bluuebunny/crossref_metadata_2025_split huggingface dataset:
9359 Patients’ Perspectives On Telemedicine In Endocrinology
Authors: Pikielny Pnina Rotman , Yoseph Liat Barzilay , Meron Michal Kasher , Rodrig Keren , Shapira Sofia 
Published: October 2024

Abstract
Disclosure: P. Rotman Pikielny: None. L. Barzilay Yoseph: None. M. Kasher Meron: None. K. Rodrig: None. S. Shapira: None.
Background: Telemedicine has emerged as an important and sometimes crucial tool in patient care, particularly during the COVID-19 pandemic. It offers numerous benefits, including time efficiency and improved access to specialized services. However, its adoption by endocrinology is constrained by the traditional emphasis on the physician-patient relationship and physical examinations. Objectives: This study evaluated patients’ perspectives on telemedicine, regarding specific aspects of satisfaction, including communication, wait times, and financial and time burdens. Methods: Surveys were delivered via text messages sent after telephone vs. frontal visits in an outpatient endocrinology clinic in a tertiary referral center. The surveys, sent from Nov 2022 to Dec 2023, investigated various aspects of satisfaction with the appointment and were based on the Telemedicine Satisfaction Questionnaire, a 5-point Likert scale questionnaire. Variations in preference levels across diverse patient groups were also examined. Answers were received via the REDCap application. Patients were told that responses were optional and answering the survey granted informed consent. Results: A total 135 patients completed the questionnaire, 93 who attended telephone and 42 after frontal visits. The groups were similar clinically: 77% were women, with an average age of 63 years. Visits were held mainly due to diabetes (22%), osteoporosis (31%), or obesity 10%), with no statistical differences between groups. 60% were followed more than a year. More patients who had telephone visits (69.9%) had previous experience with telephone visits vs. patients who had frontal visits (40.5%; p&lt;0.004). Patients who had telephone visits reported higher satisfaction with wait time (p=0.002), physicians' explanations (p=0.03) and lower financial and time burdens (p&lt;0.001). However, they were less able to share personal situations with the physician (p&lt;0.001). More patients who experienced telephone visits thought they were preferrable to frontal visits (p&lt;0.001). Notably, individuals with long-term follow-up and non-diabetic endocrine conditions had more interest in telemedicine. Conclusions: Patients report high satisfaction with telemedicine, but constrained in-person interactions remain a notable limitation. Telemedicine may not suit all patient groups or all time-points of patient care, requiring adaptation for broader use. Further research with higher response rate and specifications of different patient populations are essential to generalize these findings.
Presentation: 6/2/2024
7413 Postsurgical Complications In Gender Affirmation Surgery According To Body Mass Index: Case Series
Authors: Tovar Cortes H 
Published: October 2024

Abstract
Disclosure: H. Tovar Cortes: None.
Introduction: Therapeutic approach to gender dysphoria includes surgical interventions as part of the gender affirmation process.To make these procedures safe, it is recommended for the patient to have a normal BMI (body mass index). Obesity can increase the risk of complications during the perioperative period. To date, no studies have been published in Colombia documenting the results, and complications in patients undergoing gender affirmation surgery, and the relation to BMI. Case series A case series of patients diagnosed with gender dysphoria and multidisciplinary treatment is presented. Patients undergoing a gender affirmation surgical procedure, both in the context of transition from man to woman and from woman to man, who presented post-surgical complications are described. An analysis of the anthropometric measurements obtained through bioelectrical impedance analysis (BIA) of each of the patients was carried out; including weight, height, and BMI, with the objective of describing the surgical complications that occurred, as well as the categorization according to BMI range, and its possible correlation. From a database of 121 records of patients brought to a medical-surgical board for approval of gender affirmation procedures, a total of 78 patients were included, of which 33 presented post-surgical complications; 37 patients underwent feminization surgeries and 41 masculinization surgeries. In patients with post-surgical complications, it was found that 3% had a BMI less than 20 kg/m², 47% of the population had a BMI between 20 and 24 kg/m², 28% had a BMI between 25 and 29 kg/m², and 9 % of patients had a BMI grater than 30 kg/m². Most frequent complications were derived from thoracic masculinization surgery, highlighting suture dehiscence (7 cases), pectoral collections (6 cases) and tension hematomas (2 cases). All patients had in common post-surgical complications secondary to thoracic masculinization and BMI within normality. Conclusions Overweight and obesity are associated with an increase in surgical complications. Therefore, it is recommended that patients undergoing gender affirmation interventions should have a normal BMI, with the aim of reducing it, and achieving better surgical results. However, in our study, it was evident that these complications occurred predominantly in patients with BMI within normal range. These results could suggest that obesity is not associated with a significant increase in post-surgical complications. This provides important bases to carry out new studies that allow confirming these findings and bringing them to clinical practice. More evidence will reduce treatment barriers in these patients, allowing comprehensive treatment, and thereby improving the quality of life and biopsychosocial dysfunction of individuals with this condition. Abbreviations Body mass index (BMI), Bioelectrical impedance analysis (BIA)
Presentation: 6/3/2024
7627 Prevalence Of True Endocrinopathies In Patients Presenting To An Endocrine Clinic With Fatigue
Authors: Dimech Christina , Barnett Katherine , Hasan Farhad 
Published: October 2024

Abstract
Disclosure: C. Dimech: None. K. Barnett: None. F. Hasan: None.
