bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI300 Prolactinoma And Pregnancy: A Systematic Review And Meta-analysis
Authors: Bandeira Diego Barata , Alves Letícia Santana , Glezer Andrea , Boguszewski Cesar Luiz , Nunes-Nogueira Vania Santos 
Published: October 2023

Abstract
Disclosure: D.B. Bandeira: None. L.S. Alves: None. A. Glezer: None. C.L. Boguszewski: None. V.S. Nunes-Nogueira: None.
Introduction: Prolactinomas are the most common pituitary tumors, being an important cause of irregular menses and infertility. However, fertility can be restored, making pregnancy possible, especially for women who have achieved disease control, mainly on dopamine agonist (DA) treatment. Although literature data demonstrate safety in maternal and fetal outcomes, the evidence has not been systematically synthesized. Purpose: To perform a systematic review evaluating disease control and fetal and maternal outcomes in pregnancy of women with prolactinoma. Methods: We conducted a systematic review according to the Joanna Briggs Institute methodology for systematic reviews of etiology and risk. We included observational studies that evaluated pregnant women with prolactinoma. The outcomes of interest were spontaneous miscarriage, preterm birth, worsening of preexisting diabetes/development of gestational diabetes, tumor growth during pregnancy, headache, visual impairment, perinatal mortality, low birth weight, congenital malformations. Embase, Medline, LILACS, and CENTRAL were our source databases. To perform proportional meta-analyses, we used Stata Statistical Software 17. Results: Fifty-one studies were included encompassing a total of 2513 pregnancies in 1903 women with prolactinoma. The overall frequency of the pregnant women on DA at conception was 97% (from 49 studies of 2493 pregnancies; 95% confidence interval (CI), 93–99%); there were 9% of spontaneous miscarriage (from 38 studies of 2073 pregnancies; 95% CI, 7–12%), 3% of prematurity (from 38 studies of 1584 pregnancies; 95% CI, 3–2%), 9% of symptomatic tumor growth during pregnancy (from 38 studies of 1584 pregnancies; 95% CI, 5–15%), 4% of visual impairment (from 33 studies of 1480 pregnancies; 95% CI, 2–7%), 6% of headache (from 31 studies of 1385 pregnancies; 95% CI, 3–11%) and 4% of worsening of preexisting diabetes/development of gestational diabetes (from 9 studies of 666 pregnancies; 95% CI, 3–7%). The overall frequency of congenital malformations was 2% (from 23 studies of 1212 newborns; 95% CI, 1–4%), 2% of perinatal mortality (from 18 studies of 1123 newborns; 95% CI, 1–3%) and 6% of low birth weight (from 17 studies of 843 newborns; 95% CI, 3–9%). Conclusion: Pregnancy in women with prolactinoma is frequently safe in relation to fetal and maternal outcomes, presenting low frequency of spontaneous miscarriage, prematurity, tumor growth, visual impairment, headache, congenital malformations, perinatal mortality and of low birth weight.
Presentation: Friday, June 16, 2023
FRI319 Diagnostic And Management Challenges In A Patient With A Giant Pituitary Lactosomatotroph Adenoma
Authors: Peixe Carolina Ribeiro , López-Presa Dolores , Bugalho Maria João , Marques Pedro 
Published: October 2023

Abstract
Disclosure: C.R. Peixe: None. D. López-Presa: None. M. Bugalho: None. P. Marques: None.
Introduction: Giant prolactinomas are rare, accounting for only 2–3% of all prolactinomas. Although benign, several challenges may emerge at diagnosis and during their management. Case: A 38-yr man was incidentally diagnosed with a large skull base tumor on CT-scan undertaken due to head trauma. MRI showed a 55x33mm skull base mass, involving the clivus and sellar/parasellar regions, with bilateral cavernous sinus invasion. A chordoma was suspected leading to a transnasal biopsy, which revealed a PIT1+-plurihormonal pituitary adenoma. His serum prolactin levels were then assessed, which were markedly elevated at 50,414ng/mL (NR:4-15), with concomitant raised IGF-1 at 323ng/mL (NR:101-221). He was then referred to our Endocrine department. Retrospectively, there was a 3-yr history of erectile dysfunction, decreased libido, and infertility, although his testosterone levels were within reference range (307ng/dL; NR:240-830), and sperm analysis parameters were normal. He commenced on low dose cabergoline (0.5mg/week) and two months later clinical improvement was noted, accompanied by a marked reduction of prolactin (830ng/mL) and tumor shrinkage. He remains on cabergoline for ten months, and his latest prolactin and IGF-1 levels were, respectively, 496 and 224ng/mL. In the light of patient’s normal spermogram and restored sexual function, the couple has been referred to the Fertility clinic. Conclusions: The differential diagnosis of large skull base tumors, particularly those affecting sellar/clival regions, must always include prolactinoma, hence serum prolactin should be measured keeping in mind the possible occurrence of hook effect. Most giant prolactinomas respond to dopamine agonists, which should be considered as a first-line therapy, with marked reductions in both prolactin and tumor size often seen within the first weeks of treatment. GH-cosecretion may also ameliorate/normalize with dopamine agonists. In prolactinoma patients, infertility may or may not be directly related with hyperprolactinemia, hence a careful assessment is required, and its management may imply assisted reproductive techniques.
