bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU595 New Screening Cutoff Values For Detection Of Aldosterone Producing Adenoma Examined By LC-MS/MS And Newly Developed Non-competitive Cleia
Authors: Satoh Fumitoshi , Ono Yoshikiyo , Omata Kei , Tezuka Yuta , Yamazaki Yuto , Sasano Hironobu , Kojima Satoshi 
Published: October 2023

Abstract
Disclosure: F. Satoh: None. Y. Ono: None. K. Omata: None. Y. Tezuka: None. Y. Yamazaki: None. H. Sasano: None. S. Kojima: None.
Objective: Thinking of the poor accuracy of conventional CLEIA measurements of aldosterone, liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the ideal method but it is costly, labor intensive and time consuming. A novel non-competitive chemiluminescent enzyme immunoassay (sandwich assay) (NC-CLEIA) for measuring aldosterone was recently developed. We validated the accuracy and diagnostic ability of the NC-CLEIA and compared the results obtained with those by LC-MS/MS and also determined the new screen cutoffs by both measurements, respectively, detecting aldosterone-producing adenoma (APA) in hypertensive patients. Design and Method: We measured plasma renin activity by enzyme assay and plasma aldosterone concentrations (PAC) using LC-MS/MS and NC-CLEIA in 133 APA, 100 bilateral hyperaldosteronism and 111 essential hypertension patients to examine the accuracy of the values of PAC measured by this new NC--CLEIA as compared with those by LC-MS/MS, and determine the new screen cutoff values by both measurements to detect APA, respectively. Results: Passing-Bablok analysis revealed that NC-CLEIA (regression slope, intercept and correlation coefficient were 0.962, -0.043, and 0.994, respectively), was significantly correlated and equivalent to LC-MS/MS than RIA. Bland-Altman plot analysis of NC-CLEIA by LC-MS/MS also demonstrated much smaller systemic errors (a bias of -0.348 ng/dL with limits of agreement of -4.390 and 3.694 and 95% confidence interval). The receiver-operating characteristics analysis demonstrated that cut-off values of aldosterone/renin activity ratio obtained by LC-MS/MS and NC-CLEIA were 31.2 and 31.5 (ng/dL per ng/mL/hr) with a sensitivity of 91.0% and 90.2%, and a specificity of 75.4% and 76.8%, respectively, in terms of discriminating APA from non-APA. Therefore, we can recommend an ARR &gt; 30.0 ng/dL per ng/mL/hr as a screening cut-off by both LC-MS/MS and NC-CLEIA, which would discriminate APA with a sensitivity of 91.7% in both assays, and with a specificity of 73.0% and 73.9 %, respectively. Conclusions: This novel NC-CLEIA assay for PAC could serve as a clinically reliable alternative to LC-MS/MS to detect APA among hypertensive patients with more accuracy than the conventional methods.
Presentation: Thursday, June 15, 2023
FRI128 Hiding In Plain Sight: Late Diagnosis Of Primary Hyperaldosteronism In Patient With Atypical Presentation
Authors: Zielinski Rachel A , Syeda Asma , Esayag-Tendler Beatriz 
Published: October 2023

Abstract
Disclosure: R.A. Zielinski: None. A. Syeda: None. B. Esayag-Tendler: None.