Introduction: Fatigue is a common chief complaint, resulting in approximately 7 million physician office visits per year in the US. Fatigue is a non-specific symptom which can be associated with many acute or chronic conditions. In our clinical experience fatigue is a frequent reason for referral to the endocrine clinic, and often assessment does not reveal an endocrine pathology. However, the prevalence of endocrinopathies discovered following endocrinology assessment has not been well studied. Methods: In this retrospective study, we completed chart review of electronic medical records of patients who were evaluated for a chief complaint of fatigue at outpatient endocrinology centers belonging to an integrated health network in the Pittsburgh Metro area. We included patients aged 18-40 years old from 01/01/2019- 12/31/2022. We hypothesized that there is not a significant incidence of endocrinopathies found on evaluation. Results: Extensive clinical and laboratory data were gathered for 226 patients during the study period. 39.9% of patients were self-referred. 60.1% of patients seen were through physician referrals, however 17.9% of these patients had no prior investigations completed. The majority of patients evaluated for fatigue were female (76.5% vs 23.5%). 55.3% of patients were 30-39 years of age. 27% of patients were overweight and 23% were obese with BMI 30 or greater. Nearly half of all patients had a diagnosis of anxiety or depression (51.7% and 48.2% respectively). Of those patients with anxiety, 57.3% were prescribed an SSRI or SNRI. Similarly, 58.7% of patients with depression were prescribed an SSRI/SNRI. Patients most commonly reported other non-specific symptoms such as weight gain, poor sleep and poor mood (51.3%, 38.9%, 25.2% respectively). 54.9% of female patients presenting with fatigue were concerned for thyroid dysfunction whereas 45.3% of male patients were concerned for hypogonadism. 12.3% of patients evaluated never completed the recommended testing. Vitamin D deficiency was notably prevalent in 42.4% of patients tested. One patient was found to have secondary adrenal insufficiency in the setting of chronic exogenous glucocorticoid use for back pain. Of 163 patients tested for thyroid dysfunction, no new diagnoses of thyroid abnormalities were revealed. Conclusion: In this study, laboratory testing from an endocrinology consultation was not useful in detecting newly discovered endocrinopathies as a cause of fatigue.
Presentation: 6/2/2024
8059 An Interesting Case Of Hypogonadism Likely Caused By Cushing's Syndrome
Authors: Ripa Rashelle , Su Jennifer , Patel Ronak 
Published: October 2024

Abstract
Disclosure: R. Ripa: None. J. Su: None. R. Patel: None.