Presentation: Friday, June 16, 2023
FRI332 Check Point Inhibitor Induced Hypophysitis/Hypopituitarism
Authors: Chandpuri Ranjit Singh 
Published: October 2023

Abstract
Disclosure: R.S. Chandpuri: None.
Introduction: A case of Renal cell cancer with metastasis to contralateral kidney, which was treated with nivolumab/ Ipilimumab leading to hypophysitis/hypopituitarism. Case: 42-year-old female with past medical history of Left renal mass who underwent left radical nephrectomy. On surveillance imaging she was found to have evidence of new paraspinal mass suspicious for metastatic spread involving retroperitoneal lymph nodes and contralateral kidney. She would be referred to her oncologist for observation versus chemotherapy. Her oncologist ordered nivolumab and ipilimumab. Patient tolerated chemotherapy well. A surveillance brain MRI was ordered to check for any metastatic involvement and it showed enlargement of the pituitary gland with focal hypo-enhancing area concerning for immune check point inhibitor therapy induced hypophysitis. Labs showed- cortisol-0.8, ACTH &lt;5, TSH-0.6, Free T4-0.60, Prolactin-57.9, FSH-3.7, LH-5.0. Clinically she would complain of fatigue, generalized weakness, hypotension and amenorrhea. The patient was reluctant to start thyroid hormone replacement therapy, and she appeared clinically euthyroid. A dedicated Pituitary MRI showed partially empty sella turcica, sella measuring approximately 0.2 cm in maximal height. There was no abnormal thickening or nodular enhancement of the pituitary stalk. No suprasellar mass effect or chiasmatic compression. She was placed on Prednisone/ Hydrocortisone with improvement in her fatigue and blood pressure. Conclusion: Immune checkpoint inhibitors are a new form of immunotherapy used in the treatment of various cancers (melanoma, RCC, colorectal). These agents can cause immune-mediated pituitary lesions (hypopituitarism/hypothyroidism). These drugs can cause a spectrum of issues ranging from single hormone deficiency to pan-hypopituitarism. Due to the new advances in chemo/immune therapy, providers need to be aware of such conditions to quickly recognize and treat them. Symptoms of this condition can be masked and can be attributed to other diseases processes ie(depression, anxiety, chronic fatigue syndrome). It would be best to come up with a screening process/order set for such patients with close communication between primary care, endocrinologists, oncologists in order to identify and treat the patients.
Presentation: Friday, June 16, 2023
FRI337 Progressive Suprasellar Chordoid Glioma Presenting With Panhypopituitarism, Diabetes Insipidus And Encephalopathy
Authors: Gatillo Jan Louie D , Maningat-Goco Maria Patricia Deanna D , Co Faith Abigail K 
Published: October 2023

Abstract
Disclosure: J.D. Gatillo: None. M.D. Maningat-Goco: None. F.K. Co: None.