Background: Primary hyperaldosteronism (PHA) can go undiagnosed in patients with primary hypertension without hypokalemia and increased plasma aldosterone concentration (PAC). Case: The patient is a 72-year-old male with a history of hypertension (HTN) diagnosed at age 55 who presented to the endocrinology clinic for further evaluation. He was asymptomatic. His antihypertensive regimen included atenolol 25 mg daily and amlodipine-benazepril 10-40 mg daily. Blood pressure (BP) was well-controlled with a goal BP under 130/80 mm Hg. Physical exam was without AV nicking in a limited retina exam, no abdominal tenderness, and no peripheral edema. Family history is notable for HTN in his father and HTN complicated by stroke in a sister and a brother, all diagnosed at an older age. Labs done 5 years prior showed potassium (K) of 4.3 mmol/L [3.6 - 5.1 mmol/L], PAC of 3.2 ng/dl [upright 4.0 - 31.0 ng/dl], and plasma renin activity (PRA) of 0.1 ng/ml/hr [upright 0.5-4.0 ng/ml/hr]. More recent labs showed K of 3.8 mmol/L, PAC of 21.5 ng/dl and PRA of 0.3 ng/ml/hr. Repeat labs 6 months later showed K of 3.4 mmol/L, PAC of 15 ng/dL and PRA of 0.2 ng/mL/hr. A 3-day dexamethasone suppression test was performed to exclude familial hyperaldosteronism or glucocorticoid remediable aldosteronism. Following the test, K was 3.6 mmol/L, PAC was 11.3 ng/dl, and cortisol was undetectable. CT abdomen showed bilateral nodular thickening of the adrenal glands without a distinct adenoma. Adrenal venous sampling was done before and after ACTH stimulation. Prior to ACTH stimulation, the mean ratio of the dominant adrenal aldosterone concentration corrected with cortisol from left to right was 1.32. Following ACTH stimulation, the ratio was 2.79. A ratio greater than 4 is consistent with a good outcome after adrenalectomy. Hence, it was decided to pursue medical management. The cause of our patient’s primary hyperaldosteronism is likely due to bilateral idiopathic hyperplasia. He was started on eplerenone 25 mg twice daily and salt restriction with a goal of increasing the PRA above 1 ng/ml/hr. Discussion and Conclusion: It was initially thought that PHA represents 1% of all patients with primary HTN. However, more recent studies indicate that the prevalence is significantly higher. Additionally, the PAC in patients with PHA can fluctuate and patients can present with normokalemia, making the diagnosis more difficult to establish. It is an important diagnosis to establish and treat appropriately because there is a higher risk of cardiovascular morbidity and mortality in patients with PHA compared to patients with primary HTN.
Presentation: Friday, June 16, 2023
FRI132 Aldosterone Secretory Capacity Immediately After Surgery Predicts Biochemical Outcome 1 Year After Surgery In Primary Aldosteronism
Authors: Ishida Yuto , Nakai Kazuki , Tsurutani Yuya , Watanabe Kazuki , Saito Jun , Nishikawa Tetsuo 
Published: October 2023

Abstract
Disclosure: Y. Ishida: None. K. Nakai: None. Y. Tsurutani: None. K. Watanabe: None. J. Saito: None. T. Nishikawa: None.
Background and Objective: In primary aldosteronism (PA), the biochemical outcome of the Primary Aldosteronism Surgical Outcome (PASO) study is used to assess aldosterone hypersecretion six months to one year after surgery. However, there are few reports on whether outcomes can be predicted in the early postoperative period. This retrospective study evaluated aldosterone secretory capacity immediately after surgery using the adrenocorticotropin (ACTH) stimulation test (AST) and oral salt loading test (OST). We hypothesized that these tests would predict biochemical outcomes one year after surgery. Methods: This study assessed 282 patients with PA who underwent adrenalectomy in our hospital between 2008 and 2020 and determined biochemical PASO outcomes 1 year after surgery. Patients with serum cortisol levels ≥ 5 μg/dL after a 1 mg overnight dexamethasone suppression test (n = 9) were excluded. Patients were divided into biochemical complete success (COM) and incomplete (partial + absent) success (INC) groups. AST and OST were performed within 15 days of surgery. The relationships between various AST and OST values and outcomes were analyzed. Results: Two hundred and twenty patients and 53 patients were classified into the COM and INC groups, respectively. The INC group had significantly higher plasma aldosterone concentration (PAC) and higher PAC/cortisol ratio (A/C) at baseline, 30 min, and 60 min after ACTH loading than the COM group. The INC group showed a significantly lower level of plasma renin activity. In the OST, the INC group had a significantly higher 24-hour urine aldosterone level. Of these values, A/C at 30 minutes after ACTH loading (area under the curve (AUC) = 0.77) and 24-hour urine aldosterone (AUC = 0.78) were relatively superior predictors of the outcome, with higher AUCs than plasma renin activity (AUC = 0.63), baseline PAC (AUC = 0.71), baseline ARR (AUC = 0.72), and baseline A/C (AUC = 0.70). A/C at 30 minutes after ACTH loading had 83% sensitivity and 62% specificity when 6.03 was set as the cutoff; 24-hour urine aldosterone had 84% sensitivity and 61% specificity when 2.6 was set as the cutoff. Conclusion: AST and OST immediately after surgery are useful for predicting biochemical outcomes 1 year after surgery in patients with PA.