Introduction: Cushing’s Syndrome is a rare endocrine disorder that comprises a multitude of symptoms caused by hypercortisolism. Given non-specific symptoms, the disease can often be overlooked for more common diseases, such as diabetes, obesity, and even hypogonadism. Hypogonadism is a clinical disorder defined by decreased functional activity of the gonads. The diagnosis can often be challenging in developed males, who present with hypogonadotropic hypogonadism without an obvious cause. Here we present a case of a male who presented with hypogonadism symptoms for at least 5 years before being diagnosed with Cushing’s syndrome. Case Presentation: 58-year-old Caucasian male with a medical history of hypertension, cardiomyopathy and a BMI of 23, presented with decreased libido and erectile dysfunction. He was started on testosterone therapy three years prior, however it was discontinued due to heart failure. Without testosterone replacement, lab work was notable for: low free and total testosterone, 21.4 and 50.6 ng/dL, respectively, inappropriately normal findings of LH, FSH (1.0 and 4.9 IU/L, respectively), as well as unremarkable findings of GH, Prolactin, TSH, pituitary MRI and testes ultrasound, leading to a suspicion of hypogonadism. Due to persistent symptoms of hypogonadism and low testosterone, clomiphene was started but later changed to testosterone therapy after cardiology consultation. Shortly after, he began reporting facial flushing, associated with facial roundedness and elevated blood pressure. Upon further work up, hyperaldosteronism and pheochromocytoma testing was negative and his baseline cortisol was 21.9 mcg/dL with a low adrenocorticotropic hormone (ACTH), &lt;5 pg/mL. Further, dexamethasone suppression testing showed suboptimally suppressed cortisol (14.4 mcg/dL). An abdomen MRI with and without contrast revealed a 2.3 cm adrenal adenoma, confirming an adrenal source of Cushing’s syndrome, and he underwent an adrenalectomy. Post-procedure, his cortisol and ACTH levels normalized to 10.5 mcg/dL and 39 pg/mL, respectively, showing a revival of his hypothalamic - pituitary - adrenal axis. Unfortunately, however, his free and total testosterone levels continued to remain low (38.9 and 152 ng/dL, respectively) and he was continued on testosterone therapy. Discussion: Our patient initially presented with decreased libido, and low testosterone levels and was treated for hypogonadism, as he did not have typical Cushing’s symptoms. Due to eventual weight gain and facial edema, it was only then that work up was pursued showing hypercortisolism release, leading to a proper diagnosis of Cushing’s syndrome. Hypercortisolism can affect all parts of the body, including hormones, muscles, joints and bones. When presenting in the initial stages and with mild symptoms, the diagnosis of hypercortisolism is often challenging and can go undetected for many years.
Presentation: 6/2/2024
7053 Sex Differences in Endocrine-Related Pre-existing, COVID-19- and COVID-19 Vaccine-Related Health Conditions and Adverse Events
Authors: Knapp J , Karumanchi R , Fee C , Inslicht S , Bhargava A 
Published: October 2024

Abstract
Disclosure: J. Knapp: Other; Self; Co-founder, Aseesa Inc. R. Karumanchi: None. C. Fee: None. S. Inslicht: None. A. Bhargava: Other; Self; Co-Founder, Aseesa Inc.
COVID-19 illness-related symptoms and outcomes are highly variable, with reported sex differences. mRNA vaccines were deployed for the first-time on a large scale for COVID-19, and the endocrine effects of Pfizer’s and Moderna’s mRNA vaccines, remain to be elucidated. Associations between COVID-19 illness and/or COVID-19 vaccines and reproductive disturbances have been reported based on large nation-wide surveys and targeted studies. Yet, none of the studies have directly ascertained similarities and differences between reproductive adverse outcomes from COVID-19 illness in unvaccinated individuals versus COVID-19 mRNA vaccines in individuals without COVID-19 illness. Here, we report preliminary findings on endocrine systems from a global survey of ∼8,000-10,000 participants collected between February 2022 and October 2023. Approximately 62.5% of the participants were from the United States, and the remaining were international. Nearly 1.49% of respondents reported hospitalization after COVID-19, whereas 5.69% of the respondents reported hospitalization after vaccination in our cohort. SARS-CoV-2-related severe symptoms were reported by ∼9.3% of COVID-19 vaccinated versus 6.7% of unvaccinated individuals (p&lt;0.001). Women reported more vaccine-related adverse events (AEs) than men; 30% of men and 19% of women reported no AEs after any vaccination dose. After the first dose, 60% women and 48% of men reported some AEs, whereas after the second dose, 46% of women and 40% of men reported experiencing several AEs. Sex differences were present in endocrine and autoimmune pre-existing health conditions, including thyroid disease (13%F vs 3%M), osteoporosis (6%F vs 1%M), elevated cholesterol (M&gt;F), and hypertension (M&gt;F). Nearly 5% of women reported pre-existing irregular menstrual cycle irregularities and hormonal changes, whereas only 2% of men reported hormonal irregularities. In unvaccinated individuals, after COVID-19 illness, nearly 6% of women reported experiencing hot flashes, whereas 7.5% reported irregular menstrual cycles. In COVID-19 vaccinated individuals without SARS-CoV-2 infection, 94.6% of men and 62.5% of women respondents reported no reproductive changes. Of those reporting reproductive AEs included hormonal changes in 5% of women and 3.5% men, hot flashes in 8.5% women and 1.9% men, heavy periods and/or dysmenorrhea in 16.7% of women, and irregular periods in17.1% of women. In summary, reproductive AEs in vaccinated individuals without COVID-19 illness were more frequent than in unvaccinated individuals with COVID-19 illness. A detailed and thorough follow-up is needed to better understand if pre-existing health conditions exacerbated vaccine-associated AEs.
