bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-36 YOUNG WOMAN WITH AMNESIA
Authors: Kärki Mari , Rasku Aino Latva , Kortekangas Hannes , Kauhanen Saila , Nuutila Pirjo 
Published: January 2025

Abstract

Introduction
Insulinomas are rare neuroendocrine neoplasms (NENs), usually located in the pancreas. Traditionally, the only curative treatment is surgical. However, for single solitary NENs radiofrequency ablation (RFA) is a treatment option. In this case report, we describe the first patient with insulinoma who was treated with RFA in Finland.

Clinical Case
The patient is a 23-year-old, previously healthy woman. In April 2022, the patient’s neighbor had noticed that the patient had not been seen during the morning. The neighbor made an emergency call. A paramedic measured the blood glucose, which was low 1.2 mmol/l, glucose infusion was started, and the patient was taken to the emergency department of a local hospital. In the hospital, patient told that after December 2021 she had experienced amnesia episodes a total of six times. The symptoms were initially considered as transient amnesia. The amnesia episodes had typically been seen throughout the morning, and there were days she had no recall of the previous 8 hours. In the emergency department, a suspicion of insulinoma was raised, and the patient was sent to the endocrinology department for further examination. On the following day, after a couple of hours fasting, a remarkably decreased glucose level was detected: plasma glucose was only 2.7 mmol/l, insulin 21 mU/l and C-peptide 1.2 mmol/l. The diagnosis of insulinoma was made based on symptoms and laboratory findings. However, in the MRI of the upper abdomen, no abnormality was found in the pancreas or stomach. Due to her severe hypoglycemia symptoms, diazoxide medication 50 mg was given three times daily. After that, hypoglycemias alleviated, and the patient was able to go home to wait for further examinations. In June 2022, the whole-body positron emission tomography – computer tomography (PET/CT) imaging was made with [68Ga]-DOTANOC tracer. However, there was no abnormality found in pancreas, nor signs of any ectopic NENs. After that, the whole body [18F]-fluorodopa-PET/CT was made, but still, no insulinoma was found. In July 2022, the endoscopic ultrasound (EUS) examination finally revealed a 13 x 8 mm sized tumor in processus uncinatus in pancreas. The tumor was confirmed as a grade I insulinoma based on the biopsy. Due to the difficult location, pancreoticoduodenectomy and a non-surgical method, EUS-RFA, remained the treatment options. Since the tumor was small, RFA was performed. After the RFA, she has been symptom free, and her glucose levels have been in normal range. Six months later, plasma glucose level (fasting) was 4.9 mmol/l while insulin was 7 mU/l.

Conclusion
The treatment of pancreatic insulinoma is often surgical. However, in selected patients, curative EUS-RFA can be a good treatment option in patient with small (≤ 2 cm) localized insulinomas. It seems a safe and effective option, and compared to pancreaticoduodenectomy or enucleation, the risk of complications is clearly smaller.Figure 1endoscopic ultrasound examination
P-40 A RARE PRESENTATION OF PROLONGED HYPOGLYCEMIA: CONGENITAL LEPTIN DEFICIENCY AND INSULIN INTOXICATION
Authors: Kargün Sinem 
Published: January 2025

Abstract

Introduction
Congenital leptin deficiency (CLD) is caused by mutations in the LEP gene with an incidence of 1 in 4.4 million, presenting with symptoms such as hyperphagia, obesity. Insulin intoxication is also a rare condition that usually occurs as a result of a suicide attempt or, a medication error. There is not an algorithm for the management of insulin intoxication. Here, we report the only case in the literature presenting with congenital leptin deficiency and insulin intoxication.

