NF-1), and Carney-Stratakis dyad. Most cases are non-functional, and symptoms result from mass effects. A preoperative diagnosis usually involves biochemical and radiographic (CT/MRI/PET/MIBG) testing. Biochemical evaluation with measurement of urinary and/or plasma fractionated metanephrines and catecholamines is indicated for all PG, even if clinically non-functional. The definitive diagnosis is histopathological. Treatment options include surgical resection, radiation, and stereotactic radiosurgery.
Presentation: 6/2/2024
6797 Pituitary Apoplexy as initial Presentation of IgG4-Related hypophysitis
Authors: Alameri Majid , Alnuaimi Abdulla 
Published: October 2024

Abstract
Disclosure: M. Alameri: None. A. Alnuaimi: None.
Introduction: IgG4-related hypophysitis is a rare disease due to IgG4 lymphoplasmacytic infiltration of the pituitary gland. It can either be isolated or part of a multisystemic disease. We report a rare case of pituitary apoplexy as first manifestation of IgG4-RD. Case report: A 27-year-old previously healthy male presented to emergency department with severe headache, nausea, vomiting and visual impairment. CT brain showed a large sellar suprasellar mass of 3cm with thick rim enhancement. Blood test showed evidence of central adrenal insufficiency, central hypothyroidism and secondary hypogonadism. Patient was started on hormone replacement therapy for central adrenal insufficiency and central hypothyroidism. Pituitary magnetic resonance imaging (MRI) demonstrated a 3.1 x 2.4 x 2.4 cm well-defined large sellar suprasellar mass with thick rim enhancement with intrinsic heterogeneous T2 signal with hypointense T1 signal on fat-suppressed post contrast imaging consistent with necrotic haemorrhagic suggestive of pituitary apoplexy and background of hypophysitis. Upward displacement of optic chiasm was noted without involvement of cavernous sinus. The patient was initially treated with high-dose steroids aiming for reduction of the pituitary mass. However, eventually, he underwent transsphenoidal surgery due to alternated level of consciousness. Pituitary histopathology showed that vast majority of the tissue is necrotic. A small fragment of viable anterior pituitary tissue is present, which measures up to 5.5 mm in greatest dimension which exhibited marked chronic inflammation, predominantly comprised of small lymphocytes. Plasma cells were present and staining with IgG/IgG4 revealed two high-power fields with clusters of approximately 25 and 50 IgG4 positive plasma cells, respectively. Blood test showed elevated blood IgG4 levels of &gt;2.60 g/L (normal reference range 0.03-2.01 g/L). Case was discussed at Endocrine MDT meeting which agreed that blood tests result along with histopathology findings were in keeping with IgG4-Related hypophysitis as per the Mayo Clinic, Leporati and Japan-Korea proposed criteria. Because blood IgG4 levels were elevated, a systemic evaluation was performed. No evidence of other systemic disease found. High dose steroid therapy was initiated, which reduced remnant inflammatory sellar changes. Discussion and conclusion: IgG4-related pituitary disease should be considered as differential diagnosis in unusual presentations of pituitary apoplexy in the context of sellar suprasellar hypophysitis.
Presentation: 6/2/2024