bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI088 Vanishing Bile Duct Syndrome?
Authors: Malvar Cyerwin Monique T , Bleich David , Moran Heberth 
Published: October 2023

Abstract
Disclosure: C.T. Malvar: None. D. Bleich: None. H. Moran: None.
Background: Dyslipidemia is a common metabolic disorder in the US, but only a few conditions can cause a total cholesterol greater than 1000 mg/dl. We present a suspected case of vanishing bile duct syndrome in a patient referred to the emergency department due to transaminitis. Case Report: A 41-year-old female with type 2 diabetes mellitus and alcohol use disorder was found to have abnormal liver function tests. She had jaundice, pruritus, and bipedal edema for 2 weeks, but had quit drinking approximately 2 years ago. She denied any recent travel, sick contacts, prior history of hyperlipidemia, family history of premature CAD or lipid abnormalities. On chart review, she received Azithromycin 2 months before presentation for a presumed upper respiratory tract infection. On evaluation, she had scleral icterus and jaundice. Initial labs revealed Na 117 (133 - 145 meq/l), Cl 84 (97 - 110 meq/l), glucose of 542 (70 - 109 mg/dl), total bilirubin 20.9 (&lt;=1.0 mg/dl), 218 (0 - 33 U/L), AST 133 (0 - 32 U/L), GGTP 778 (5 - 36 u/l), Alkaline phosphatase 2,327 (35 - 105 u/l), Lipase 252 (13 - 60 U/L), Total cholesterol 1329 (100 - 200 mg/dl), LDL 1282 (0 - 99 mg/dl), HDL 13, and Triglycerides 172 (0 - 200 mg/dL). Alpha 1 antitrypsin, Liver Kidney Microsomal (LKM-1) Antibody, ANA, Antimitochondrial antibody, Anti-smooth muscle antibody, Ceruloplasmin, CMV, EBV, HSV, and HIV were all within normal limits. An abdominal CT revealed a right pleural effusion and cholelithiasis without gallbladder wall thickening. A right upper quadrant ultrasound demonstrated hepatic steatosis. Magnetic resonance cholangiopancreatography (MRCP) showed no focal lesions, fatty infiltrations, or ductal dilatation. Ursodeoxycholic acid and cholestyramine were started for pruritus. Pseudohyponatremia was due to the increased lipid fraction in blood. Lipoprotein phenotyping revealed type IIb hypercholesterolemia with elevated triglycerides. An apo-lipoprotein B level was 147 mg/dl at the upper limit of normal (range 50-150 mg/dL). Cholestasis-induced hypercholesteremia was considered as a diagnosis. Endoscopy esophageal ultrasound with liver biopsy revealed a smooth liver with non-cirrhotic appearance, severe cholestatic pattern of injury, including bile duct infarcts, and marked bile ductular reaction. Ezetimibe was started instead of a statin due to elevated liver enzymes. Discussion: Vanishing bile duct syndrome is an extremely rare condition unknown to many clinicians. Patients present after drug-induced liver injury. Treatment focuses on symptomatic relief and supportive care. Hyperlipidemia in these patients minimally respond to statins and are thus avoided. The prognosis of these patients can vary from slow recovery to eventual cirrhosis with end-stage liver disease requiring transplant. Increasing awareness among physicians is essential to facilitate its diagnosis and management.
Presentation: Friday, June 16, 2023
FRI095 Pseudo Anion Gap Metabolic Acidosis Secondary To Severe Hypertriglyceridemia
Authors: Connery Grissim C , Ward Samuel , Izuora Kenneth E , Champion Amber 
Published: October 2023

Abstract
Disclosure: G.C. Connery: None. S. Ward: None. K.E. Izuora: None. A. Champion: None.