Clinical Case
A 33-year-old woman was admitted to the hospital with dizziness, nausea, and unconsciousness. She had applied nearly 300 IU insulin aspart of committing suicide. She had congenital leptin deficiency, hypothyroidism, and prediabetes. She had leptin replacement during 2020-2021 and didn’t have a replacement since then. Her body mass index was 62.2. Her blood pressure was 95/60 mm/Hg, Sp02 was 88 %, and heart rate was 120 per minute. Her blood glucose was 29 mg/dl, and there was respiratory acidosis. Liver and renal function tests, electrolytes, coagulation parameters, and thyroid hormones were normal. Chest x-ray and brain tomography were normal. Despite subsequent infusion of 20% dextrose solution via central catheter, serum glucose could only be kept at 70-80 mg/dl. In the following hours patient’s consciousness, pH level, and oxygen saturation returned to normal. We had to follow the patient with a high concentration of glucose (150-200cc/h %10 dextrose) for ten days because of reappearing hypoglycemia. On the 10th day of follow-up, we stopped IV glucose for a short time and measured the fasting hormones shown in Table 1. at 7.00 a.m. As there was hypocortisolemia, we applied 5mg prednisolone twice daily in the following days. Twenty-four hours after cortisol administration, we could easily stop the IV glucose. We followed the patient with 5mg prednisolone twice daily and oral carbohydrate intake for three days and didn’t observe hypoglycemia. Afterwards, we stopped prednisolone and the patient was normoglycemic for the following days. We again measured the fasting hormones shown in Table 2. At 7.00 a.m. three days after the last dose of prednisolone. The patient was not hypoglycemic or hypocortisolemic since then; vital parameters were all normal and we discharged the patient.

Conclusion
Prolonged hypoglycemia may have occurred in different mechanisms. Our patient had a thick subcutaneous fat tissue because of CLD; therefore, absorption of insulin may have increased and half life may be prolonged. Also, high dose exogenous insulin may have triggered the production of insulin antibodies causing prolonged duration of insulin action and hypoglycemia. Moreover, deep hypoglycemia may have affected the pituitary-adrenal cortisol axis causing relative adrenal insufficiency. The steroid decreased the insulin antibodies and also corrected the relative cortisol deficiency. More cases and data are needed to shed light on this subject.Table 1: Table 2:
O-02 A RARE COLLISION TUMOR OF THE PITUITARY: CO-EXISTENCE OF CRANIOPHARYNGIOMA AND PROLACTINOMA
Authors: Uzun Ilknur , Hacioglu Aysa , Karaca Zuleyha , Unluhizarci Kursad , Okcesiz Izzet , Oral Şükrü , Selçuklu Ahmet 
Published: January 2025

Abstract

Introduction
Pituitary adenomas are the most common lesions of the sellar region. The most common (40%) functional pituitary adenomas are prolactinomas. Craniopharyngiomas are epithelial tumors of embryonal origin originating from Rathke's sac. Very few cases of collision tumors co-existing with pituitary adenoma and craniopharyngioma have been described in the literature.

Clinical Case
We present a case of histopathologically proven craniopharyngioma accompanying prolactinoma in a 63-year-old female patient diagnosed with prolactinoma 40 years ago. She was treated with bromocriptine after the diagnosis, and the treatment was switched to cabergoline four years later. Although the biochemical remission was achieved, there was no significant decrease in tumor size. She had not received any treatment during last 4 years before the administration. She was admitted to our clinic with a complaint of headache. Her serum prolactin level was 1550 ng/ml ((Reference:4,79-23 ng/ml). According to the pituitary Magnetic Resonans Imaging(MRI); reports were as follows in 2007; an isolated 8x6x13 mm adenoma was observed, and then in 2015; another cystic lesion (craniopharyngioma?) was detected adjacent to the infindibular stalk in addition to the defined pituitary adenoma (Figure 1a). In the last pituitary MRI (2022); a cystic lesion extending from the sellar cavity to the suprasellar cistern and a solid mass lesion located left to the cavernous sinus, was observed (Figure 1b). Upon a dramatic increase of the tumor volume on pituitary MRI, she underwent pituitary surgery. The histopathological diagnosis was adamantinomatous craniopharyngioma. Postoperative prolactin level decreased to 10 ng/ml. Since prolactin levels decreased after the diagnosis of craniopharyngioma, the surgical material was re-evaluated by the pathologist. No evidence of prolactinoma was found. Significant regression was observed in the patient's 1st month follow-up pituitary MRI compared to the preoperative MRI. Postoperatively, prolactin levels remained within the normal range for the first 6 months. After the 6th month, cabergoline treatment was started when prolactin levels increased to 497 ng/ml.

