bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT463 Hormonal Contraceptive Use and Hypothyroidism Risk
Authors: Gloe Shawna , Carroll Ty B 
Published: October 2023

Abstract
Disclosure: S. Gloe: None. T.B. Carroll: Consulting Fee; Self; Corcept Therapeutics. Research Investigator; Self; Corcept Therapeutics, Novartis Pharmaceuticals.
Introduction: Thyroid dysfunction is one of the most common endocrine disorders, with an estimated 4.3% of the US affected by subclinical hypothyroidism and 0.3% affected by overt hypothyroidism. Chronic autoimmune thyroiditis is the most common cause of hypothyroidism in the US and is estimated to affect 5-10x more women than men. Given this higher incidence in women, it is possible that hormonal difference or hormonal medications may play a role in thyroid dysfunction. Nearly 15% of women aged 15-49 use oral contraceptive pills (OCP) and 10.4% use other long-acting reversible hormonal contraceptives. A recent study showed a 25% increased prevalence of hypothyroidism in women with prior OCP use and in women with more than 10 years of OCP use the risk of developing hypothyroidism was nearly 4 times as high. Methods: Using the TriNetX database, four distinct groups of women aged 18-45 were identified using data from 1/1/2010 -1/1/2020. The four groups were EPC (n=5849), POC (n=5052), IUD (n=1000), and controls without prior hormonal contraception use (n = 6677). Demographic data, date of diagnosis of hypothyroidism, alcohol use, tobacco use, and BMI was obtained for each subject. Exclusion criteria included thyroidectomy (partial or total), lack of sufficient medication data, and a hypothyroidism diagnosis prior to or within 90 days of the first contraceptive medication order. A logistic model was then created accounting for known risk factors for the development of hypothyroidism (race/ethnicity, alcohol use, smoking, and BMI).Results: Initial comparison of treatment groups to controls demonstrated an no difference in risk of developing hypothyroidism for the EPC group (OR=1.18, p=0.2), but the POC and IUD groups had decreased risk of hypothyroidism (OR=0.39, p=&lt;0.001 and OR=0.45, p=0.029, respectively). Using the logistic model, all groups demonstrated a decreased risk of hypothyroidism as compared to the control group (EPC: OR=0.3, p=&lt;0.001, POC: OR=0.14, p=&lt;0.001, IUD: OR=0.12, p=&lt;0.001). Additionally, individuals identifying as Black/African Americans were less likely to develop hypothyroidism when compared to white/Caucasian subjects (OR=0.25, p=&lt;0.001). Finally, BMI showed a fairly weak but significant association with development of hypothyroidism (OR=1.04, p=&lt; 0.0001). Conclusion: Contrary to prior research, our data suggests a potential protective effect against the development of hypothyroidism for EPC, POC, and IUD use. The data also confirms prior studies showing a lower incidence of hypothyroidism in individuals who identify as Black/African American and perhaps those with lower BMI.
Presentation Date: Saturday, June 17, 2023
SAT499 Amyloid Goiter: A Case Series
Authors: Paz-Ibarra Jose , Concepción-Zavaleta Marcio , Solis Pazmino Andrea Paola , Peralta Jose Somocurcio 
Published: October 2023

Abstract
Disclosure: J. Paz-Ibarra: None. M. Concepción-Zavaleta: None. A.P. Solis Pazmino: None. J. Somocurcio Peralta: None.
