bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT246 Ectopic (Penile) Calcification in 1, 25 Vitamin D Induced Hypercalcemia
Authors: Berquist John , Santosh Reddy Deepika 
Published: October 2023

Abstract
Disclosure: J. Berquist: None. D.S. Reddy: None.
A 60-year-old male with a history of well controlled type 2 diabetes and HTN presented with acute renal failure (initial creatinine 19.9 mg/dL, GFR 11). Kidney biopsy during admission was consistent with acute tubular necrosis and mild diabetic nephropathy. Serum calcium was normal at that time. He received temporary dialysis and eventually discharged home with improved (though still elevated) creatinine. On follow up labs a month later, he was noted to have high serum calcium. He was temporarily lost to follow up and was readmitted four months later due to persistent severe hypercalcemia. Peak serum calcium on his new admission was 13.2 mg/dL. Phosphorus level three months prior was 5.9 mg/dL, though had now improved to 2.7 mg/dL. Other labs this admission include creatinine 2.54 and GFR 33 (which was consistent with previous months), PTH 11 pg/mL, 25-OH Vitamin D 10 ng/mL, 1,25-Dihydroxy Vitamin D elevated at 84.8 pg/mL and magnesium low at 1.5 mg/dL. SPEP and UPEP were both negative and PTHrP was not measured. Kappa/Lamda free light chain ratio was mildly elevated at 1.77 (0.26-1.65). QuantiFERON Gold, HIV, Beta-2 microglobulin, ANA, and flow cytometry were negative. He received calcitonin x 2, IVF, zoledronic acid, and denosumab (three days later), which improved his calcium to 11.5 by discharge 11 days later. He underwent a CT Chest/Abdomen/Pelvis, T spine, and L spine that were remarkable for multiple bilateral partially calcified pulmonary nodules and hepatic steatosis with splenomegaly. PET CT showed 20 hypermetabolic osseous lesions throughout axial skeleton, multiple pulmonary, liver, and splenic lesions and lymphadenopathy in the head, neck, chest, abdomen. There was also diffuse calcification of the penile corpora. Pathology via biopsies of a retroperitoneal lymph node as well as bone marrow showed non-caseating granulomas.
Lastly, 1-2 months ago, he noticed pain and hardening of his penis. On exam, there is a deep firmness with palpation and distal penile tenderness. There are no cutaneous lesions on the penis or anywhere else on the skin. Calciphylaxis was a consideration, but isolated penile involvement is rare. Additionally, it is rare to develop calciphylaxis without end stage renal disease. A review of the literature showed many cases of penile calciphylaxis, though none were without cutaneous involvement. Sarcoidosis of the penis is also very rare and cases in the literature cite either a cutaneous or intraurethral lesion. This case appears unique in the findings of penile calcification palpable on exam and visible on imaging, without any cutaneous manifestations, in the setting of previous though recovered acute renal failure and 1, 25 Vitamin D-mediated hypercalcemia in sarcoidosis.
Presentation: Saturday, June 17, 2023
THU589 Positivity Rates Of Screening Criteria For Primary Aldosteronism: A Cohort Comparison Study
Authors: Marcelli Marco , Panov Alexandra , Bi Caixia , Funder John W , John McPhaul Michael 
Published: October 2023

Abstract
Disclosure: M. Marcelli: None. A. Panov: None. C. Bi: None. J.W. Funder: None. M.J. McPhaul: None.
