bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-04 A PATIENT WITH A GIANT ADRENAL MASS DETECTED DURING PREGNANCY
Authors: Belten Zeynep Elüstü , Ciftci Sema , Mert Meral , Çakır Ilkay , Kimyon Özge Şahin , Mısıroğlu Fuat , Piskinpasa Hamide 
Published: January 2025

Abstract

Introduction
Although the frequency of adrenal incidentalomas is increasing, they are rarely detected due to lack of imaging during pregnancy. Here, we present a case of adrenal incidentaloma diagnosed during pregnancy.

Clinical Case
A 32-year-old female patient was diagnosed with a mass in the liver during obstetric ultrasonography performed in the 4th month of pregnancy and was referred to gastroenterology clinic for further examination, but any additional intervention could not be made because of patient’s refusion. She underwent an emergent caesarean section at 36th weeks of pregnancy. A mass approximately 15 cm in size, thought to be of adrenal origin, was detected in the retroperitoneal area posterior to the liver at the surgery. Abdominal MRI revealed a 188*121*113 mm non-adenomatous lesion, at right adrenal gland, containing cystic necrotic areas, and not suppressed in fat-suppressed series (figure 1A). At initial assesment by endocrinology, the patient denied any paroxysmal or persistent hypertension, weakness, weight gain and hirsutism. Physical examination was found normal, no signs of Cushing’s syndrome was observed. Laboratory testing including 24-hour urine catecholamines, basal cortisol, dehydroepiandrosterone sulfate (DHEA-S), adrenocorticotropic hormone (ACTH) were in reference ranges. The cortisol levels were supressed following the low-dose dexamethasone test. Adrenal carcinoma was suspected based to radiological features of the lesion. FDG uptake of the mass with a SUVmax: 16.9 was reported at PET-scan (figure 1B). Laparotomy for right adrenal gland was planned, but the patient disapproved once again. She underwent to adrenalectomy 18 months later after the mass was detected. Surprisingly, the pathology resulted as adrenocortical adenoma. Ki67 labeling index was found to be 3-4%, immunohistochemical staining of tissue specimens showed that synaptophysin and chromogranin A negative ( - ), but CD56 positive (++). The patient was lost for approximately 1 year and then aplied to our clinic with another unplanned pregnancy. She is doing well at the 32nd week of her second pregnancy.

Conclusion
Large and non-adenomatous masses detected during pregnancy are likely to be malignant and these masses are usually known with poor-prognosis. Rarely, as seen in our patient, huge adrenal masses may exhibit a benign behavior compatible with an uncomplicated long process despite suspicious radiological imaging features.Figure 1A:Abdominal MRI revealed a 188*121*113 mm non-adenomatous lesion, at right adrenal gland containing cystic necrotic areas. B:Increased uptake of FDG in the right adrenal region (SUVmax: 16.9)
P-11 A CASE OF TUBERCULOSIS ADRENAL INSUFFICIENCY
Authors: Lateef Mustafa Mohamed Abdu , Khudhair Mahmood Shakir 
Published: January 2025

Abstract

Introduction
Adrenal tuberculosis is rare form of extrapulmonary tuberculosis, and may cause to primary adrenal insufficiency. This report presents a case of middle age male diagnosed with adrenal tuberculosis.
Tuberculosis is a major health concern worldwide. The extrapulmonary manifestations account for 5% to 15% of all cases, although adrenal tuberculosis is uncommon, it can lead to primary adrenal insufficiency and has diagnostic challenges due to its nonspecific presentation. Pulmonary Tuberculosis is still common in Iraq, although no case reports exit up to our knowledge of adrenal Tuberculosis.