Presentation: 6/3/2024
6428 Update on Genetic F6428 actors of Nonalcoholic Fatty Liver Disease
Authors: Heshmati Hassan M 
Published: October 2024

Abstract
Disclosure: H.M. Heshmati: None.
Background: Nonalcoholic fatty liver disease (NAFLD) is a pandemic with a prevalence of 25% among the adult population worldwide. NAFLD is a spectrum of liver disorders ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). NASH can progress to cirrhosis and hepatocellular cancer. The pathogenesis of NAFLD is complex and multifactorial, involving metabolic, epigenetic, and genetic factors. Several medical conditions (e.g., obesity, type 2 diabetes, inflammation, insulin resistance, disrupted gut microbiome, and impaired intestinal barrier function) are important risk factors associated with and/or contributing to NAFLD. This review presents an update on the genetic factors of NAFLD identified by the genome-wide association studies (GWAS). Methods: A systematic search of literature was conducted using the search terms nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, cirrhosis, hepatocellular cancer, obesity, type 2 diabetes, epigenetics, and genetics. Results: Evidence for the contribution of genetic factors to NAFLD is further emphasized by the ethnic differences in the prevalence of NAFLD (e.g., higher prevalence among Hispanic American compared to African American adults). Based on the results of the GWAS, several genetic modifiers are relevant to NAFLD development and progression. They include variations in patatin-like phospholipase domain-containing protein 3 (PNPLA3), transmembrane 6 superfamily 2 (TM6SF2), membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7), glucokinase regulatory protein (GCKR), programmed cell death protein 1 (PDCD1), and hydroxysteroid 17β-dehydrogenase 13 (HSD17B13) genes (non-exhaustive list). These genetic modifiers interact with the metabolic and epigenetic factors for the development and progression of NAFLD and are responsible for the variability in the severity of NAFLD. The PNPLA3 gene variant (rs738409), which is the first and the best validated genetic modifier, is associated with a high risk of development and progression of NAFLD. The PDCD1 gene variant (rs7421861) is independently associated with hepatocellular cancer development. In contrast, the HSD17B13 gene variant (rs72613567) may have a protective effect for NAFLD risk. Conclusion: NAFLD is a multifactorial condition with a complex pathogenesis involving the interactions between metabolic, epigenetic, and genetic factors. The prevalence and risk of NAFLD differ across populations mainly due to genetic polymorphisms. Genetic factors relevant to NAFLD include variations in PNPLA3, TM6SF2, MBOAT7, GCKR, PDCD1, and HSD17B13 genes. A better understanding of these genetic modifiers and their mechanisms of action should allow a better risk prediction of the development of NAFLD and its progression to cirrhosis and hepatocellular cancer and help the development of new and selected therapies for NAFLD.
Presentation: 6/3/2024
7479 An Uncommon Indolent Form Of Adrenocortical Carcinoma
Authors: Arumugam M , Kim G 
Published: October 2024

Abstract
Disclosure: M. Arumugam: None. G. Kim: None.