Current screening for primary aldosteronism (PA) relies on a single blood draw for plasma aldosterone concentration (PAC) and plasma renin activity (PRA) to establish an aldosterone-to-renin ratio (ARR). However, ARR cutoff levels vary between expert centers. Many studies have demonstrated that PAC may not represent a patient’s actual aldosterone status, suggesting the possible fallibility of the ARR. To investigate this possibility, we compared the positivity rates of 2 indicators of probable PA—ARR&gt;28.9 and suppressed renin (PRA&lt;1 ng/ml/hr)—in a cohort of 38,507 paired PAC and PRA samples. For each indicator, we also assessed positivity rates by self-reported sex (20578 [53.5%] women, 17882 [46.5%] men). Of the cohort, 1623 (4.2%) tested positive for possible PA based on an ARR of 28.9; 19551 (50.8%) tested positive for suppressed renin. Among the latter group, 2585 (6.7%) had PAC&gt;15 ng/dL, 8465 (22%) between 5-15 ng/dL, and 8501 (22.1%) &lt; 5 ng/dL. A recent algorithm suggested by Vaidya (1) defines the first of these groups as overtly positive screening and the second, intermediate group as positive screening, for a total positivity rate of 28.7%. Given the suppressed renin, there are probably a handful of positive PA cases, even in the 22.1 % group with PAC&lt;5 ng/dL. A second finding was that rates of probable PA differed by sex. These differences were minor for the ARR criterion (4.3% of women vs. 4.1% of men tested positive) but major for the suppressed renin criterion with PAC&gt;15 ng/dL (5.7% of women vs. 7.9% of men tested positive) and 5-15 ng/dL (23.6% of women vs. 20.2 of men tested positive). Florid PA was the only condition where more males than females tested positive, a finding deserving further expert consideration and study. In comparing two indicators of probable PA, the ARR criterion yielded a lower positivity rate than the suppressed renin criterion, suggesting that most PA cases may remain undetected if using AAR as a screening test.Reference: (1) JCEM 2020;105:3771
Presentation: Thursday, June 15, 2023
THU593 Unilaterally Selective Adrenal Vein Sampling For Identification Of Surgically Curable Primary Aldosteronism
Authors: Paolo Rossi Gian , Bagordo Domenico , Amar Laurence , Azizi Michel , Riester Anna , Reincke Martin , Degenhart Christoph , Widimský Jiří , Naruse Mitsuhide , Deinum Jaap , Kocjan Tomaz , Negro Aurelio , Rossi Ermanno , Kline Gregory , Tanabe Akiyo , Satoh Fumitoshi , Christian Rump Lars , Vonend Oliver , Willenberg Holger S , Fuller Peter J , Yang Jun , Nian Chee Nicholas Yong , Magill Steven B , Shafigullina Zulfiya , Quinkler Marcus , Oliveras Anna , Lee Bo-Ching , Chang Chin-Chen , Wu Vin-Cent , Krátká Zuzana , Battistel Michele , Rossitto Giacomo , Seccia Teresa M 
Published: October 2023

Abstract
Disclosure: G. Rossi: None. D. Bagordo: None. L. Amar: None. M. Azizi: None. A. Riester: None. M. Reincke: None. C. Degenhart: None. J. Widimský: None. M. Naruse: None. J. Deinum: None. T. Kocjan: None. A. Negro: None. E. Rossi: None. G. Kline: None. A. Tanabe: None. F. Satoh: None. L. Rump: None. O. Vonend: None. H.S. Willenberg: None. P.J. Fuller: None. J. Yang: None. N. Chee: None. S.B. Magill: None. Z. Shafigullina: None. M. Quinkler: None. A. Oliveras: None. B. Lee: None. C. Chang: None. V. Wu: None. Z. Krátká: None. M. Battistel: None. G. Rossitto: None. T.M. Seccia: None.