Clinical Case
40-year-old man, sanitation worker, presents with 3 months history of significant weight loss and fever with night sweating. He complains of nausea, occasional vomiting, fatigue, unintentional weight loss of approximately 12 kg, decreased appetite, abdominal pain and joint pain. He also reports skin hyperpigmentation particularly in the hand creases, mouth and mucous membranes of the lips. There are no respiratory symptoms such as shortness of breath or cough. The past medical history is unremarkable. There is positive family history of pulmonary tuberculosis (grandmother). He does not smoke or drink alcohol.
Physical examination reveals ill-looking malnourished patient, with BP of 100/60 with postural hypotension, PR of 80 bpm and RR of 24/min. There is diffuse hyperpigmentation particularly noted in palmer creases and oral cavity. The other system examinations are normal.
Laboratory investigations revealed mild normochromic normocytic anemia (Hb 11.4), and mild lymphocytosis, Na 126 mEq/l, k 4.1 mEq/l, FBS 87 mg/dl, high ESR, mild elevation of TSB 1.8 mg/dl normal renal function, morning cortisol of 0.75 Mcg/dl and morning ACTH of 1808 pg/ml.
Imaging studies show a normal chest X-ray. Abdominal CT reveals bilateral adrenal enlargement in size with lobulated irregular contours and heterogeneous density exhibiting foci of calcification and central cystic/necrotic non-enhancing centers, with predominantly peripheral enhancement seen on the contrast scan. The mean density of the solid parts of the glands is around 30-40 HU on the native scan, the right adrenal measures 2.7x1.7x2.7 cm, the left adrenal measures 5.6x3.2x2.5 cm. IGRA test is positive. Adrenal biopsy was not performed because the presentation was highly suggestive of adrenal tuberculosis.The diagnosis was primary adrenal insufficiency due to adrenal tuberculosis Anti TB drugs were initiated on standard regimen of INH, Rifampicin, Pyrazinamide, and Ethambutol. Hydrocortisone replacement was initiated. The patient required higher dose of hydrocortisone (20 mg in the morning, 10 mg at 6 pm) which could be due to CYP 3A4 induction by rifampicin Fludrocortisone 0.1mg daily was also started. The patient’s symptoms improve dramatically after initiation of treatments, with gradual increase in body weight.Figure 1:Hyperpigmentation of the patient hands
P-30 ROLE OF PLASMAPHERESIS IN TREATING A RARE CASE OF EXOGENOUS INSULIN ANTIBODY SYNDROME (EIAS) IN A YOUNG PATIENT WITH TYPE 1 DIABETES MELLITUS IN BABYLON GOVERNORATE: A CASE REPORT
Authors: Alsaffar Yassamin Riyadh , Algburi Saif Mohammed 
Published: January 2025

Abstract
Clinical Case
A 17-year old female patient who was diagnosed with type 1 diabetes mellitus (DM) seven years ago, and she had continuously very high blood glucose readings with recurrent admissions to the emergency unit due to attacks of DKA. In addition to a planned diet, she was on more than 250 units of insulin per day (while her weight was 75 kilograms). She was initially on human insulin in the form of twice NPH insulin injections, and pre-meal regular insulin injections, in addition to repeated regular insulin correction doses without any reduction of her blood glucose. Then she was shifted to insulin analogues (to eliminate the possibility of insulin immunogenicity which have been encountered with the use of human insulin), in form of basal insulin Glargine OD, plus pre-meal rapid acting insulin Glulisine without any noticeable response. Continuous switching of her injection sites, with an in-hospital observed insulin injections (to avoid noncompliance), even the use of intravenous route did not help to achieve a glycemic control. Later on, metformin 1000 mg XR BID was added to her daily treatment without any benefit. A screen of anti-insulin antibodies was done and found to be elevated (which should be negative after all these years after her initial diabetes diagnosis). A presumptive diagnosis of EIAS (Exogenous Insulin Antibody Syndrome) was put. A small dose of steroids was administered with close observation (to avoid exacerbation ketosis) without any improvement. Then Cellcept (Mycophenolate mofetil), an immune modulator was added at a dose of 500 mg BID and increased 48 hrs. later to 1000 mg BID and resulted in a minimal reduction of her blood glucose levels. Finally the decision of plasmapheresis was made and an informed consent was obtained from the family after explaining the condition. A good response was recorded after the 1st session, with a minimal decrease of her total daily insulin doses. Later on, an additional excellent response was received during the next 2 sessions with a rapid decline of her glucose readings and her total daily insulin doses. She had recurrent attacks of hypoglycemia during her third and last plasmapheresis session. Her total daily dose of insulin was successfully reduced by more than 50%, and her general condition was improved noticeably without any recorded adverse reactions, as shown in the blood glucose logbook photos attached below.Figure 1:Glucose logbook after the 3rd and last session of Plasmapheresis Table 1:Response parameters to three sessions plasampheresis therapy
P-51 A RARE CASE IN WHICH ACROMEGALY IS PROVEN CLINICALLY AND BIOCHEMICALLY DESPITE NEGATIVE GH IMMUNOHISTOCHEMICAL STAINING
Authors: Özışık Hatice , Ünal Kocabaş Gökçen , Ulaş Ezgi , Ertan Yesim , Biçeroğlu Hüseyin , Yürekli Banu Sarer , Yarman Sema 
Published: January 2025