Background: Amyloid goiter (AG) is a rare presentation of thyroid swelling, characterized by the presence of deposits of amyloid protein in the thyroid tissue, accompanied by fat deposition or thyrolipomatosis. It may occur in 50% and up to 80% of patients with primary and secondary amyloidosis, respectively. Currently, the treatment is surgical resection of the thyroid gland. The present study reports a case series of primary thyroidal nodular amyloid goiter diagnosed by fine-needle cytology (FNC). Clinical cases:There were 2 female and 1 male patient from Peru. All three patients had comorbidities prior to AG diagnosis. F1: 65 years old, history of Rheumatoid Arthritis, Sjogren’s disease nephron Angio sclerosis, and polycystic kidney disease. F2: 67 years old, history of rheumatoid arthritis, end-stage renal disease (ESRD), arterial hypertension. M1: 28-year-old man with a history of pulmonary tuberculosis, bronchiectasis, and ESRD on HD due to renal amyloidosis of 9 years' evolution. They reported dyspnea, dysphagia, and dysphonia. On their physical examination, they had a bilateral, firm, and diffusely enlarged thyroid gland. Her serum T3, T4, and TSH levels were all normal. The PAAF reported a colloid goiter (Bethesda II). A total thyroidectomy was performed, with no complications. An alcohol-fixed smear was stained with Congo red: the amyloid material appeared cherry red and it also showed apple-green birefringence when observed with a polarizing microscope. Conclusions: Secondary amyloidosis generally has a neoplastic origin or is secondary to chronic inflammatory diseases. The development of a giant goiter with compressive symptoms is the most common form of presentation and represents amyloid infiltration of the gland. Total thyroidectomy is the method of choice for both diagnosis and treatment of amyloid goiter. Histological evaluation of the resected thyroid gland is crucial to make a definitive diagnosis.
Presentation Date: Saturday, June 17, 2023
SAT502 Choristoma: A Very Rare Cause of Thyroid Nodule. Clinical Case and Literature Review
Authors: Rocha José Vicente , da Cruz Rafael Moiteiro , Alexandre Maria Inês , Gomes Ana , López-Presa Dolores , Bugalho Maria Joao 
Published: October 2023

Abstract
Disclosure: J. Rocha: None. R. Moiteiro da Cruz: None. M. Alexandre: None. A. Gomes: None. D. López-Presa: None. M.J. Bugalho: None.
Introduction: A choristoma is a well delimitated benign lesion formed by normal tissue in an unusual location. Choristomas are rare lesions that are mainly reported in the eye, tongue or ears. The etiology of the choristoma is not well established but congenital defects in cell migration and exposure to chronic inflammation are two of the suggested hypothesys. Diagnosis is made after surgical removal of the mass, usually with no other associated abnormalities. To our knowledge, to this day there is only one other case of thyroid choristoma described in literature. Clinical case: A 70-year-old man presented to the emergency department with hyperglycemia, polydipsia and polyuria. Personal history was notable for non-Hodgkin lymphoma in remission after stem cell autologous transplant, currently under high dose prednisolone treatment due to sudden cervical enlargement. Cervical imaging with CT scan showed a 47mm hypodense nodule of the right thyroid lobe. The patient was refered to an Endocrinology appointment.Thyroid function was normal, with normal serum calcitonin and negative anti TPO and antiTG antibodies. Fine-needle aspiration biopsy was notable for folicular lesion of undetermined significance. During the following weeks there was a noticeable thyroid enlargement causing positional dyspnoea and dysphonia. Ultrassound revealed a 73mm nodule of the right lobe, predominantly cystic and isoechoic in the solid regions. At this point the patient underwent total thyroidectomy without complications.Histopathological examination revealed a choristoma composed of cysts lined by squamous epitelium, smooth muscle bundles, mature adipose tissue, areas of calcification and ossification and extramedullary hematopoiesis; there were also signs of old and recent haemorrhage and foreign body granulomas. No cytological atypia or tumoral necrosis were found. Conclusion: Thyroid choristomas are extremely rare entities. Unlike the previously described case our patient had a rapid growth of the cervical mass. This case is specially relevant due to its clinical course, existing comorbidities and rarity of the final diagnosis.
Presentation Date: Saturday, June 17, 2023
FRI218 Von Hippel-Lindau With Pheochromocytoma And Severe Orthostatic Hypotension
Authors: Ebrahimi Neda , Rivas Pajuelo Cynthia G , Habibi Roshanak , Tariq Sarah , Penquite Sara Ashlyn 
Published: October 2023

Abstract
Disclosure: N. Ebrahimi: None. C.G. Rivas Pajuelo: None. R. Habibi: None. S. Tariq: None. S.A. Penquite: None.
Introduction: Von Hippel-Lindau (VHL) syndrome clinically manifests with benign and malignant tumors across multiple organ systems including the cerebellum, retina, kidney, and adrenal glands. Pheochromocytoma occurs in 25-30% of patients with VHL. Up to 50% of patients with pheochromocytoma present with hypertension or paroxysmal hypertension, although patients can be normotensive on presentation. Patients with pheochromocytoma are often severely volume depleted due to chronic vasoconstriction. Here we present a case of VHL with pheochromocytoma complicated by profound orthostatic hypotension after initiation of alpha-blockade.
Case Presentation: A 32-year-old man presented for evaluation of progressive headache and diplopia. Patient was normotensive on initial presentation with BP 129/80mmHg. Brain MRI with contrast subsequently revealed a posterior fossa cystic mass with an avidly enhancing central nodule concerning for hemangioblastoma. Given these findings, a CT chest/abdomen/pelvis was obtained, which demonstrated a 4.6 x 5.0 cm right adrenal mass, several enhancing renal lesions, and multiple cystic lesions throughout the pancreas. This constellation of radiological findings was clinically concerning for VHL. Further endocrinologic work-up revealed plasma metanephrines 663 pg/mL (insert reference range here), plasma catecholamines 770 pg/mL (insert reference range here), which confirmed the diagnosis of pheochromocytoma. Alpha blockade was initiated with doxazosin 4 mg BID, and a high sodium diet (insert g/day). Shortly after initiation of doxazosin, patient developed severe orthostatic hypotension despite salt loading and volume resuscitation. Ultimately doxazosin was discontinued, and surgery was postponed due to severe symptomatic orthostatic hypotension limiting patient’s ability to get out of bed. High sodium diet was continued on hospital discharge and alpha-adrenergic blockade was later re-initiated which patient is tolerating well. Patient is pending adrenalectomy in the coming weeks. Discussion: Orthostatic hypotension in pheochromocytoma is expected due to volume depletion from chronic vasoconstriction. Alpha adrenergic blockade is required to alleviate hypertension, allow for adequate volume expansion, and to prevent a hypertensive crisis intraoperatively. Clinicians should be aware of the commercially available alpha-adrenergic antagonists and when they should be temporarily discontinued. There is no preferred alpha-adrenergic antagonist agent, however doxazosin has shown to cause less orthostatic hypotension and does not have such an antihypertensive effect as of Phenoxybenzamine.
Presentation: Friday, June 16, 2023
THU553 Anti-tumor Effect Of Rosiglitazone Via Upregulating 15-PDGH In Prolactin Secreting Adenoma
Authors: Kang Chan Woo , Hun OH Ju , Wang Eun Kyung , Lee Soohyun , Nam Jung Ho , Hong Jae Won , Lee Eun Jig , Ku Cheol Ryong 
Published: October 2023

Abstract
Disclosure: C. Kang: None. J. Oh: None. E. Wang: None. S. Lee: None. J. Nam: None. J. Hong: None. E. Lee: None. C. Ku: None.
Background: Rosiglitazone, a synthetic peroxisome proliferator-activated receptor γ (PPAR γ) ligand, are used to treat type II diabetes. Over the last few years, PPAR γ has received much attention for its ability to exert variable tumors. Objective: The aim of this study is to investigate the anti-tumor effect of rosiglitazone on prolactin secreting pituitary adenomas and its mechanism. Materials & Methods: Lactotroph cell line (GH4, MMQ) were treated with Phosphate-buffered saline (PBS) or rosiglitazone. In vitro analysis such as qPCR, immunoblot, prolactin (PRL) ELISA, Cell proliferation assay, and Fluorescence-activating cell sorting (FACS) analysis were performed to examine the effect of rosiglitazone on Lactotroph cell lines. Result: To investigate the direct effect of rosiglitazone on PRL secretion of the pituitary adenomas, GH4 and MMQ cells were treated with rosiglitazone 1, 5, 10, 50 μM for 72 hr. Both PRL mRNA and secretion levels were significantly decreased by rosiglitazone in a dose-dependent manner. In previous studies, 15-PDGH has been implicated as a tumor suppressor gene with the property that inhibits the tumor growth. Interestingly, 5 μM rosiglitazone upregulated the mRNA and protein levels of 15-PDGH in both GH4 (4.73-fold) and MMQ (4.04-fold) cells. Next, we investigated whether rosiglitazone had any effects on the proliferation of prolactinoma cells. Proliferation of the GH4 and MMQ cells were significantly decreased by rosiglitazone in a dose-dependent manner after treatment. Rosiglitazone potently induced cell cycle arrest in sub-G1inGH4 and MMQ cells. Furthermore, rosiglitazone treatment significantly increased both early (2.31-fold) and late apoptosis (1.9-fold) of GH4 and MMQ cells. Conclusion: These results collectively position 15-PDGH as a potential new therapeutic target for prolactinomas and implicate rosiglitazone as a possible alternative pharmacological approach for prolactinomas.
Presentation: Thursday, June 15, 2023
SAT342 Stress-induced Cardiomyopathy And Pheochromocytoma
Authors: Rivas Pajuelo Cynthia G 
Published: October 2023

Abstract
Disclosure: C.G. Rivas Pajuelo: None.
Introduction Pheochromocytoma (PCC) can be associated with certain genetic syndromes such as Neurofibromatosis type 1(NF1). About 5-7% of patients with NF1 will develop PCC/PGL in their lifetime. Typically, PCC presents with hypertension, and rarely, as stress-induced cardiomyopathy. Herein we present a case of a patient with NF1, and stress-induced cardiomyopathy due to Pheochromocytoma. Case presentation: A 63-year-old woman with medical history of NF1 presented to the hospital for acute hypoxemic respiratory failure and hypertensive emergency. On admission, had troponin level 27 ng/L, pro-BNP 2446 pg/ml; had a transthoracic echocardiogram (TTE) that showed EF of 30%, with global hypokinesis, anteroseptal and inferoseptal akinesis. Given NF1 history and hypertension, a CT chest/abdomen/pelvis was ordered and showed bilateral adrenal adenomas; a 2.6 cm left adrenal adenoma HFU 3, and a right adrenal mass 4.0 x 3.7 cm HFU 45 with indeterminate density. Biochemically, had markedly elevated plasma catecholamines (epinephrine 352 pg/mL, Norepinephrine 1904 pg/mL) and urinary metanephrines (2155 mcg/24 h). She markedly improved after IV diuresis, and prior to discharge was started on alpha-blockade with prazosin. This was titrated as outpatient, with addition of metoprolol 1 week later. MIBG showed intense tracer uptake in the right adrenal gland suggestive of pheochromocytoma, the left adrenal nodule was lipid rich. A repeat TTE 2 months later showed improved EF to 60% and had left heart catheterization revealing normal coronary arteries. She underwent right laparoscopic adrenalectomy, with final pathology report of 4.8 cm pheochromocytoma with negative margins.
Discussion: Stress-induced cardiomyopathy is a life-threatening complication that can be the initial presentation in patients with PCC. Hypersecretion of catecholamines specifically norepinephrine and epinephrine, are thought to play a role in combination with PCC tumor cells, to act synergistically and induce direct cardiotoxic effect. Treatment with medical management followed by surgical excision of the PCC will reverse cardiomyopathy as in our patient. Ultimately, because patients with NF1 are at increased risk for PCC, it is recommended they undergo screening with plasma metanephrines and catecholamines or urinary metanephrines at least every 1-2 years especially if hypertension or tachycardia are present.
Presentation: Saturday, June 17, 2023
THU407 CRISPR/Cas9-based Knockout Of CFTR Alters Mechano-sensitivity And Proteomic Profile In An Osteocyte Model
Authors: Du Wanting , Chen Junjiang , Ruan Ye Chun 
Published: October 2023

Abstract
Disclosure: W. Du: None. J. Chen: None. Y. Ruan: None.
Osteocytes, the most abundant bone cell type with recognized endocrine functions, play essential roles in mechano-signal transduction in the skeletal system required for bone modelling/remodelling and mineral homeostasis, although the underlying molecular mechanisms are not fully understood. Bone problems are present in cystic fibrosis (CF), a genetic disease resulted from mutations in CF transmembrane conductance regulator (CFTR), which is a Cl− channel gene recently revealed to be expressed in osteocytes with its exact roles largely unexplored. In the present study, CRISPR/Cas9 technology was used to knock out CFTR (CFTR-KO) in MLO-Y4, a commonly used osteocyte model, which resulted in a significant decrease (by 80.7 ± 7.4%) in shear force-induced Ca2+ oscillations (measured by Fura-2 imaging) as compared to wild-type (WT) cells (n = 205 (WT) and 114 (KO) cells, t-test, p &lt; 0.001). However, the CFTR-KO cells did not show, in comparison with WT cells, any reduction in expressing (measured by quantitative PCR, n = 5) Piezo1 or TRPV4, two reported key mechano-sensitive Ca2+ channels in osteocytes, nor change in cell membrane stiffness (measured by atom force microscope, n = 58 (WT) and 64 (KO) cells, t-test, p &gt; 0.05). Moreover, the shear-force-stimulated Ca2+ oscillations in WT cells were observed to be dependent on extracellular Cl−, which together suggested possibly a direct role of CFTR, through its Cl- channel function, in osteocyte mechano-sensitivity. We next performed proteomic analysis by mass spectrometry detection of whole-cell protein extracts from the MLO-Y4 cells, which revealed downregulation of genes related to focal adhesion, gap junction and actin cytoskeleton regulation in CFTR-KO cells. These results, therefore, have suggested a crucial involvement of CFTR in osteocyte function, providing new insights into mechanistic understanding of the mechano-transduction in the skeletal system. This work was supported in part by Health and Medical Research Fund of Hong Kong (No.18191361), Theme-based Research Scheme of Hong Kong (No. T13-402/17N), and Areas of Excellence Scheme of Hong Kong (AoE/M-402/20).
Presentation: Thursday, June 15, 2023
THU417 Associations Between Glucose Metabolism And Trabecular Bone Score In Subjects With Acromegaly
Authors: Kuzma Martin , Payer Juraj , Vanuga Peter , Sagova Ivana , Pavai Dusan , Jackuliak Peter , Killinger Zdenko , Binkley Neil 
Published: October 2023

Abstract
Disclosure: M. Kuzma: None. J. Payer: None. P. Vanuga: None. I. Sagova: None. D. Pavai: None. P. Jackuliak: None. Z. Killinger: None.