Chordoid glioma is a rare central nervous system neoplasm of uncertain origin, with most cases seen at anterior wall or roof of the third ventricle. It is described as a perplexing lesion as it tends to mimic benign lesions at the onset but eventually some develop with threatening complications. We present a case of a 39 year old Filipino, female, who initially presented with a 1- year history of memory lapses, behavioral changes, and blurring of vision. MRI showed 4.3 x 3 x 4.2 cm heterogeneously enhancing suprasellar mass and was initially worked-up as pituitary macroadenoma. The imaging also showed heterogeneously enhancing extra-axial lesion along the right anteromedial temporal convexity. She underwent pterional craniotomy and sub temporal craniectomy with excision biopsy of tumor. Histopathology confirmed the diagnosis of chordoid glioma WHO Grade 2. However, only a few days after the surgery, she began to experience emotional lability and more behavioral changes. She then received oral Temozolomide for 4 cycles and whole brain radiotherapy for 32 cycles. Approximately 10 months since diagnosis was made, patient eventually developed seizures and manifested progressive drowsiness and generalized weakness. Patient was diagnosed and clinically presented with Panhypopituitarism and Diabetes Insipidus. She was maintained on levothyroxine, prednisone and desmopressin. A repeat MRI was done which showed apparent progression in the size (4.6 x 3.7 x 4.1 cm) of the heterogeneously enhancing suprasellar mass with signs of tumor infiltration and extension in the left lateral ventricle. Further, patient was treated with Bevacizumab and Nimotuzumab. Repeat MRI showed regression in size of the known suprasellar mass and improvement of symptoms. Little is still known about chordoid gliomas especially in the Asian population - their initial presentation as well as the best diagnostic approach and treatment strategy for this elusive disease. There is no formally recognized treatment protocol for chordoid glioma, and postoperative mortality and morbidity is high. More case reports are needed in order to ascertain the best diagnostic and treatment strategy for patients with chordoid glioma and its endocrine complications.
Presentation: Friday, June 16, 2023
FRI342 Hypophysitis Mimicking As Pituitary Adenoma
Authors: Chao Alex , Dhaliwal Athena , Yu Kaylee , Polis Sarah Najwa , Vernetti Nicholas John , Nakhle Samer 
Published: October 2023

Abstract
Disclosure: A. Chao: None. A. Dhaliwal: None. K. Yu, MD: None. S.N. Polis: None. N.J. Vernetti: None. S. Nakhle: None.
Background: Hypophysitis is defined as inflammation of the pituitary gland and causes include lymphocytic, granulomatous, xanthomatous, and IgG4 related hypophysitis. Hypophysitis can sometimes mimic a pituitary mass. It is more common in the female and associated with pregnancy. Lymphocytic hypophysitis may present with symptoms related to expansion of the pituitary gland and hormone deficiency. Expansion of the gland often causes headaches. Compression of the optic chiasm results in a decrease in the visual field, color perception, and in rare cases, diplopia due to lateral expansion of the pituitary gland.It also affects hypothalamic-pituitary axis and commonly impairs hormone production from corticotrophs, gonadotrophs and thyrotrophs. Patients treated with glucocorticoids can have hormonal recovery and resolutions of imaging findings. Clinical Case: Patient is a 30-year-old, previously healthy, female who initially presented to the emergency department with a worsening headache over the preceding three months. Brain MRI demonstrated a 1.8 cm enhancing mass and the radiologist interpreted the findings as a pituitary macroadenoma. The patient was seen by neurosurgery and was started on high doses of dexamethasone at 4 mg twice a day for three months duration.
After treatment, the patient’s headache improved although she reported an 80-pound weight gain. CT of the head three months later reported a prominent pituitary gland in size compatible with history of pituitary adenoma but decreased in size to 0.9 cm. Repeated brain MRI six months after treatment showed resolution of the mass. The patient also noted a cessation of her menstrual cycle around the onset of headache and laboratory evaluation consistent with hypogonadotropic hypogonadism (FSH 5.5 mIU/mL, LH 2.8 mIU/mL and estradiol 22 pg/mL). Regular menstrual cycles returned seven months after glucocorticoid treatment. Almost two years after the onset of her headaches, the patient was referred to the endocrine clinic for further evaluation of fatigue, low libido, and persistent weight gain. Repeat anterior pituitary function tests were unremarkable and showed FSH 5.6 mIU/mL, LH 3.3 mIU/mL, Estradiol 34 pg/mL, Sodium 139 mmol/L, IGF-1 129 ng/mL (-0.4 standard deviation), Ferritin 20 ng/mL, Prolactin 15.6 ng/mL, TSH 4.38 mIU/L, T4 free 1.1 ng/dL, Cortisol AM 10.9 mcg/dL, and Testosterone 13 ng/dL. Conclusion: We present a case of hypophysitis mistaken for a non-functioning macroadenoma with mild mass effect on the undersurface of the optic chiasm, headache and hypogonadotropic hypogonadism. The patient did not have risk factors such as pregnancy or other autoimmune conditions. After glucocorticoid treatment, recovery of hypogonadotropic hypogonadism and resolution of headache, and radiographic findings.