Abstract

Introduction
The diagnosis of acromegaly is confirmed by high IGF-1 and GH levels. When a GH-secreting pitNET is resected, immunocytochemistry with GH staining typically supports the diagnosis. It is very rare for these tumors to stain negatively for GH in the presence of clinical and biochemical acromegaly. We are presenting a case of growth hormone (GH)-secreting PitNET with negative immunostaining for GH.

Clinical Case
50-year-old male with history of headache and visual disturbances was found to have a pituitary macroadenoma. Years before the presentation, he noticed his shoe size had increased. Physical exam was notable for enlarged nose, thick lips, mandibular prognathism, and enlarged hands and feet. Blood pressure was 140/90 mmHg. Pre-operative laboratory results were remarkable for elevated GH 5.6 ng/ml (0.03-2.47) and IGF-1 816 ng/ml (80.6-207) levels. OGTT suppressed GH nadir 3.95 ng/ml. Pituitary MRI revealed an invasive macroadenoma measuring 37x31x40 mm (Figure 1). The patient underwent transsphenoidal surgery. Although GH and IGF-1 levels decreased after surgery, they did not return to the normal range. Visual field loss improved. Surprisingly, in the histopathological examination, no immunohistochemical staining was detected with GH and other anterior pituitary hormones, and Ki-67 was found to be 2%. Due to disease activity (IGF-1:278 ng/ml; 1.3XULN), medical treatment was started first with dopamine agonist and then continued with somatostatin receptor agonist (IGF-1:322 (1.6xULN). The remaining tumor tissue remained stable under treatment.

Conclusion
Silent somatotrophinomas detected by immunohistochemical staining have been reported in the literature. Conversely, endocrinologists should keep in mind that there may be rare cases in which immunohistochemical GH staining is negative but clinical and hormonal acromegaly is evidenced.Figure 1Magnetic resonance imaging (MRI) revealed a pituitary macroadenoma 37x31x40 mm in size, with Knosp grade 4 on the right and grade 1 on the left
P-52 ASYMPTOMATIC MIXED PITUITARY MACROADENOMA IN A YOUNG MALE PATIENT
Authors: Omma Tülay , Imge Aydoğan Berna , Emmez Hakan , Cesur Mustafa 
Published: January 2025

Abstract

Introduction
Central hyperthyroidism due to a thyrotropin (TSH)-secreting pituitary adenoma is a rare cause of hyperthyroidism, representing 0.5-1.0% of all pituitary adenomas. The etiopathogenesis of TSH-secreting-adenomas is unknown and no definite role for various oncogenes has been proven. Plurihormonal pituitary adenomas reveal greater tumor recurrence and local invasion than do mono-secreting pituitary adenomas and therefore they need to be followed more closely.

Clinical Case
We present the case of a 19-year-old male who was admitted to the endocrinology clinic, was asymptomatic, and had abnormal thyroid tests during routine examinations. Laboratory tests revealed TSH 1.33 (normal RI), freeT4 2.5 (high), freeT3 6.78 (high), and the patient had tachycardia (pulse 120/min) on physical examination, but had no complaints. Thyroid antibody tests were negative, and ultrasonography revealed normal thyroid gland size and homogeneous parenchyma. Alpha subunit test was requested with suspicion of TSHoma and genetic test was requested considering thyroid hormone receptor resistance. In the pituitary panel tests, the patient's GH and IGF1 tests were found to be high for his age and gender, The lowest GH value in the GH-OGTT test was 3.95 ng/mL. LH was high but testosterone was within the normal reference range. The patient was found to have mandibular prognathism and his secondary sex characteristics were normal. Pituitary MRI revealed a nodular appearance on the left side of the pituitary gland, measuring 13x9 mm, hypointense on T1A, hyperintense on T2A, and showing contrast medium uptake. The infundibulum deviates to the right, and there is no pressure on the optic chiasm. Visual field test was normal. AlphaSubunit pituitary tumor marker value was found to be high at 1.9ng/mL (RIs ≤0.5). The genetic test for resistance to thyroid hormone, also came back normal. The patient underwent endoscopic transsphenoidal pituitary adenomectomy due to pituitary macroadenoma by an experienced neurosurgeon. No postoperative complications developed. In cytopathological evaluation, histochemical studies performed with silver stain showed that the reticulin roof was lost. In immunohistochemical studies, SF-1, PIT-1, LH (diffuse), GH (densely granular), TSH (rare) and LMWK (perinuclear cytoplasmic weighted) were positive. T-PIT and Prolactin were negative. Ki-67 proliferation index was 5%. Postoperative pituitary tests were normal and no deficiency was observed and no treatment was required. At the postoperative 3rd month follow-up, the lowest GH value in the GH-OGTT test was 0.16 ng/mL, and no residual mass was observed in the pituitary MRI. The patient, who had no postoperative complaints, is being followed up by the endocrinology clinic.

Conclusion
Mixed pituitary tumors are rare and can sometimes appear as silent tumors, but may be aggressive during follow-up, so better follow-up is necessary.Table 1:Pituitary panel biochemical results
P-53 PITUITARY STALK INTERRUPTION SYNDROME: A CASE REPORT
Authors: Rıza Baykal Gokhan , Keskin Müge , Yazgan Pınar , Aydın Cevdet , Topaloğlu Oya , Ersoy Reyhan , Çakır Bekir 
Published: January 2025

Abstract

Introduction
Pituitary stalk interruption syndrome (PSIS) is a congenital abnormality of the pituitary gland responsible for GH deficiency or global pituitary insufficiency and is usually characterized by the triad of a very thin or interrupted pituitary stalk, an ectopic (or absent) posterior pituitary (EPP), and hypoplasia or aplasia of the anterior pituitary visible on magnetic resonance imaging (MRI). The etiology of this syndrome is not fully understood, and many theories, like perinatal injuries or defective organogenesis due to genetic or environmental factors during pregnancy, are proposed. In family cases of PSIS, rare mutations of HESX1, LH4, OTX3, SOX3 and PROKR2 may be the cause. In the majority of cases, no genetic cause is found. The symptoms and signs of this syndrome typically become apparent in the neonatal period and childhood. Sometimes symptoms can be overlooked, and diagnosis can be delayed.

Clinical Case
A 22-year-old male presented in our clinic with hypothyroidism and growth hormone deficiency. He had previously received growth hormone (GH) treatment for 6 years until he was 15 years old. He was receiving levothyroxine therapy for hypothyroidism. Complete blood count, serum electrolytes, erythrocyte sedimentation rate, urinalysis, and thyroid function tests were normal. Hormonal analysis showed FSH: 11.9 U/L (N = 1.4-18.1 U/L), LH: 4.1 U/L (N = 1.5-9.3 U/L), prolactin: 9.1 μg/L (N = 5.4-15.4 μg/L), ACTH: 24.5 pg/mL (N = &lt;46), fasting morning cortisol: 17.2 μg/dL (N = 5.2-22.4 μg/dL), total testosterone: 4.03 μg/L (N = 1.64-7.53 μg/L), free testosterone: 6.39 pg/mL (N = 5.4-40 pg/mL), IGF-1: 114 μg/dL (N = 161-384 μg/dL). Brain MRI revealed slightly hypoplastic sella turcica and adenohypophysis measuring 4.2 mm in height, thin infundibulum, and ectopic posterior pituitary located posterior to the infundibulum in the suprasellar cistern. The diagnosis of pituitary stalk interruption syndrome is mainly based on its clinical manifestations, laboratory tests, and imaging examinations.

Conclusion
PSIS is a rare congenital malformation that presents with significant growth and developmental challenges in children. The symptoms can be disregarded, and the diagnosis will therefore be delayed. Early diagnosis and treatment are crucial for improving growth outcomes and overall quality of life. It must be considered in the presence of combined or isolated hypopituitarism. MRI is the imaging modality of choice for the diagnosis of this condition. Regular monitoring and supportive care are essential components of effective management for these patients.
Can Family Policies Enhance Fertility? An Ex Ante Evaluation Through Factorial Survey Experiments
Authors: Guetto Raffaele , Alderotti Giammarco , Vignoli Daniele 
Published: January 2025