Background/Objective: Severe hypertriglyceridemia can falsely alter multiple lab parameters due to the high lipid fraction of the blood sample. We present a patient who initially presented with severe metabolic acidosis but proved to have normal pH and bicarbonate after correction for hypertriglyceridemia. Case Report: A 34-year-old female with past medical history of recurrent acute on chronic pancreatitis secondary to hypertriglyceridemia, type 2 diabetes, obesity, and hypertension presented to the emergency department with epigastric pain. The patient was initially diagnosed with acute pancreatitis, diabetic ketoacidosis (DKA), and hyponatremia. Initial labs showed sodium 116 mmol/L, glucose 617 mg/dL, bicarbonate &lt; 5 mmol/L, blood ketones 0.8 mmol/L, lactic acid 2.57 mmol/L, and creatinine 0.95 mg/dL. A venous blood gas (VBG) revealed pH 7.42, pCO2 36 mmHg, pO2 62 mmHg, and bicarbonate 24 mmol/L. Her lipid panel revealed triglyceride levels &gt; 4000 mg/dL. The discrepancy in bicarbonate levels between the blood chemistries and VBG were attributed to a pseudo-anion gap metabolic acidosis secondary to her hypertriglyceridemia. After treatment with insulin infusion, hypertriglyceridemia resolved and her bicarbonate levels on renal function panel normalized. Discussion: The high lipid fraction of blood plasma in patients with severely high triglyceride levels can confound other laboratory parameters. Pseudo hyponatremia secondary to elevated triglycerides is one example of a commonly known lab abnormality. In our patient, her initial bicarbonate levels on renal function panel led to concern for severe metabolic acidosis that was not consistent with her mild blood ketones and lactic acid levels. Further investigation with VBG revealed normal pH and bicarbonate levels. Conclusion: Severe hypertriglyceridemia may significantly alter bicarbonate measurement on blood chemistries. Further investigations with blood gasses should be pursued to confirm these abnormalities when suspected.
Presentation: Friday, June 16, 2023
FRI108 Role Of Obesity In Patients With Coronary Artery Dissection
Authors: Karki Sadichhya , Deenadayalan Vaishali , Shoura Sami , Gajjar Rohan , Shahi Anoj 
Published: October 2023

Abstract
Disclosure: S. Karki: None. V. Deenadayalan: None. S. Shoura: None. R. Gajjar: None. A. Shahi: None.
Background: Coronary artery dissection (CAD) is an established cause of acute coronary syndrome (ACS) in the general population. However, its risk factors and pathophysiology remain poorly understood. We aim to compare the clinical outcomes in patients admitted for CAD with and without obesity. Methods: This was a trend study of the National Inpatient database from 2010 to 2019. Adult patients (age &gt;18) with a principal diagnosis of APE were identified using the International Classification of Diseases code, tenth revision (ICD-10), and were divided into two groups based on a secondary diagnosis of Morbid Obesity (MO). Primary outcomes evaluated were in-patient mortality, Length Of Stay (LOS) and Total Hospitalization Charges (THC). Secondary outcomes included acute severity measures like blood transfusion, Intensive Care Unit (ICU) admission, Cerebrovascular Accidents (CVA), and Acute Kidney Injury (AKI). Multivariate linear and logistic regression were used to adjust for confounders. We estimated trends, inpatient mortality, mean length of hospital stays (LOS) and mean total hospital charges (THC) over the period. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes. Results: Out of 2,440 adult patients admitted with CAD, 440(18%) were found to be obese. The mean age in obese group vs non-obese was 52.8 and 55.9 years respectively. There was a trend towards an increased inpatient mortality among obese patients compared to non-obese with aOR 2.36 (95% CI 0.73-7.59, p=0.148) however, this did not reach statistical significance. Similarly, there was no statistically significant difference in terms of LOS and THC. Among secondary outcomes, the rate of blood transfusion (11.3% vs 4.7%, aOR 1.97, 95% CI 0.77-5.04), AKI (15.9% vs 9.7%, aOR 1.23, 95%CI 0.58-2.65) and CVA (2.2% vs 1.5%, aOR 0.43, 95% CI 0.03-7.58) seemed to be increased in obese group. Odds of ICU admission was similar between both the groups (10.2 % vs 10.5%, aOR 0.75, 95% CI 0.33-1.68). Conclusion: Obesity does not significantly increase the in-patient mortality and other secondary outcomes among patients admitted for CAD which is reassuring. Future studies looking into the pathophysiology behind this phenomenon are needed.