Presentation: Friday, June 16, 2023
FRI346 Can We Miss Panhypopituitarism After Transsphenoidal Surgery?
Authors: Makawi Alladdin , Huynh James , Elshimy Ghada 
Published: October 2023

Abstract
Disclosure: A. Makawi: None. J. Huynh: None. G. Elshimy: None.
Introduction: Disorders of water and osmolality due to aberrant ADH secretion and posterior pituitary function are common causes of morbidity among patients who undergo transsphenoidal hypophysectomy surgery (TSS). Postoperatively, central diabetes insipidus (DI) may present as a complication in up to 30% of cases. Moreover, hypopituitarism is an important complication of TSS, and can manifest as adrenal crises if missed by clinicians. We present a patient who underwent TSS for pituitary adenoma with postoperative course complicated by hypogonadism that was misdiagnosed for 10 years. Additionally he developed DI, secondary adrenal insufficiency (AI), and central hypothyroidism after resolution of his central hypogonadism. Case Description: 64-year-old male with medical history significant for chronic hypogonadism on hormonal replacement therapy and diabetes, presented for sleep disturbance and deviated septum with incidental finding of a large sphenoidal mass on CT imaging. MRI of brain confirmed a 4 cm macroadenoma invading from the inferior sella into the bilateral cavernous sinuses, clivus, and sphenoid sinus. Patient was then referred to neurosurgery for transsphenoidal resection. Patient underwent surgery and perioperative course complicated by a small CSF leak. He stayed in the neuro-ICU after the surgery and was monitored by the surgical team without endocrine consultation. He was discharged without proper postoperative evaluation of the HPA axis or education on symptoms of pan-hypopituitarism. Shortly after, he experienced significant symptoms consistent with adrenal insufficiency which prompted a visit to the emergency room. Thereafter, he finally presented to the neuroendocrine clinic for follow-up. Labs were notable for cortisol 1.2 mcg/dl, TSH 0.018 mcIU/ml, FT4 0.2ng/dl, and Na 130 mEq/ml, normal testosterone 551 ng/dl, mildly persistently elevated Na 147 mEq/ml with positive water deprivation test confirming central DI. He was treated with hydrocortisone and Synthroid for adrenal insufficiency and hypothyroidism respectively and was started on desmopressin for central DI. Discussion: Pan-hypopituitarism frequently occur after neurosurgical interventions and failure to involve endocrinology in the management of these cases may lead to missed diagnoses, unnecessary morbidity and mortality. This report serves as an excellent illustration of the importance of both surgical and medical management to prevent life-threatening complication such as adrenal crises as a result from pan-hypopituitarism.
Presentation: Friday, June 16, 2023
FRI365 A Patient With A Bronchial Carcinoid Presents With Cushingoid Symptoms Due To A Potentially Dangerous Supplement
Authors: Morales Tomas , Samarasinghe Shanika 
Published: October 2023

Abstract
Disclosure: T. Morales: None. S. Samarasinghe: None.
Introduction: Well-differentiated bronchial neuroendocrine neoplasms often follow a clinically indolent course and rarely cause Ectopic ACTH syndrome. Iatrogenic corticosteroid use is the most common cause of Cushing syndrome and should be considered in all patients regardless of clinical background. Clinical Case: A 59-year-old woman with an 11-year history of a 1.5 cm well differentiated bronchial carcinoid, presented with Cushingoid features. Hormonal activation of her known bronchial carcinoid was considered. Testing resulted in a normal 24-hour urine 5-HIAA (6 mg/d, n&lt;15 mg/dL), elevated chromogranin A (201 ng/mL, n&lt;103 ng/mL), normal histamine (&lt;1.5 ng/mL, n &lt;1.7 ng/mL), low-normal 7 AM serum cortisol (5.1 ug/dL, n 3.6-19.3 ug/dL), normal 7 AM ACTH (17 pg/mL, n&lt;46 pg/mL) and a surprisingly low 24-hr urinary free cortisol (1.8 mcg/hr, n 4.0-50.0 mcg/hr). A late night saliva cortisol was 0.03 mcg/dL (n 3.4-16.8 mcg/dL). Echocardiography showed no evidence of carcinoid heart disease. A Dotatate PET-CT scan to assess for neuroendocrine tumor progression showed a stable right upper lobe pulmonary nodule with no evidence of metastatic disease. Ectopic Cushing syndrome was excluded given the low cortisol levels, and exogenous steroids were suspected, however the patient denied the use of oral, inhaled, or injected steroids. A cosyntropin stimulation test yielded a pre-stimulation cortisol of 6.2 ug/dL with an adequate post-stimulation cortisol of 23.5 ug/dL (n &lt;46 pg/mL). At this stage of evaluation, the patient received an FDA alert regarding a glucosamine supplement she had started 4 months prior for joint pain. The notification advised of hidden drug ingredients including dexamethasone, diclofenac, and methocarbamol contained within Artri King glucosamine supplements not listed on the product label, but verified by FDA lab analysis. The FDA had received several adverse event reports including liver toxicity and death associated with such products. The patient’s symptoms gradually improved after discontinuation of the supplement. Conclusion: Ectopic ACTH production is reported in less than 5% of patients with squamous cell lung cancer and 3% of patients with lung or pancreatic (non-MEN1) neuroendocrine tumors. Factitious corticoid exposure is rare and can be evaluated with synthetic corticosteroid serum testing. Cushing syndrome due to supplements containing unreported corticosteroid doses should be considered in patients with typical Cushingoid features and contradictory hormonal testing.