Adrenal venous sampling is recommended for the identification of unilateral surgically curable primary aldosteronism, but is often clinically useless, owing to failed bilateral adrenal vein cannulation. Our objective was to investigate if only unilaterally selective adrenal vein sampling studies can allow identification of the responsible adrenal. Among 1625 patients consecutively submitted to adrenal vein sampling in tertiary referral centers, we selected those with selective adrenal vein sampling result in at least on side and surgically cured unilateral primary aldosteronism, used as gold reference. The accuracy of different values of the relative aldosterone secretion index (RASI), which estimates the amount of aldosterone produced in each adrenal gland corrected for catheterization selectivity, was examined. We found prominent differences of RASI values distribution between patients with and without unilateral primary aldosteronism. The diagnostic accuracy of RASI values estimated by the area under ROC curves (AUROC) was 0.714 and 0.855, respectively, in the responsible and the contralateral side; RASI values &gt;2.55 and ≤0.96 on former and the latter side furnished the highest accuracy for detection of surgically cured unilateral primary aldosteronism. Moreover, in the patients without unilateral primary aldosteronism only 20% and 16% had RASI values ≤0.96 and &gt;2.55. With the strength of large real-life dataset and use of the gold reference entailing an unambiguous diagnosis of unilateral primary aldosteronism, these results indicate the feasibility of identifying unilateral primary aldosteronism using unilaterally selective adrenal vein sampling results.
Presentation: Thursday, June 15, 2023
THU599 Serum And Urinary Free Cortisone As Novel Predictor Of Low-renin Arterial Hypertension
Authors: Tapia-Castillo Alejandra , Perez Jorge , Sandoval Alejandra , Allende Fidel , Solari Sandra , Fardella Carlos E , Carvajal Cristian 
Published: October 2023

Abstract
Disclosure: A. Tapia-Castillo: None. J. Perez: None. A. Sandoval: None. F. Allende: None. S. Solari: None. C.E. Fardella: None. C. Carvajal: None.
A large proportion of low-renin hypertensive (LRH) patients correspond to primary aldosteronism (PA) caused by excessive MR activation mediated by excess of aldosterone. However, some of these LRH patients have low to normal serum aldosterone levels, where is thought the MR activation is aldosterone-independent and more likely due to glucocorticoid-mediated MR activation, as occurs in the nonclassical apparent mineralocorticoid excess (NCAME), which is characterized by high cortisol/cortisone ratio and low cortisone, affecting not only blood pressure (BP) control and urinary potassium excretion but also causing cardiac and renal damage, endothelial dysfunction and subclinical inflammation. Objective: To evaluate cortisone as a predictor of LRH and its association with parameters of kidney and vascular damage. Design: A cross-sectional study was carried out in 206 adult subjects. The subjects were classified according to low-renin phenotype (plasma renin activity (PRA) &lt;1ng/ml*h) and low serum cortisone (&lt;p25th). We measured clinical, biochemical, renal and vascular parameters. Statistical analyses as group comparisons were performed by Mann Whitney, and discriminatory analyses by ROC curves. Results: We identified 43% of subjects with low-renin phenotype. PRA was associated with serum aldosterone (r=0.36; p&lt;0.001) and serum cortisone (r=0.22; p=0.001). A binary logistic regression analysis shows that cortisone predicts low-renin phenotype (OR=0.4 [95% CI, 0.21 – 0.78]). The ROC curves show an AUC for serum cortisone was 0.62 (95% CI: 0.54 to 0.69; p = 0.004) and urinary cortisone 0.6 (95% CI: 0.52 to 0.67; p = 0.02) to discriminate subjects with low-renin from controls. Subjects with low serum cortisone showed a higher albuminuria, PAI-1 and lower sodium renal excretion. Urinary free cortisone was also associated to blood pressure and serum potassium (p&lt;0.05). Conclusion: These findings highlight the concept that the low-renin phenotype is dictated not only by serum aldosterone levels but also by low cortisone, suggesting it should be considered in endocrine arterial hypertension screening, complementary in the diagnosis of primary aldosteronism since it could generate false positives in the calculation of the aldosterone to renin ratio. Moreover, our study suggests that low cortisone levels could be associated with future occurrence of vascular and kidney damage.
Presentation: Thursday, June 15, 2023
FRI102 A Case Of Subclavian Artery Stenosis: Utility Of Lipoprotein (a) In Secondary Prevention Of Atherosclerotic Vascular Disease
Authors: Iqbal Fizzah , Allen Haas Richard 
Published: October 2023

Abstract
Disclosure: F. Iqbal: None. R.A. Haas: None.
Introduction: Atherosclerosis is the most common cause of upper extremity peripheral arterial disease (PAD). Prevalence of subclavian artery stenosis in the general population is approximately 2% with one study reporting a prevalence of 6.8% in those with diabetes mellitus (DM). We present a case of symptomatic upper extremity PAD in a patient with well controlled Type 1 DM and LDL-cholesterol at goal, but significantly elevated Lp(a). Clinical Case: 57-year-old Caucasian female with Type 1 DM (on CSII), hypothyroidism, obesity (BMI:43), hypertension and hyperlipidemia presented with several month history of left arm pain and cramping worsened by activity. At presentation, HbA1c was 6.1% and TSH 1.036 uIU/mL. She had been on atorvastatin, 40 mg once daily for several years with the addition of ezetimibe two years prior following an elevated coronary calcium score of 63. She underwent a left upper arm arterial duplex which showed 50-99% left subclavian and left axillary artery stenosis along with bilateral ICA stenosis. Lipid profile showed Total-C 112 mg/dL, LDL-C 59 mg/dL and HDL-C 34 mg/dL. She denied any symptoms of TIA or CVA. Vascular surgery recommended medical management with aspirin and risk factor modification. Cardiology advised CT chest-angiogram which showed moderate left subclavian stenosis and mild wall thickening of the great vessels and descending thoracic aorta. Work-up for arteritis was negative. A stress Echocardiogram showed inducible apical wall ischemia however no significant coronary artery disease was seen on angiogram. Her atorvastatin dose was increased to 80 mg once daily but as her diffuse atherosclerosis was out of proportion to her risk factors an Lp(a) level was checked and came back elevated at 356 nmol/L (desirable &lt;75). She was continued on statin therapy, ezetimibe discontinued and Evolocumab (PCSK-9 inhibitor) was commenced. At follow-up (after 6 months of evolucamab treatment), she reported improvement in symptoms and repeat lipid profile was notable for Total-C 90, LDL-C 33, HDL38 and a 41% reduction in Lp(a) to 209. Conclusion: Lipoprotein (a) is an atherogenic, pro-inflammatory LDL-cholesterol like particle, the concentration of which is largely genetically determined. While the association between elevated Lp(a) and coronary artery disease has been well studied, there are few studies describing its relevance in peripheral artery disease. In our patient with symptomatic subclavian stenosis, the high Lp(a) served as marker of her diffuse atherosclerosis and elevated ASCVD risk. Although targeted Lp(a) lowering therapies are currently under investigation with promising initial results, currently the focus of management remains LDL-cholesterol lowering. PCSK9 inhibitors lower Lp(a) by 25%-40% and are a valuable treatment option.
Presentation: Friday, June 16, 2023
FRI114 PUFAs Implicated In Platelet Activation Differ In Receptor Mediated Vs Post-receptor Insulin Resistance
Authors: Klein Rachael , Chung Stephanie T , Brown Rebecca J 
Published: October 2023

Abstract
Disclosure: R. Klein: None. S.T. Chung: None. R.J. Brown: None.
Background: Severe insulin resistance (IR) can be classified as receptor mediated, in which all downstream signaling is blocked, or post receptor IR where some downstream signaling pathways are decreased and others are increased. Receptor-mediated IR occurs in rare mutations of the insulin receptor (INSR), whereas in most forms of IR, including type 2 diabetes (T2DM) and lipodystrophy (LD), IR is post-receptor. LD is a group of syndromes characterized by deficiency of fat depots leading to metabolic dysfunction similar to obesity. Patients with post-receptor IR have increased atherosclerotic cardiovascular disease (ASCVD) risk. Thrombosis underlies pathology of ASCVD and is a result of platelet (PLT) activation. Polyunsaturated fatty acids (PUFAs) are embedded in the PLT membrane and play a key role in thrombosis. During PLT activation, cytosolic phospholipase A2 (cPLA2) hydrolyzes membrane lipids, generating free PUFAs, leading to synthesis of mediators of blood vessel constriction, inflammation, and thrombosis. Methods: This was a cross-sectional study of subjects with INSR (N=30) and LD (N=30) matched for age, sex, HbA1c and pubertal stage. Untargeted metabolomic (848 compounds) and lipidomic (984 compounds) analysis was completed on serum after an 8-12 hour fast. Analyses were conducted by t-test and Mann-Whitney with adjustment for multiplicity. Bonferroni corrected P&lt;0.05 was considered significant. Results: Of 19 long chain PUFAs (ω=3, ω=6) measured, 14 were significantly elevated in LD vs INSR, including arachidonate, docosahexaenoate, docosapentaenoate, stearidonate, and adrenate. There was no difference in linoleate, dihomo-linoleate, tetradecadienoate, linolenate, or docosadienoate levels between LD vs INSR. Among 8 long chain saturated FAs, only 3 were significantly higher in LD, 4 were comparable, and 1 was higher in INSR. All long and medium chain monounsaturated FAs were similar in LD vs INSR. cPLA2 was not different between LD and INSR. Conclusions: Our study shows that liberated PUFAs were higher in the patients with LD compared to INSR. A similar trend was not seen for other FFA such as saturated and monounsaturated FFA, suggesting that higher PUFAs in LD are unlikely to be caused by global differences in FFA metabolism, such as different peripheral uptake of FFA via lipoprotein lipase activity or diet. Instead, our data suggest an increase in PLT membrane ability to store and release PUFAs. These data suggest increased ASCVD risk in post-receptor insulin resistance may be partially mediated through differences in platelet activation.
Presentation: Friday, June 16, 2023
THU246 What’s The Importance of GAD Antibodies In Patients With Stiff Person Syndrome
Authors: Barnett Anne , Elshimy Ghada 
Published: October 2023

Abstract
Disclosure: A. Barnett: None. G. Elshimy: None.
Introduction: Stiff Person Syndrome (SPS) has a strong autoimmune component with positive serology for GAD-65 antibody as one of the diagnostic criteria. GAD is an enzyme selectively concentrated in neurons secreting the neurotransmitter gamma-aminobutyric acid (GABA) but is also present in pancreatic beta cells. Hence, insulin-dependent diabetes mellitus (LADA) can develop in patients with SPS. We present two cases that highlight the importance of this association and the difference in the time of onset to ensure appropriate screening. Case: Our first case was a 46-year-old female with systemic sclerosis and SPS that was diagnosed with steroid-induced diabetes in 2012 with HbA1c 8.7% (4.3-6.1%). Her GAD-65 antibody was significantly elevated at 1971 (less than 2nmol/L). For almost 8 years, the patient only required insulin therapy while on high dose steroids, but eventually developed persistent hyperglycemia requiring insulin therapy. Her C-peptide was 0.49 (0.78-5.19ng/mL) with plasma glucose of 201 (74-106mg/dL), consistent with beta-cell dysfunction. The second case was a 60-year-old female with a 20-year history of SPS who was diagnosed with type 2 diabetes in 2014 after receiving high doses of steroids while undergoing chemotherapy for breast cancer. She was initially well-controlled on oral medications until 2 years after her initial diabetes diagnosis where her HbA1c increased rapidly to 8.1% (4.8-5.9%). At that time, she was started on insulin therapy and antibody testing was pursued which showed positive GAD-65 antibody greater than 250 (less than 5IU/mL) consistent with LADA. She had a negative IA-2 antibody undetectable. Due to other autoimmune associations, she was also screened for thyroid disease revealing an elevated TPO-antibody with a normal TSH 4.02 that is being monitored. Discussion: SPS is associated with autoantibodies and other autoimmune disorders including but not limited to type 1 diabetes, anti-thyroglobulin antibodies and anti-parietal cell antibodies. In both cases, the diagnosis of SPS preceded the onset of diabetes then with a latent “honeymoon” phase not requiring long-term insulin therapy for years, most consistent with LADA. However, there are exacerbating factors including high-dose steroids which could be misleading and result in diagnosing these patients with type 2 diabetes initially. It should be taken into consideration that there is variability in the time of onset of beta-cell dysfunction, which varied from 2 to 8 years in our patients. Hence, the recognition of the correlation of autoimmune-mediated diabetes and the variable time course to insulin deficiency is critical for the continued monitoring in patients with SPS. Physicians should be aware of the importance of screening patients with SPS for type 1 diabetes mellitus and differentiate it from steroid-induced type 2 diabetes to avoid developing diabetic ketoacidosis in these patients.
Presentation: Thursday, June 15, 2023
THU252 Can An AI Chatbot, ChatGPT, Help Our Patients with Diabetes And Weight Loss?
Authors: Cheng Emily , Wu Gloria , Zhao Weichen , Wong Adrial , Yong Lee Jae , Tien Katherine 
Published: October 2023

Abstract
Disclosure: E. Cheng: None. G. Wu: None. W. Zhao: None. A. Wong: None. J. Lee: None. K. Tien: None.
Background: ChatGPT, launched 11/30/22, has the newest Artificial Intelligence (AI) software for natural language algorithms to answer questions. It does not use the internet and is current to 2021 level of knowledge. According to the CDC, 37.3M Americans have diabetes, and approximately 70M Americans are overweight or obese (1/3 of all adults). 54% of U.S. adults have a literacy level below 6th grade. Many overweight people are at risk for diabetes. Purpose: To evaluate the newest AI chatbot, ChatGPT, for its answers to questions about diabetes and weight loss. Methods: Questions about diabetes and weight loss were created and typed into ChatGPT and similarly texted to an older AI software-mediated chatbot, Google Assistant. Questions: 1. How can I treat my diabetes and weight problem at the same time? 2. What medications can I use for weight loss? 3. What herbal medicines can I use for weight loss? 4. If I have hypertension and I want to lose weight, what should I do? 5. Where can I obtain reliable information about weight loss? The word count and Flesch-Kincaid Reading Level were the metrics used to assess ChatGPT and Google Assistant responses. The Flesch-Kincaid Reading Level is a mathematical formula used by the U.S. Department of Education that determines a passage’s grade level by the length of a sentence and the number of syllables in the words. Results: Word count: CHAT:Q1=189; Q2=199; Q3=217; Q4=230; Q5=210 vs GOOGLE: Q1=65, Q2=46, Q3=56; Q4=58; Q5=45. CHAT Word Count Avg=209, SD=15.86; GOOGLE Word Count Avg=54, SD=8.46; P-value=0.0000246. Flesch-Kincaid: CHAT: Q1=13.1; Q2=11; Q3=11, Q4=11.7, Q5=15.5 vs. GOOGLE: Q1=5.6, Q2=10.9, Q3=10.2, Q4=12, Q5=1.6. CHAT Flesch-Kincaid Avg=12.46, SD=8.06; GOOGLE Flesh-Kincaid Avg=8.6, SD=4.36; P-value=0.09366. Google Assistant has a lower average grade level of comprehension than ChatGPT. For Q1, ChatGPT is at a 13.1 grade level vs GOOGLE at a 5.6 grade level. This is due to Google Assistant’s use of websites as an answer, whereas ChatGPT is trained using information prior to 2021. Conclusion: ChatGPT uses artificial intelligence to create a natural language and it provides answers which are coherent and understandable for those with a high school education. In the future, as more users use ChatGPT, its internal software for reinforcement will produce responses more geared to the reading level of the lay public.
Presentation: Thursday, June 15, 2023