Introduction: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy that typically presents with characteristic clinical and biochemical manifestations that are aggressive in nature. We present a case of ACC which was incidentally noted on imaging with no symptoms or signs of hormone excess. Case report: A 62-year-old male was noted to have an adrenal mass during evaluation of 30 lb unintentional weight loss and failure to thrive. The adrenal mass measured 18.3 x 14.4 x 6.8 cm with central necrosis and demonstrated extrinsic mass effect on surrounding structures. He denied any symptoms of hypercortisolism or clinically apparent androgen excess. He quit smoking 31 years ago and occasionally chews tobacco. Overnight dexamethasone suppression test with 2 mg dexamethasone showed an appropriately suppressed cortisol of 1.3. Androgen levels including DHEA-S, androstenedione, testosterone, and 17 hydroxy-progesterone were all within the normal range. PET CT revealed intensely increased radiotracer uptake in a large central necrotic mass in left adrenal gland, suggestive of malignant neoplasm. No other abnormal radiotracer activity was noted to suggest metastasis. The patient underwent left adrenalectomy. Intraoperatively, invasion of left kidney and tail of the pancreas was noted. Left nephrectomy was performed, and the pancreas was dissected off. The pathologist used three different staging systems to characterize the adrenal tumor. The Helsinki scoring system and Reticulin Algorithm were consistent with Adrenocortical Carcinoma. The Lin-Weiss-Bisceglia grading interpreted it as adrenal oncocytic neoplasm of uncertain malignant potential. Given the latter interpretation, the case was sent to Massachusetts General Hospital (MGH) for expert opinion. MGH deemed the tumor to be low-grade adrenocortical carcinoma. Conclusion: This is an uncommon presentation of adrenocortical carcinoma with patient presenting with weight loss and failure to thrive but without biochemical findings such as elevated cortisol or androgens.
Presentation: 6/1/2024
8710 “The Refractory Giant”: Functional FSH-Producing Pituitary Adenoma, A Case Report
Authors: Manolas Melina , Samavedam Janaki Manasa , Stefan Simona , Sapna Fnu 
Published: October 2024

Abstract
Disclosure: M. Manolas: None. J. Samavedam: None. S. Stefan: None.
Introduction: Gonadotroph pituitary adenomas are common but typically hormonally silent. Functioning gonadotroph adenomas (FGAs) are rare, accounting for less than 1% of pituitary adenomas, and pose unique clinical challenges. We report a rare case of a functional FSH-producing pituitary macroadenoma refractory to multiple resections. Clinical Case: A 50-year-old woman with a long history of FSH-producing pituitary macroadenoma, complicated by central adrenal insufficiency and hypothyroidism, was admitted for altered mental status and complete vision loss. Brain MRI revealed a residual pituitary mass over 8cm in size with multi-directional extension. She initially presented at age 35 with menorrhagia and diplopia. She underwent transsphenoidal resection (TSS) in Jamaica with no records of hormonal assessments or pathology available from that procedure. In 2012, brain MRI showed residual invasive 3.2cm tumor compressing the optic chiasm. Laboratory results revealed high FSH of 74.5 mIU/mL (RR: Follicular, days 2-3 - 3.0-14.4; Follicular, midcycle - 5.8-21.0; Luteal - 1.2-9.0), low LH of 2.68 mIU/mL (RR: Follicular, days 2-3 - 1.1-11.6; Follicular, midcycle - 17.0-77.0; Luteal - 1.0-14.7), and significantly elevated Estradiol of 1800 pg/mL (RR: 6.0-490) concerning for a functional, FSH-producing adenoma. Pathology from repeat TSS confirmed isolated FSH immunopositivity. She was started on Bromocriptine but given refractory menorrhagia required total hysterectomy and bilateral salpingo-oophorectomy, after which her Estradiol level was undetectable. Between 2014 and 2020 the tumor grew from 3.8cm to 6.8cm, resulting in ongoing visual field defects necessitating a third TSS. Surprisingly, the tumor consistently demonstrated a Ki-67 index of 3% or less. Despite a low mitotic index, it eventually exceeded 8cm in size, causing hallucinations, seizures, memory deficits, and complete vision loss due to progressive extrasellar extension with mass effect on the right temporal lobe. The family is engaged in discussions to weigh the risks and benefits of further tumor debulking. Conclusion: In premenopausal women, FGAs may present with menstrual irregularities, menorrhagia, or ovarian hyperstimulation syndrome as a consequence of hypothalamic-pituitary-gonadal axis dysregulation. They often go undiagnosed or misdiagnosed until the patient develops symptoms of mass effect. Standard treatment for FGAs is tumor resection. While dopamine agonists can help reduce estradiol levels and ovarian size, they do not appear to decrease pituitary tumor size. Existing literature shows that FSH-producing FGAs typically respond well to surgical resection. However, our case is exceptional due to the unusual size of the tumor, its rapid regrowth, and its resistance to multiple resections despite a low Ki-67 index. This atypical case warrants reporting and further discussion.
Presentation: 6/2/2024