Presentation: Friday, June 16, 2023
FRI133 Diagnosis Of Liquorice Induced Hypertension By Mass Spectrometry - A Simpler And Less Expensive Method
Authors: Daníel Árnason Árni , Sigurdsson Baldur Bragi , Cook Elizabeth , Þorsteinsdóttir Margrét , Wallerstedt Sven , Agusta Sigurjonsdottir Helga 
Published: October 2023

Abstract
Disclosure: Á.D. Árnason: None. B.B. Sigurdsson: None. E. Cook: None. M. Þorsteinsdóttir: None. S. Wallerstedt: None. H.A. Sigurjonsdottir: None.
Background: The diagnosis of liquorice induced hypertension (LIH) has been confirmed by measuring the urinary ratio of free cortisol/cortisone by gas chromatography. The aim of this study was to evaluate if analysis of this ratio in serum (QS) is as sensitive and selective compared to analysis of the urinary ratio (QU) using mass spectrometry (LC-MS/MS) and if the analysis of serum GA (glycyrrhetinic acid) correlates to the ratio of QS in order to diagnose LIH. Methods: We included 125 individuals, 117 normotensive (NT) and 8 hypertensive (HT). Mean age was 31.6 years for the whole group (W), 31.1 years for NT, 39 years for HT, 31.1 years for men (n=72) and 32.2 years for women (n=53). The study was prospective and double blind, participants consuming 150 mg of capsuled GA daily for 2 weeks (n= 62) or placebo (n=63). Highly selective and sensitive validated inhouse LC-MS/MS method, able to measure both serum and urine samples, was used to quantify free cortisol and cortisone. An additional validated in-house method was used to quantify serum 18β-GA. Mean values with standard deviation of QS, QU and serum GA was obtained for W and the subgroups. The mean difference (mdiff) in QS, QU and serum GA before and after GA intake (or placebo) was evaluated with Wilcoxon test and correlation by Spearman correlation test. Results: For W the mdiff for QS was 0.936 (±3.19, p&lt;0.001) and for QU it was 0.214 (±0.493, p&lt;0.001), QS and QU correlated (p&lt;0.001, rho=0,605). For NT the mdiff for QS was 0.877 (±3.22, p&lt;0.001) and for QU it was 0.203 (±0.498, p&lt;0.001), Qs and QU correlated (p&lt;0.001 and rho=0.610). For HT the mdiff for QS and QU was not significant. For men the mdiff for QS was 1.30 (±2.85, p&lt;0.001) and for QU it was 0.241 (±0.474, p&lt;0.001), QS and QU correlated (p&lt;0.001, rho=0.635). For women the mdiff of QS was 0.446 (±3.58, p=0.00816) and for QU it was 0.176 (±0.520, p=0.0360), Qs and QU correlated (p&lt;0.001, rho=0.477).The mdiff for GA for W was 6.78x105 (±1.04x106, p&lt;0.001), for the NT the mdiff in GA was 6.50x105 (±1.00x106, p&lt;0.001), for HT it was not significant. For men it was 7.18x105 (±9.15x105, p&lt;0.001) and for women it was 6.24x105(±1.19x106, p=0.0140). There was a positive linear relationship between the mdiff of QS and GA and QU and GA, for all groups (p&lt;0,05). Conclusions: We conclude that the new inhouse LC-MS/MS method is a sensitive and reliable method to evaluate Qs, Qu and serum GA. Further, this new inhouse method is a reliable method to diagnose LIH.
Presentation: Friday, June 16, 2023
FRI148 Adrenal Vein Sampling: Intra-protocol Hormonal Variability
Authors: Lee Chaelin , Salman Zara , Shields James , Turcu Adina F 
Published: October 2023

Abstract
Disclosure: C. Lee: None. Z. Salman: None. J. Shields: None. A.F. Turcu: None.