Conclusion
Pituitary adenoma and craniopharyngioma collision tumors are extremely rare. Only 6 patients with the coexistence of craniopharyngioma and prolactinoma have been reported in the literature, including our case. Histopathological diagnosis may be necessary to differentiate craniopharyngioma from cystic macroprolactinoma.Figure 1:Magnetic Resonans ImagingFigure 1: a. Post-contrast coronal pituitary MRI examination revealed a pituitary adenoma (thick arrow) located in the left cavernous sinus. aAnother cystic mass lesion (thin arrow) was detected adjacent to the infindibular stalk.; b. Coronal contrast-enhanced pituitary MRI image showed cystic (arrow) and
P-47 A CASE OF SPONTANEOUS REMISSION AFTER METYRAPONE IN CUSHING'S DISEASE
Authors: Tunç Ali , Muradov Ilkin , Sulu Cem , Çapar Mehmet Umut , Kadıoğlu Pınar 
Published: January 2025

Abstract

Introduction
Cushing's disease (CD) is characterized by exposure to cortisol excess and is caused by excessive secretion of adrenocorticotropic hormone (ACTH) from a pituitary adenoma. The diagnosis, management, and follow – up of patients with Cushing's disease pose significant challenge to clinicians, making it one of the most cumbersome condition in routine endocrinology practice. Here we report an unusual case of CD which underwent remission while on oral treatment.

Clinical Case
A 23-year-old male presented with hypertensive crisis and weight gain. He had a history of obesity and hypertension for the past eight years. Physical examination revealed central obesity, a buffalo hump, facial acne, and striae around the umbilicus. Initial laboratory tests showed basal cortisol levels of 9.9 and 11.56 µg/dl. Consecutive morning ACTH levels were 24 and 38 pg/ml. The 1 mg dexamethasone suppression test (DST) and the 2-day 2 mg DST showed no suppression (13 and 11 µg/dl, respectively). Urinary free cortisol and late night salivary cortisol levels were increased 2.3 and 3 folds, respectively. These results confirmed the ACTH – dependent cortisol excess.
In differential diagnosis of ACTH dependent Cushing’s syndrome, no adenoma detected by pituitary imaging, leading to inferior petrosal sinus sampling (IPSS). The results of IPSS suggested a pituitary source with a central to peripheral ratio greater than 3. Although the patient was referred for pituitary surgery, he did not provide consent for surgical intervention and preferred medical treatment. He was initially started ketoconazole and pasiretoide, but soon after switched to metyrapone due to market shortage of former drugs. The patient experienced a 6-month off period without metyrapone due to an earthquake. Remarkably, during this period without medical therapy, his blood pressure normalized without medication, and there was no recurrence of weight gain, acne, or buffalo hump. Subsequent laboratory tests showed a 1 mg DST result of 0.31 µg/dl, nocturnal serum cortisol of 1.03 µg/dl, and nocturnal salivary cortisol of 0.01 µg/dl (reference range: 0-0.14 µg/dl), and normal UFC levels.

Conclusion
Spontaneous remission in Cushing's disease is rare, with only a limited number of cases reported in the literature. There have been instances of spontaneous remission following metyrapone treatment. It is hypothesized that metyrapone inhibits steroidogenesis, reducing negative feedback on tumor cells and stimulating increased ACTH synthesis. The resultant increase in ACTH production may heighten the metabolic demands of corticotroph cells, potentially exceeding the blood supply to the pituitary gland, leading to spontaneous infarction of corticotroph cells and subsequent remission of Cushing's disease.
P-56 THE CASE OF SUBACUTE THYROIDITIS IN AN ELDERLY PATIENT MIMICKING MALIGNANCY
Authors: Rıza Baykal Gokhan , Keskin Müge , Özdemir Didem , Topaloğlu Oya , Ersoy Reyhan , Çakır Bekir 
Published: January 2025

Abstract

Introduction
Subacute thyroiditis is a self-limiting inflammatory thyroid disease characterized by fever, neck pain, and thyroid dysfunction. It typically appears following an upper respiratory tract viral infection. Most cases of subacute thyroiditis are diagnosed through clinical and laboratory testing. The thyroid gland is large, painful, and tender during thyroid examination. Blood tests typically reveal elevated levels of free T4 and free T3, as well as a significantly increased sedimentation rate and C-reactive protein (CRP). Ultrasonographic findings of subacute thyroiditis are well defined.