Introduction: Previously, it was thought that increased risk of vertebral fractures (VF) in acromegaly is associated with impaired trabecular bone. More recently, cortical bone was proposed as one of the fracture risk determinant. However, trabecular compartment is still decreased. Glucose intolerance is a frequent complication of acromegaly and is directly attributable to the excess circulating growth hormone and IGF-1 concentrations and thus possibly lead to trabecular bone detoriation.Objectives: To assess effect of glucose metabolism on DXA-derived bone parameters, such as bone mineral density (BMD), trabecular bone score (TBS), cortical and trabecular vBMD, surface BMD and cortical thickness of proximal femur among patients with acromegaly. Patients and methods: In total, 70 consecutive patients (24 males/56 female, mean age = 55.6 years) with acromegaly based on current ADA guidelines were divided in two subgroups according to glucose metabolism(GM): abnormal GM (n=35; 14 males/21 females; 15 with active disease) and normal GM (n=35;10 Males /25 Females; 11 with active disease). Subjects were prospectively followed up for two years. At baseline and year 2; all subjects had pituitary hormonal measures, fasting plasma glucose (FPG), HBA1c, C-peptide, insulin resistance index (IRI) and DXA measurement performed. From DXA, BMD, TBS and 3D-Shaper parameters were derived. Results: At baseline; subjects with abnormal GM had lower TBS (1.166±0.15) in comparison to normal GM subjects (1.232±0.12; p&lt;0.05). Insulin like growth factor 1 (IGF-1), FPG, HBA1c, C-peptide, IRI and bone parameters was correlated in simple regression model. FPG, HBA1c, C-peptide and IRI was negatively associated with TBS. No correlation between GM parameters and other bone measures was observed. Multiple regression model of all GM parameters weighted by IGF-1 revealed HBA1c as a significant predictor of TBS value (Estimate =-0,054; p=0.04). At year 2; FPG and HBA1c was negatively associated with TBS. In multiple regression IGF-1-weighted model, no significant predictor of TBS was observed. Conclusion: Acromegaly subjects with abnormal GM have lower TBS in comparison to those with normal GM. The best GM parameter to predict TBS in acromegaly was HBA1c. This study showed that trabecular bone microstructure, as indirectly assessed by TBS, is likely resulting of impaired glucose metabolism.
Presentation: Thursday, June 15, 2023
THU448 Multiple Non-traumatic Vertebral Fractures After Discontinuation Of Denosumab
Authors: Riahi Shayan , Crawford Andrew Robert , Gruntmanis Ugis 
Published: October 2023

Abstract
Disclosure: S. Riahi: None. A.R. Crawford: None. U. Gruntmanis: None.
Background: In multiple studies, including a post-hoc analysis of the FREEDOM trial1, an increased risk of vertebral fractures has been demonstrated in patients after discontinuation of denosumab. Clinical Case: A 65-year-old female presented to the endocrinology clinic for evaluation of severe osteoporosis. She was diagnosed with osteoporosis in 2017 after a DXA scan demonstrated a lumbar spine T-score of −3.5. She was started on denosumab therapy by her primary care provider to treat her osteoporosis and received a total of 10 injections over 5 years, during which time she experienced no fractures. Her lumbar spine T-score improved to −2.6 in March of 2021. She received her last injection of denosumab in December of 2021 and was told that she no longer needed denosumab therapy. She began to develop severe pain in her back in October of 2022 and noticed a 3-inch height loss. X-rays done in November of 2022 demonstrated a new compression fracture in L2. Due to persistent debilitating pain, patient had repeat X-rays performed 1 week later which demonstrated multiple age indeterminate compression fractures which MRI was able to confirm at T5, T7, and T9-T12. Repeat DXA scan in December of 2022 demonstrated a lumbar spine T-score of −3.1. Serum C-Telopeptide (CTX) was 1060pg/mL. Patient had adequate calcium and vitamin D intake, and secondary causes of osteoporosis were excluded. Conclusion: This case report highlights the rapid reversibility of the beneficial effects of denosumab on bone density and bone remodeling after discontinuation of the drug (evidenced by the significantly elevated CTX), the importance of close follow up, and the use of transition therapy in patients after discontinuation of denosumab to attenuate the risks associated with stopping the medication. It also places import on the use of MRI imaging, especially in the cases of rebound associated vertebral fractures secondary to denosumab discontinuation2 for those patients in whom you have high suspicion to better characterize compression fractures when x-ray findings are not felt to be sufficient.
References: (1) Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen JB, McClung M, Roux C, Törring O, Valter I, Wang AT, Brown JP. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res. 2018 Feb;33(2):190-198. doi: 10.1002/jbmr.3337. Epub 2017 Nov 22. PMID: 29105841. (2) Anastasilakis, A.D., Evangelatos, G., Makras, P. et al. Magnetic resonance imaging has an advantage over conventional spine X-rays in the evaluation of rebound-associated vertebral fractures following denosumab discontinuation. Endocrine69, 516–518 (2020). https://doi.org/10.1007/s12020-020-02333-1
Presentation: Thursday, June 15, 2023