References: Hayes, AR, Grossman, AB. Distinguishing Cushing's disease from the ectopic ACTH syndrome: Needles in a haystack or hiding in plain sight? J Neuroendocrinol. 2022; 34 (8):e13137; www.fda.gov/drugs/medication-health-fraud/public-notification-artri-king-contains-hidden-drug-ingredients
Presentation: Friday, June 16, 2023
FRI367 An Unusual Presentation Of A Thyroid Nodule: A Thyroid Paraganglioma
Authors: Owrangi Mohammad-Ehsan , Hasan Farhad 
Published: October 2023

Abstract
Disclosure: M. Owrangi: None. F. Hasan: None.
Introduction: Thyroid paraganglioma (PGL) is a rare thyroid tumor that originates from inferior laryngeal paraganglia. We present a case of a patient initially believed to have a thyroid nodule which turned out to be a PGL. Case Presentation: A 49 year-old white female with history of GERD and mild dysphagia who was found to have a left parathyroid adenoma vs. a left exophytic thyroid nodule. Previous ultrasounds had all showed slow but progressive enlargement of the lesion. Her labs had showed iPTH, Ca, TSH, and free T4 all within reference range and she was clinically euthyroid. She had 2 fine needle aspirations (FNA) which were both non diagnostic. She ultimately underwent surgical excision of the mass. The pathological examination showed cells that were positive for synaptophysin, chromogranin, GATA-3, S100, and neuron-specific enolase. They were negative for Ki-67, PTH, thyroglobulin, TTF-1, CK AE1/AE3, and CD 138. The overall findings were consistent with thyroid PGL. Discussion: In this case Thyroid PGL was diagnosed after pathological examination, including immunohistochemistry, was performed on a surgically excised sample, after 2 FNAs were non-diagnostic. Thyroid PGLs are elusive tumors. One study suggested that since they were first described in 1964, until 2015, there have only been 54 reported cases of thyroid PGLs, with a strong female predominance (88.9%). They often present as asymptomatic thyroid nodules and their diagnosis can be difficult by FNA alone as they can morphologically mimic medullary thyroid carcinoma, intrathyroidal parathyroid proliferation, metastatic neuroendocrine tumor, or calcitonin-negative neuroendocrine tumor of the thyroid gland (CNNETT). Thyroid PGLs are often benign, slow growing tumors and account for only 0.012% of all head and neck tumors with a malignancy rate of 4-16%. They usually present as single nodules averaging 3.5 cm and are often diagnosed with routine ultrasound assessment of the neck. Since they are associated with the parasympathetic nervous system, signs and symptoms including tachycardia, palpitations, and weight loss due to hormonal activity are classically absent from thyroid PGLs. In about 30% of cases, thyroid PGLs have a genetic predisposition and are more than one and associate with other tumors such as pheochromocytoma. Major hereditary disorders associated with paraganglioma include von Hippel-Lindau disease, multiple endocrine neoplasia, familial paraganglioma syndromes 1 to 4, and neurofibromatosis. Therefore, it is highly recommended that patients with a diagnosis of thyroid PGL undergo additional investigations with imaging, hormonal activity assessment, and genetic testing. Given the difference in management of thyroid PGLs compared to its cytology mimics, and their association with some familial cancer syndromes, use of immunohistochemical staining is crucial in making the correct diagnosis.
Presentation: Friday, June 16, 2023