Clinical Case
A 68-year-old male was consulted by the anesthesia department before the endoscopy and colonoscopy procedure planned to screen for malignancy. He was very worried and afraid because of the possibility of cancer and was psychologically negatively affected. He presented with night sweats and 10 kg of weight loss in the last 6 weeks. He had no history of previous disease. When a detailed history was taken, he stated that he had severe pain in his neck before his complaints started and that it went away on its own after a few weeks. On examination, he had no fever, a heart rate of 90 beats per minute, and a blood pressure of 120/80 mmHg. Neck examination showed no thyromegaly or lymphadenopathy. The general and systemic examination was unremarkable. Laboratory investigations showed hemoglobin 12.2 g/dL, WBC 8380 (x109/L), erythrocyte sedimentation rate (ESR) 78 mm/hour, CRP 50.1 mg/L, thyroid stimulating hormone 0.08 mIU/L (N = 0.55 – 4.78 mIU/L), free t4 1.4 ng/dL (N = 0.89 – 1.76 ng/dL), free t3 4.34 ng/L (N = 2.3 - 4.2 ng/L), and negative anti-thyroid peroxidase and thyroid stimulating immunglobulin. Thyroid ultrasonography was suggestive for subacute thyroiditis. He was given NSAIDS. Since his free T4 and T3 levels were normal at follow-up, endocrinological approval was given for the planned procedures. It was recommended to have a beta blocker ready during the procedure if needed. No findings in favor of cancer were detected in the detailed examinations, and the weight loss was attributed to subacute thyroiditis.

Conclusion
When elderly patients have complaints of weight loss or fatigue, it is important to exclude thyrotoxicosis and make a diagnosis by performing the necessary examinations. Subacute thyroiditis may not be severe; it is easy to diagnose with careful history-taking and simple laboratory examinations, and clinicians should keep it in mind in the differential diagnosis of weight loss.
P-59 A CASE REPORT: A RARE CASE OF PAPILLARY THYROID CARCINOMA WITH BRAIN METASTASIS WITHOUT LOCAL RECURRENCE
Authors: Şakar Kenan , Altundal Aslı Akıncı , Şimşek Hakan , Cinar Nese 
Published: January 2025

Abstract

Introduction
Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and generally has an excellent prognosis. However, distant metastases, particularly to the brain, are rare and associated with poor outcomes. This case report presents a 67-year-old female patient with a history of PTC, who developed brain metastasis in the follow-up.

Clinical Case
A 67-year-old female patient presented four years ago with a rapidly growing 4 cm mass, extending from the right thyroid gland to the right jugular vein. Fine-needle aspiration biopsy (FNAB) of the lesion was reported as suspicious for follicular neoplasm. Ultrasound imaging revealed pathological lymphadenopathy in the bilateral cervical chains. The patient underwent total thyroidectomy and bilateral neck dissection. Pathology confirmed the diagnosis of the follicular variant of papillary thyroid carcinoma (PTC), with extrathyroidal extension into muscle and adipose tissue, as well as lymph node metastases.
After surgery, while the patient's TSH level was 68.6 µIU/ml, her thyroglobulin (Tg) level was 1.02 ng/ml, with negative anti-Tg antibodies. The patient received 150 mCi of radioactive iodine (RAI) approximately 3 months after surgery. One year after RAI therapy, a whole-body iodine scan showed no evidence of residual disease or metastasis. Follow-up Tg levels of the patient remained around 0.04 ng/ml. 3.5 years after surgery, there was a slight increase in thyroglobulin levels (0.26 ng/ml), although no recurrent disease was detected on ultrasound of the thyroid bed. The patient was planned to be under close surveillance but she did not come to visits regularly. The patient subsequently presented with complaints of imbalance and brain MRI revealed a mass lesion measuring 46x43x55 mm in the frontal region. The mass was surgically resected, and the pathology confirmed metastatic papillary thyroid carcinoma (PTC). A postoperative whole-body iodine scan was negative for metastatic disease. At that time, the TSH level was 0.5 µIU/ml, and thyroglobulin (Tg) was 0.04 ng/ml. Cranial radiotherapy was planned for the patient.

Conclusion
Approximately 10% of patients with PTC develop distant metastases, most commonly to the lungs and bones. Brain metastasis from PTC is extremely rare, occurring in less than 1% of cases. Due to its rarity, brain metastasis from PTC is not typically considered in the differential diagnosis for patients presenting with new neurological symptoms, potentially delaying diagnosis. Despite aggressive treatment, the prognosis for patients with PTC and brain metastasis remains poor, with a median survival of approximately 17 months. This case highlights the importance of considering the possibility of brain metastasis in high-risk PTC patients who present with neurological symptoms despite the lack of significant elevation in thyroglobulin (Tg) levels or evidence of recurrence on neck ultrasound.
P-76 UNEXPECTED RAISE OF PROCALCITONIN IN PATIENT WITH TREATED FOR DF INFECTION REVEALED MEDULLARY THYROID CANCER
Authors: Bublik Evgeniya , Vanushko Vladimir , Victorovna Shmyreva Maria , Ryzhkova Ekaterina , Терёхин Сергей , Фарманов Александр , Vinogradskaya Olga , Zilov Aleksey 
Published: January 2025

Abstract

Introduction
To demonstrate the importance of differential diagnosis of rare causes of procalcitonin (PCT) elevation.

Materials-Methods
Case of patient with diabetic foot infection, knee joint injury, and persistent elevation of PCT level on antibiotic therapy.

Results
PCT and C-reactive protein (CRP) are biomarkers of sepsis. Raised PCT and CRP after antibacterial therapy (ABT) can be associated with different factors.
Reviewed publications suggest the following causes of elevated PCT: ketoacidosis, liver diseases, acute kidney injury, trauma, burns, calcitonin-secreting neuroendocrine tumors, medullary thyroid cancer (MTC).

Clinical Case
70-year-old woman with type 2 diabetes mellitus was admitted for closed fracture of the right patella. Persistent wound of the right foot after a forefoot amputation in 2022, dry necrosis of the 4th toe of the left foot was found. Tests detected: PCT - 7.3 ng/mL (0-0.5), CRP - 156 mg/L (0.0-5.0). ABT and local wound care were initiated. A left lower limb revascularization and a 4th left toe disarticulation were performed. In 5 days open reduction and osteosynthesis of the right patella were performed.
After 2 weeks of ABT there were no signs of wound infection, CRP level decreased but PCT was still high, 5.7 ng/mL (0-0.5). One of the hypotheses was that the raised PСT was not related to infection. The patient had previously had a multinodular goiter so the calcitonin level was checked (above 950 pg/mL). Thyroid biopsy detected medullary carcinoma (MTC).
Later total thyroidectomy and central neck dissection were performed. Histology: medullary thyroid carcinoma (MTC) (pT2N0(0/2), Lv0, Pn0, R0). No pathogenic or probably pathogenic mutations were found. In 1 month, calcitonin was 3.7 pg/mL.

Conclusion
Causes of elevated procalcitonin (PCT) may be not related to infections, which is an important finding for physicians treating comorbid diabetic patients with infection. This case underscores the role of PCT in the diagnosis of MTC.
While the current findings highlight its utility in clinical practice, further studies are needed to explore full potential and establish standardised guidelines for use PCT in MTC management.
Zaproszenie na dobre ścieżki
Authors: Mączkowski Krzysztof M. 
Published: January 2025

Autor omawia nowe książki trzech tubylczoamerykańskich pisarzy - N. Scotta Momadaya, Richarda Wagamese oraz Claytona Thomasa-Müllera - wskazując, że łączy je wspólna tematyka. Dotyczą one bowiem kwestii związanych z tubylczą filozofią oraz refleksją dotyczącą relacji człowieka z naturą. W konkluzji autor sugeruje, że recenzowane książki ułatwiają czytelnikom zrozumienie reguł tubylczego świata, poprzez zwrócenie uwagi na cechy, takie jak uważności, wrażliwość i pokora.
Hohe Feste, niedere Feste. Der liturgische Festalltag in den Konventen des Deutschen Ordens
Authors: Löffler Anette 
Published: January 2025

High feasts, low feasts. The everyday liturgical festivities in the convents of the Teutonic Order

The liturgical life of the priest brothers of the Teutonic Order took place to a considerable extent in the convents and castles. Depending on the degree of celebration, the daily festivities in the Teutonic Order were organized. Complex liturgical regulations regarding the prioritization of the feasts had to be followed, which resulted from the degree of the feast. The higher the degree of celebration, the more extensive and complex the liturgy was on this and other days. The existing festival calendar also had to be taken into account, in which men's feasts, Sundays, movable feasts and saints’ feasts had to be classified.
However, the definition of a feast by its degree of celebration was already recorded differently in the underlying liturgical manuscripts. The forms in the liturgical manuscripts, in turn, sometimes differed from the entries in the calendars. Even with a requirement in the standards code, the range was wide. The example of the fixed degree commemoratio shows very clearly what deviations can occur.
Over time, the liturgy of the Teutonic Order changed, so that new festivals were added and the degree of celebration of existing festivals was changed. This is also shown by the feast of St. Barbara of Nicomedia, in which, despite all the uniformity, individual characteristics came into play. This means an elevation from the lowest level of celebration, the commemoratio, to a solemnity with its own rhyme office.