Presentation: Friday, June 16, 2023
FRI109 D-Allulose Inhibits NF-kB- And AP1-Mediated Inflammatory Pathways In HepG2 Cells
Authors: Gupta Nidhi , Batch-Joudi Jennifer , Danielle Graham Lauren , Champagne Kareen , Warda Firas , John Haas Michael , Mooridian Arshag 
Published: October 2023

Abstract
Disclosure: N. Gupta: None. J. Batch-Joudi: None. L.D. Graham: None. K. Champagne: None. F. Warda: None. M.J. Haas: None. A. Mooridian: None. Nothing to Disclose: NG, J B-J, LG, KC, FW, MJH, ADM. Source of Research Support: No outside funding was used for this research.
Rare sugars such as D-allulose and its derivatives are defined as monosaccharides that are rare in nature. D-allulose is an epimer of D-fructose and is used primarily as a non-nutritive sweetener. D-allulose is also a functional food due to its ability to lower fasting plasma glucose and post-prandial glucose levels in both normoglycemic and diabetics, most likely due to its insulin-mimetic properties as well as its ability to enhance glucagon-like peptide 1. D-alluose has also been shown to possess anti-inflammatory and immunosuppressant activity in allogenic orthotopic liver transportation, neutrophil activation, and monocyte chemoattractant protein-1 expression in endothelial cells. We examined the effects of D-allulose on two well characterized pathways that promote inflammation in HepG2 hepatoblastoma cells, specifically nuclear factor κB (NF-κB) and activator protein 1 (AP1). HepG2 cells were exposed to tumor necrosis factor α (TNFα) (10 ng/ml), lipopolysaccharide (LPS) (10 nM), and high dextrose (27.5 mM). Treatment with 0, 2.8, 5.5, 11, 22, and 27.5 mM D-allulose decreased TNFα-dependent NF-κB and AP1 reporter plasmid activity and 2.8- and 5.5-mM D-alluose decreased NF-κB p50 and p65 subunit expression, measured by Western blot. D-allulose treatment increased IκB expression in TNFα treated cells. D-alluose also suppressed c-jun, phospho-c-jun, and c-fos AP1 subunit expression in TNFα treated cells. Similar effects were observed in D-allulose-treated cells (2.8 and 5.5 mM) exposed to high dextrose and LPS. These results suggest that D-allulose mediates some of its anti-inflammatory effects via suppressing NF-κB and AP1 activity.
Presentation: Friday, June 16, 2023
FRI110 Prevalence Of Thromboembolic Events In 51 Patients Treated For Cushing’s Disease With Pituitary Surgery At University Hospital Of Wales Over A 15-year Period
Authors: Raj Suresh John Romesh Paul , Witczak Justyna , Rees Aled , Hayhurst Caroline , Lansdown Andrew 
Published: October 2023

Abstract
Disclosure: R. Suresh John: None. J. Witczak: None. A. Rees: None. C. Hayhurst: None. A. Lansdown: None.