Background: Primary aldosteronism (PA) might arise from one or both adrenal glands. Treatment of PA relies on determining the relative contribution of aldosterone from the two adrenal glands. Adrenal vein sampling (AVS) is essential to identifying patients with lateralized PA (LPA), who benefit from surgery. AVS procedure and interpretation protocols differ between centers. Variability in AVS lateralization has been primarily attributed to cosyntropin use and lateralization index (LI) thresholds. However, data on intra-protocol variability are lacking. Methods: We retrospectively reviewed the clinical records of patients with PA who underwent AVS at University of Michigan between January 2015 and December 2022. In our center, AVS is performed both before and after cosyntropin stimulation, and 6 sets of paired adrenal vein and peripheral serum are obtained: 3 at baseline, and 3 between 5-30 min after cosyntropin stimulation. We included patients who had successful adrenal vein catheterization and valid data from 6 time points. A LI≥4 was considered indicative of LPA. We assessed the rates of inconsistent AVS results within baseline and cosyntropin stimulated samples as proportion of sets in which 1/3 LIs provided different subtyping results than the other 2/3. Results: Of 361 patients included, 107 (29.6%) patients had at least one inconsistent LI. Of these, 74 (20%) patients had an inconsistent LI within the basal sets, 45 (12%) within the cosyntropin stimulated sets, and 12 (3.3%) patients had a discrepant result in both baseline and cosyntropin stimulated sets. The highest outlier rates were observed in the first basal sample (30.3%), followed by the third basal sample (21.9%), the first post-cosyntropin sample (16.0%), and the last post-cosyntropin sample (13.5%). Patients with one intra-protocol outlier were younger (mean age 52.2 ± 11.5 vs. 56.2 ± 10.8 years), but there were no sex, race distribution, or BMI differences between the two groups. Conclusions: The intra-procedural AVS data variability is almost twice as high in basal vs. post-cosyntropin stimulation sampling, particularly in the initial set, likely mediated by acute ACTH fluctuations during the procedure. Our results emphasize the importance of obtaining multiple AVS data sets, in order to best inform the decision for or against surgery.
Presentation: Friday, June 16, 2023
SAT076 Olanzapine Induced Pancreatitis
Authors: Mandhan Akash , Friedman Naomi , Stefan Simona 
Published: October 2023

Abstract
Disclosure: A. Mandhan: None. N. Friedman: None. S. Stefan: None.
Background: Olanzapine, an atypical antipsychotic, is commonly used to treat a variety of mental health conditions, including schizophrenia, bipolar disorder, and depression. Acute pancreatitis from olanzapine is rare. Drug-induced pancreatitis represents 0.1-2% of all cases of acute pancreatitis. Here we describe a case of olanzapine induced severe pancreatitis and new onset of diabetes. Clinical Case: A 43-year-old male with history of bipolar disorder was admitted with vomiting and altered mental status. Symptoms began a week prior to presentation and included polydipsia and polyuria. He had no known history of hyperlipidemia, diabetes or alcohol use. He was treated with olanzapine for six months prior to presentation, and the dose was increased to 35mg/day one month prior to hospital admission. On exam, he appeared older than his stated age, confused, restless and dehydrated. He was afebrile but tachycardic and hypotensive. Laboratory evaluation was notable for glucose of 1619 mg/dL (70-140 mg/dL) metabolic acidosis with ketonuria, lipase level of 684 U/L (n&lt;60), and triglyceride (TG) level of 1574 mg/dL (&lt;150 mg/dL). CT of the abdomen showed severe acute interstitial pancreatitis with retroperitoneal fluid and possible necrosis, normal-appearing gallbladder, no cholelithiasis. He was made NPO, and started on IV fluids and IV Insulin therapy. His HbA1C was 12.6% with negative GAD and IA2 antibodies, consistent with type 2 diabetes. Within twenty-four hours of presentation his DKA resolved, and TG levels down trended below 1,000 mg/dL. He was transitioned to subcutaneous insulin and combination therapy of fenofibrate. The patient was discharged on basal insulin, metformin, fenofibrate, a low dose statin and omega-3 fatty acids. His TG at discharge was 210 mg/dL and olanzapine was not restarted. Conclusions: Olanzapine induced pancreatitis has been described as a rare cause of pancreatitis in the literature. To date, there is only one additional case report about acute necrotizing pancreatitis from olanzapine. Given the ubiquitous use of olanzapine in treating psychiatric disorders, it is important that physicians are aware of this rare but potentially life-threatening adverse reaction. The exact mechanism by which olanzapine causes pancreatitis is unclear, and case reports suggest hypertriglyceridemia as the most common proposed etiology of olanzapine-induced acute pancreatitis. Patients should have a screening lipid panel before beginning therapy to optimize treatment outcomes.
Presentation: Saturday, June 17, 2023
OR24-03 Triglyceride Clearance In Hypertriglyceridemic Pancreatitis: Time-course And Implications For Management
Authors: Majumdar Sachin K 
Published: October 2023

Abstract
Disclosure: S.K. Majumdar: None.