Abstract
This article explores the family policies–fertility nexus by assessing the potential impact of parental leaves, childcare services, and child benefits on fertility through a factorial survey experiment (FSE). We focus on Italy, where persistently low fertility rates are often linked to limited welfare support for families. We surveyed 4,022 respondents aged 20–44 and exposed them to various scenarios characterized by different family policy packages. We asked them to ascribe short-term fertility behavior to a fictitious couple under each scenario. Results show that each family-friendly policy envisioned positively impacts ascribed fertility. The availability of full-time, public childcare services seems more relevant than higher child benefits, whereas more generous and gender-equal parental leaves are perceived as less relevant. However, results suggest that only a consistent mix of financial benefits, parental leave schemes, and childcare provisions can boost fertility. In contrast, marginal changes in single policy levers are most likely ineffective. The FSE reveals that a couple's socioeconomic status is perceived as more important than family policies for fertility: ascribed fertility increases when both partners are employed and household income is high. We conclude by discussing the policy implications of our findings.
Stratified Impact of Therapies on Anaplastic Thyroid Cancer Outcomes in the Pre-Gene-Targeted Therapy Era
Authors: Zhang Kun , Wang Xinyi , Lei Jianyong , Su Anping , Wei Tao , Li Zhihui , Chen Ya-Wen 
Published: January 2025

Abstract

Background
Anaplastic thyroid cancer (ATC) is a highly lethal disease, often diagnosed with advanced locoregional and distant metastases, resulting in a median survival of just 3–5 months. This study determines the stratified effectiveness of baseline treatments in all combinations, enabling precise prognoses prediction and establishing benchmarks for advanced therapeutic options.

Methods
The study extracted a cohort of pathologically confirmed ATC patients from the Surveillance, Epidemiology, and End Results program. Overall, 1879 patients from 2000 to 2018 were identified from the database. Kaplan–Meier survival curve estimation and Cox proportional hazard regression were applied.

Results
Overall, compared with no treatment, surgery raised 1-year overall survival (OS) from 0.6% to 30% and median survival from <1 month to 3 months in ATC patients. For stage IVa, surgery increased 1-year OS from 21.5% to 71.8% and median survival from 2 to 23.5 months, and in stage IVb, surgery increased 1-year OS from 9.4% to 41.3% and median survival from 2 to 7 months; however, in stage IVc, the benefits of surgery were not markedly different from non-surgical approaches. When combined with surgery, other effective non-surgical ATC treatments demonstrated a surgery-dominant synergistic effect, particularly for stages IVa and IVb ATC, but not for stage IVc ATC.

Conclusions
Our study provides insights into stratified baseline treatments for patients with ATC in all stages, emphasizing surgery’s vital role in a multimodal approach.
Surface heating measurements with temperature-sensitive paint films using fluorescent lifetime analysis
Authors: Edwards Sophia , Gragston Mark 
Published: January 2025

Temperature-sensitive paint applied to an adhesive film was used to measure surface heating utilizing a fluorescent signal lifetime analysis, in which the ratio of excitation and decay exposures was mapped to temperature via calibration. This work discusses a two-level model of the TSP fluorescence in response to pulsed excitation and uses it to extract the temperature variation of emission decay lifetimes in a ruthenium-based paint. The resulting calibration curves from the lifetime analysis are used in measurements of wall heating in a small shock tube at a net frame rate of 25 kHz. The results show good agreement with simultaneously acquired IR thermography obtained at 240 Hz.
Noise and stability characteristics of electrically controllable mid-infrared filters for high-sensitivity NDIR sensors
Authors: Awane Yusuke , Inoue Takuya , Noda Susumu 
Published: January 2025

This study investigates the noise performance of a non-dispersive infrared (NDIR) gas sensor using multi-quantum wells (MQW) and photonic crystal (PC) structures. Noise levels were evaluated using the Allan variance method, and the limit of detection (LOD) was found to be 3.8×10−3 abs. at a 10 ms integration time and 2.7×10−4 abs. at a 3 s integration time, and long-term stability was also evaluated through filter stacking. To enhance the performance, the filter design was optimized through adjustments to the MQW absorption peak, PC resonance frequency, and doping concentration. Additionally, improvements in the optical system increased the modulated light intensity by approximately 8.5 times, reducing the LOD to 3.2×10−5 abs. at a 3 s integration time. These advancements enable high-sensitivity gas detection suitable for industrial applications such as automotive exhaust gas measurement and environmental monitoring.