Background: Hypercortisolism is associated with a hypercoagulable state and both arterial and venous thromboembolic events (TE). Aim: To determine the prevalence of TE in our cohort of patients with Cushing’s Disease (CD) undergoing pituitary surgery. Methods: Patients with a clinical & biochemical diagnosis of Cushing’s Disease who had undergone pituitary surgery at University Hospital of Wales between 2007-2022 were identified from a database. Clinical, biochemical and radiological data were studied from the time of diagnosis to the period of 6 months following pituitary surgery. Results: 51 patients were identified: 15 Male, 36 Female, median age 46 (11-77)y. Total group: 5/51 (9.8%) patients had a TE. Pre-surgery: 2/51 (3.9%) had a TE (Deep vein thrombosis (DVT) = 1; Aortic thrombus = 1), both at time of diagnosis. Mean 24-h Urinary Free Cortisol (UFC) was 1126nmol in TE group vs 662nmol in non-TE group (p=0.64) and mean cortisol after overnight dexamethasone suppression test (ODST) was 251nmol/L in the TE group vs 327nmol/L in the non-TE group (p=0.64). Post-surgery: All patients received standard thrombo-prophylaxis with low-molecular weight heparin peri-operatively. 3/51 (5.9%) had TE within 6-months post-surgery (DVT=1, pulmonary embolism (PE)=1, cavernous sinus thrombosis=1), all occurred within 21 days of surgery and none had other risk factors for VTE. Mean time from diagnosis to surgery was 187 days in TE group vs 127 in non-TE group (p=0.43). At diagnosis, mean 24-h UFC was 560nmol in TE group vs 699nmol in non-TE group (p=0.82), mean cortisol after ODST was 420nmol/L in TE group vs 321nmol/L in non-TE group (p=0.46). Mean post-op cortisol was 221nmol/L in TE group vs 257nmol/L in no TE group (p=0.85). No TE events occurred between 22 days-6 months post-surgery. Conclusion: In our cohort, 9.8% patients had a TE event. 3.9% occurred pre-surgery and 5.9% in the early post-operative period, which concurs with data from other studies. There was no correlation with level of hypercortisolism and TE events in our group. Timing, dose & duration of prophylactic anticoagulation in CD patients needs careful consideration.
Presentation: Friday, June 16, 2023
FRI120 Metabolic Profile Of A Young Adult Population Assisted By A Primary Health Care Unit In A Large Urban Center
Authors: Barberá Boghossian Rodney , Campello Lopes Carolina , de Barros Junqueira Livia Lopes Monteiro , Góes Neno João Oliveira , Silva de Almeida Beatriz Câmara , Ferrão Raphaella , Velho Junior Ivan da Costa , Castellões de Rezende Pedro Paulo , da Costa Fernandes Ana Cristina Tenório , Gomes Monteiro Daniela Fiuza 
Published: October 2023

Abstract
Disclosure: R.B. Boghossian: None. C.C. Lopes: None. L.L. Junqueira: None. J.O. Neno: None. B.C. Almeida: None. R. Ferrão: None. I.D. Velho Junior: None. P.C. Rezende: None. A.T. Fernandes: None. D.F. Monteiro: None.
Introduction: Dyslipidemia, Glucose Intolerance (GI), Diabetes Mellitus (DM), and Metabolic Syndrome (MS) are metabolic conditions often asymptomatic and related to high cardiovascular (CV) morbidity and mortality. Nonetheless, these conditions are not commonly screened in younger adults. The LapARC cohort Study is a population-based study to assess CV risk profile in a young adult population. Objective: To evaluate the prevalence of dyslipidemia, DM, GI, and MS in a young adult population enrolled in the Family Health Strategy (FHS) in an urban center. Methods: Cross-sectional population study that enrolled individuals aged 20-50 years registered in an FHS unit. Sociodemographic, anthropometric characteristics, and CV risk factors were recorded. Office blood pressure (BP) was obtained by the average of 2 measurements obtained on two different occasions. All participants underwent laboratory evaluation (lipid and glycemic profile) and home blood pressure monitoring (HBPM). The bivariate analysis compared paciente with and without metabolic alterations. SPSS 19.0 was used in the statistical analysis. Results: We evaluated, up until this moment, 632 individuals [39.6% male gender; average age: 33.6 ± 9 years old]. The most common modifiable CV risk factors were physical inactivity (44.0%), and obesity (26.0%). The prevalence of dyslipidemia was 40%. These individuals were older, more obese and with a bigger association of hypertension and GI. Regarding the glycemic profile, 57 (9%) individuals with GI e 18 (3%) with DM. Diabetic pacientes were older, obese, with a bigger prevalence of hypertension and dyslipidemia while those with GI had just bigger prevalence of dyslipidemia compared to normoglicemic individuals. A total of 74(12%) individuals were diagnosed with MS. These were older, more obese, sedentary, with a bigger prevalence of hypertension, higher office BP and HBPM and higher levels of albuminuria. Conclusion: This young and apparently healthy population has an adverse cardiometabolic profile, indicating the importance of precocious CV risk stratification. Thus, efficient primary preventive strategies can be implemented to reduce the probability of CV disease development in the future.
Presentation: Friday, June 16, 2023
FRI124 Insights From The Incidence Of Primary Aldosteronism In Patients With Hypokalemia (IPAHK+) - Study
Authors: Gruber Sven , Stasi Evangelia , Boan Pion Antonio , Steiner Regula , Sudano Isabella , Beuschlein Felix 
Published: October 2023

Abstract
Disclosure: S. Gruber: None. E. Stasi: None. A. Boan Pion: None. R. Steiner: None. I. Sudano: None. F. Beuschlein: None.
Background: Hypokalemia plays an important role in the diagnosis and management of primary aldosteronism (PA). The hypokalemic variant of the disease accounts for about one third of all cases. However, little is known about the incidence of PA in a hypokalemic population. Design: The IPAHK+ study is an epidemiological, monocentric, cross-sectional trial to provide evidence on the incidence of PA in a hypokalemic outpatient population. Methods: Recruitment of outpatients with hypokalemia ≤3 mmol/l is carried out on a continuous referral-basis through an automated data delivery system at the University Hospital Zurich (USZ). Todate, 69 patients underwent the study protocol, which includes guideline-compliant workup for PA. Results: The mean age of the participants was 52.5±1.5 years with a sex ratio of 35:34 women to men, a mean potassium value of 2.77±0.03 mmol/l [1.8; 3.0] and a prevalence of arterial hypertension of71%. PA was diagnosed in 45.9% of all participants, all of whom had a history of hypertension. The incidence of PA increased continuously with decreasing potassium level with proportions of 26.7%,45.8% and 59.1% in the subgroups of 3.0 mmol/l (n=15), 2.8-2.9 (n=24) and ≤2.7 mmol/l (n=22),respectively. In the subgroup of hypertensives the incidence of PA was as high as 65.1%. Prior testing,60.9% of all patients presented at least with one plausible other cause for their hypokalemia with potential drug triggers accounting for the largest portion (33.3%). Among participants on diuretics the incidence of PA was 57.9%. Conclusions: The incidence of PA in the investigated outpatient population was more than 4 out of 10and inversely correlated with baseline potassium levels. Moderate or severe hypokalemia, regardless of its cause, should therefore prompt evaluation for PA in hypertensive individuals. Normotensive PA was not observed in our cohort. The significance of the study is limited by the still low number of enrolled patients with a potential selection bias.
Presentation: Friday, June 16, 2023
FRI137 Histologic And Genetic Characteristics Of Primary Aldosteronism In Late Adulthood
Authors: Blinder Amy , Nanba Kazutaka , Sapiro Dina , Baker Jessica , Liu Chia-Jen , Bancos Irina , Lyden Melanie , Young William , Wachtel Heather , Cohen Debbie , Luther James , Ann Williams Tracy , Reincke Martin , Else Tobias , Giordano Thomas J , Udager Aaron , Rainey William E 
Published: October 2023

Abstract
Disclosure: A. Blinder: None. K. Nanba: None. D. Sapiro: None. J. Baker: None. C. Liu: None. I. Bancos: None. M. Lyden: None. W. Young: None. H. Wachtel: None. D. Cohen: None. J. Luther: None. T.A. Williams: None. M. Reincke: None. T. Else: None. T.J. Giordano: None. A. Udager: None. W.E. Rainey: None.
Background: There is accumulating evidence that changes in adrenal histology and regulation of renin-angiotensin-aldosterone system occur with age. Primary aldosteronism (PA) is the most common cause of endocrine hypertension. Recent clinical studies suggest unique characteristics of PA in elderly patients, including high prevalence of comorbidities and low clinical cure rate after adrenalectomy. However, histologic and genetic features of PA in late adulthood have not been well elucidated. Objective: To determine histologic and genetic characteristics of PA in late adulthood. Methods: Seventy-six patients who underwent unilateral adrenalectomy at the age of 60 or older were included in this study. Formalin-fixed, paraffin-embedded (FFPE) sections of resected adrenal tissue were used for the analysis. Aldosterone synthase (CYP11B2) immunohistochemistry (IHC) was performed to identify the source of inappropriate aldosterone production. Histologic classification was made according to the HISTALDO (histopathology of primary aldosteronism) consensus. CYP11B2 IHC-guided DNA capture followed by sequencing analysis using direct Sanger sequencing or ion torrent based next-generation sequencing (NGS) was performed. Results: Median age of the studied patients was 70 (interquartile range: 64-73). Based on the CYP11B2 IHC, histologic diagnosis was made as follows; aldosterone-producing adenoma (APA, n=23), aldosterone-producing nodule (APN, n=41), and non-functioning adrenocortical adenoma (NFA, n=6). The remaining six cases had multiple CYP11B2-expressing neoplastic lesions, including APA with APN (n=2) and multiple APNs (n=4). Co-existence of NFA with APA or APN(s) was also observed in 13. Sequencing analysis revealed that somatic KCNJ5 mutation was the most frequent genetic alteration in APA (7/23, 30%), whereas somatic CACNA1D mutation was the most common genetic cause of APN (20/39 with successful sequencing, 51%). Of the 18 sequenced NFA DNA samples, two had somatic mutations in CTNNB1 (n=1) and GNAS (n=1). Conclusion: APN is the major histologic feature of PA in late adulthood. Co-existence of NFA also appears to be a frequent observation in this age population. Somatic CACNA1D and KCNJ5 mutations are common in APN and APA, respectively.
Presentation: Friday, June 16, 2023
FRI138 Diagnostic Accuracy Of Plasma Renin Activity Measured By Radioimmunoassay And LC-MS/MS For The Screening Of Primary Aldosteronism
Authors: Hong A Ram , Hee Yoon Jee , Yong Park Ji , Choi Wonsuk , Kyung Kim Hee , Kang Ho-Cheol 
Published: October 2023

Abstract
Disclosure: A. Hong: None. J. Yoon: None. J. Park: None. W. Choi: None. H. Kim: None. H. Kang: None.
Background: Plasma aldosteronism (PA) is screened based on the levels of aldosterone-to-renin ratio (ARR) and/or plasma aldosterone concentration. However, false positive cases are often observed due to low levels of plasma renin activity (PRA). Here, we aimed to compare diagnostic accuracy of PRA measured by radioimmunoassay (RIA) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the screening of PA. Materials and Methods: We retrospectively included 67 patients in whom PRA was measured using both RIA and LC-MS/MS due to adrenal incidentaloma or suspected secondary hypertension in a tertiary referral center. Patients with ARR≥20 underwent saline infusion test (SIT) and/or captopril challenge test (CCT) for the confirmation of PA. Results: The mean PRA was 3.1±7.5 ng/mL/hr by RIA and 3.0±6.3 ng/mL/hr by LC-MS/MS (P=0.284). The mean ARR was 53.7±137.4 by RIA and 41.2±129.9 by LC-MS/MS. The correlation coefficient between RIA and LC-MS/MS was 0.992 in patients with ARR&lt;20 (n=38) (P&lt;0.001) and 0.595 in patients with ARR ≥20 (n=29) (P=0.001). In patients who underwent confirmative test (CCT or SIT), false-positivity rate was 77.8% (7/9) based on RIA and 66.7% (6/9) based on LC-MS/MS. Conclusion: PRA measured using LC-MS/MS showed a significant positive correlation with PRA using RIA, particularly at ARR&lt;20. ARR calculated by both methods for PRA revealed similar false-positives. Further studies are needed to validate diagnostic accuracy between the two methods of PRA for PA screening.
Presentation: Friday, June 16, 2023