Introduction: Uncertainty exists for how to optimally manage severely elevated triglyceride (Tg) levels in patients with hypertriglyceridemic (HTg) pancreatitis. Standard recommendations include NPO (nil per os) status and intravenous (iv) insulin for most patients, yet information is lacking in regards to the natural time-course of Tg lowering, the degree of benefit insulin provides and for whom it may be indicated, and for the Tg level at which transition to feeding would be appropriate. Underlying Questions: (1) What is the natural time-course of triglyceride (Tg) lowering when nutritional intake is held and (2) does it differ according to etiology of hypertriglyceridemia? (3) What is the role of intravenous insulin in acute Tg lowering, and (4) at what threshold of Tg can nutritional intake safely resume? Methods: A retrospective study of patients hospitalized from October 2013 through December of 2018 with a diagnosis of pancreatitis associated with hypertriglyceridemia Tg ≥ 5.65 mM (500 mg/dL), in absence of other causes, was performed by medical record review. The time-course of Tg lowering was assessed for differences in relation to initial Tg values, use of iv insulin, ethanol vs. non ethanol associated causes, and time to Tg values of &lt; 5.65 mM (500 mg/dL) vs &lt; 11.29 (1000 mg/dL). Results: Sixty-six cases were identified and 45 had multiple measurements for time-course evaluation. Those with initial Tg values &lt; 45.16 mM (4000 mg/dL) achieved Tg levels &lt; 11.29 mM in &lt; 3 days, while 18.8% with higher values took 5-9 days. Insulin therapy was associated with a longer duration, and ethanol with a shorter duration, of hypertriglyceridemia. Tg clearance in ethanol associated hypertriglyceridemia appeared independent of insulin treatment. Time to Tg &lt; 5.65 mM vs &lt; 11.29 mM was significantly longer when initial Tg levels were &gt; 22.58 mM (2000 mg/dL). Conclusion: An arbitrary threshold of 45.16 mM (4000 mg/dL) for initial Tg’s in HTg pancreatitis appears to separate those likely to achieve Tg’s &lt; 11.29 mM in &lt; 3 vs. &gt; 3 days, independent of cause or treatment in absence of known genetic defects in Tg clearance. Insulin therapy remains appropriate for hyperglycemic patients but appears unnecessary for isolated ethanol associated hypertriglyceridemia. A threshold Tg of &lt;11.29 mM appears more practical than &lt;5.65 mM for resuming nutritional intake. A randomized trial is necessary to confirm these findings.
Presentation: Saturday, June 17, 2023
THU105 PHH Parameters Are New Minimal-Invasive Markers Of Glycemic Homeostasis Of Type 1 Diabetes
Authors: Harvengt Antoine 
Published: October 2023

Abstract
Disclosure: A. Harvengt: None.
Aims: Recently, our team introduced the concept of post-hypoglycemic hyperglycemia(PHH) in the context that recovery of hypoglycemia impacts cardiovascular risk.GLUREDIA study aimed to evaluate whether PHH parameters correlated with glycemichomeostasis during the first year after type 1 diabetes onset and helped to distinguishpediatric patients undergoing partial remission or not. Methods: In the GLUREDIA study, longitudinal values of clinical parameters,continuous glucose monitoring metrics and residual beta-cell secretion from childrenwith new-onset type 1 diabetes were analyzed for one year. PHH is defined as anyhypoglycemia followed within two hours by hyperglycemia. PHH parameters werecalculated using an in-house built algorithm. Cross-sectional correlations betweenPHH parameters (i.e., PHH frequency, PHH duration, PHHAUC) and glycemichomeostasis markers were performed using adjusted mixed-effects models. Results: PHH parameters were strong markers to differentiate remitters from non-remitters (all p &lt; 0.001), the most sensitive being PHH/Hyperglycemia duration ratio(cut-off &lt; 0.02, sensibility: 86%, specificity: 68%). Among those, PHHAUC correlatedwith clinical parameters and continuous glucose monitoring metrics and inverselycorrelated with residual beta-cell secretion (all R2 &gt; 0.22, p &lt; 0.001). Furthermore,combination of PHH parameters identified three groups of patients that might benefitfrom distinct therapeutic management. Finally, patient classification into fourglucotypes, as previously described, independently validated PHH parameters asreliable markers of glycemic homeostasis and improved the segregation of patientswith intermediate values of IDAA1C and CPEPEST. Conclusion: PHH parameters are new minimal-invasive and easily assessed markersof partial remission and glycemic homeostasis during the first year of type 1 diabetesthat allow patient-specific therapeutic management.
Presentation: