bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT283 The Incidence Of Worsening Symptoms Of Adrenal Insufficiency And COVID-19 Infection After Receiving COVID-19 Vaccine In Patients With Adrenal Insufficiency: A Survey-based Study
Authors: Al Sibai Khaled , Lundholm Michelle D , Nachawi Noura , Baikovitz Jacqueline , Bena James , Cecilia Lansang M 
Published: October 2023

Abstract
Disclosure: K. Al Sibai: None. M.D. Lundholm: None. N. Nachawi: None. J. Baikovitz: None. J. Bena: None. M. Lansang: None.
Introduction: There is uncertainty if COVID-19 vaccine administration can induce enough stress to precipitate worsening of adrenal insufficiency (AI) or even adrenal crisis. The aim of the study is to evaluate the incidence of worsening symptoms of AI after receiving the COVID-19 vaccine in patients with AI. Methods: This is a single-center survey study of patients with either primary or secondary AI by ICD code in our electronic medical record. Diagnoses were confirmed with chart review and patients were included if on stable physiologic glucocorticoid replacement doses for at least 3 months prior to COVID-19 vaccination. These patients were sent a survey asking about the date/type of vaccine, the occurrence of AI symptoms, and if they took a higher dose of oral GC, or took injectable GC, or sought a higher level of medical care. Results: There were 340 eligible patients, and 61 patients to date have completed the survey (18% response rate). Responders were 64% female, 41% with primary AI, and 56% with secondary AI. The median age was 57 (IQR 50, 68) years with a median hydrocortisone-equivalent replacement dose used of 20 (IQR 20, 25) mg daily. Each vaccination was treated as a separate event. A total of 194 COVID vaccination events were recorded, which included 35 (18%) vaccination events when higher doses of GC were used, 35% of which were after onset of symptoms. Mild AI symptoms, i.e., fever, weakness, nausea/vomiting, diarrhea, and dizziness, body aches, and weakness occurred in 62% of events. The most reported symptoms were body aches and weakness (48% and 35% respectively). Severe AI symptoms, i.e., low blood pressure and fainting, occurred in 4.6% of events. The need to use injectable GC, seeking medical care or ED visits occurred in 5.7%. There was no significant difference in seeking medical care nor using injectable GC for patients who took stress dose GC vs those who did not (OR 0.69, 95% CI 0.10,4.88, p=0.7). Conclusion: At present analysis, the incidence of worsening AI-related symptoms was high after COVID-19 vaccination (62%). Most reported symptoms were mild and self-limited that did not require a higher level of medical care. About 6% of survey takers used injectable GC or sought a higher level of care. Our preliminary results do not support routine prophylactic stress-dose GC for receiving COVID-19 vaccines in patients with AI. We estimate another 100 patients to complete our survey.
Presentation: Saturday, June 17, 2023
SAT287 Clinical And Biochemical Characteristics In Female Adolescents Diagnosed With Non-classic Congenital Adrenal Hyperplasia (NCCAH)
Authors: Hayes Dorado Juan Pablo , Calla Ayala Marco Antonio , Lafuente Rodrigo Zapata , Bustencio Cristian Ramos , Montalvo Claudia Gorena , Porcel Ivana Chiri 
Published: October 2023

Abstract
Disclosure: J. Hayes dorado: None. M. Calla Ayala: None. R. Zapata Lafuente: None. C. Ramos Bustencio: None. C. Gorena Montalvo: None. I. Chiri Porcel: None.
The aim of this study was to evaluate the clinical and biochemical characteristics in female adolescents diagnosed with NCCAH in comparison to female age-matched healthy controls. A total of 39 female adolescents, aged 10-15 years, were enrolled in this study, including 24 patients with NCCAH (mean age 12.9±1.4 years) and 15 healthy controls (mean age 13.2±1.1 years). Data was collected on anthropometry, clinical features of hyperandrogenism (hirsutism, acne, alopecia) and menstrual irregularities, and ovarian ultrasound was performed. Hormonal and metabolic markers were assessed. Hirsutism was present in 91.7% of the NCCAH females and 46.7% of the controls (p&lt;0.001), while acne and alopecia were defined in 83.3% and 66.7% of the NCCAH patients, respectively, compared to 33.3% and 26.7% of the healthy females (p acne &lt;0.0001 and p alopecia =0.003). No significant difference was found in the rate of menstrual disorders between the groups. The BMI and waist circumference did not differ between NCCAH females and healthy controls. No significant difference was found in the parameters of lipid and glucose metabolism between the groups. Testosterone and basal levels of 17 OH Progesterone were significantly higher in NCCAH females (p&lt;0.01). Polycystic ovaries were detected by ultrasound in 8.3% of the NCCAH and 6.7% of the controls, without significant difference between the groups. NCCAH in female adolescents is characterized by clinical and biochemical hyperandrogenism. No significant difference was found in the rate of menstrual disorders, the BMI, waist circumference and the parameters of lipid and glucose metabolism between the groups.
Presentation: Saturday, June 17, 2023
SAT296 Ambulatory 24-hour Tissue Microdialysis Of Cortisol And Metabolites, A Tool For Precision Management In Addison’s Disease
Authors: Botusan Ileana , Berinder Katarina , Methlie Paal , Upton Thomas , Zavala Eder , Simunkova Katerina , Vassiliadi Dimitra Argyro , Marinelli Isabella , Russell Georgina M , Grytaas Marianne Aardal , Tsagarakis Stylianos , Lightman Stafford Louis , Husebye Eystein Sverre , Kampe Olle , Oksnes Marianne , Bensing Sophie 
Published: October 2023

Abstract
Disclosure: I. Botusan: None. K. Berinder: None. P. Methlie: None. T. Upton: None. E. Zavala: None. K. Simunkova: None. D.A. Vassiliadi: None. I. Marinelli: None. G.M. Russell: None. M.A. Grytaas: None. S. Tsagarakis: None. S.L. Lightman: None. E.S. Husebye: None. O. Kampe: None. M. Oksnes: None. S. Bensing: None.
Background: The autoimmune attack on the adrenals in AD (Addison’s disease) results in lack of the vital hormones cortisol and aldosterone, rendering AD patients dependent on life-long hormone replacement therapy. Current therapies cannot replicate the physiological well-tuned, circadian and ultradian hormonal oscillations properly, probably contributing to increased mortality, morbidity and reduced quality of life. No established biomarker for treatment monitoring exists hampering treatment optimization. Ambulatory 24-hour dynamic steroid profiling may represent a novel therapy-monitoring tool, providing new insights in different replacement therapy regimes. Aim: We aimed to assess 24-hour profiles of free cortisol and metabolites in patients with AD on different glucocorticoid replacement therapies (GRT) and compare the results with healthy volunteers (HV). Material and methods: The study includes 41 patients with AD on different GRT regimes (hydrocortisone, cortisone acetate, modified release hydrocortisone) and 214 healthy participants. Twenty minute microdialysis fractions were collected ambulatory from abdominal subcutaneous tissue over 24 hours using a novel and portable microdialysis fraction collector (U-RHYTHM). Steroid hormones were analyzed by ultrasensitive liquid chromatography tandem mass spectroscopy (LC-MS/MS). Dynamic biomarkers were used to define hormone parameters in both healthy and hormone-replaced participants, and to assess the “time in range” for patients on GRT compared with the profiles of healthy controls. Results: Free cortisol and cortisone levels were measurable in all AD patients, while 18- hydroxycortisol, and corticosterone were detected only in a few AD patients suggesting the persistence of residual adrenal function. Lower cortisol levels during night were observed in AD compared with controls. Ambulatory 24-hour dynamic steroid profiling revealed marked interindividual variations partially depending on the type of GRT and dosing-regime. Conclusions: The 24-hour profiles of free cortisol and cortisone differs between patients with AD and healthy volunteers. Ambulatory 24-hour microdialysis samplings may provide a novel dynamic tool to monitor GRT in AD providing opportunity for individual dose adjustment.
Presentation: Saturday, June 17, 2023
SAT301 Patient-centered Outcomes Measures To Assess Quality Of Life In Adrenal Insufficiency Treatment
Authors: Hover Whitaker J , Lowe Katherine E , Lowe Melissa E , Kallet Julia G , Slovick Michal F , Majka Susan L , McDermott Michael T , Regan Elizabeth A 
Published: October 2023

Abstract
Disclosure: W.J. Hover: None. K.E. Lowe: None. M.E. Lowe: None. J.G. Kallet: None. M.F. Slovick: None. S.L. Majka: None. M.T. McDermott: None. E.A. Regan: None.
Individuals with adrenal insufficiency (AI) have been shown to have reduced quality of life in spite of hormone replacement. Although late-stage insufficiency and adrenal crisis may show signs including hypotension and electrolyte abnormalities, patient-reported symptoms may predict outcomes in AI and can be a key factor in understanding poor quality of life in adrenal insufficiency. The SF-36, a generic quality of life (QoL) survey has been reported in adrenal insufficiency but may lack disease-specific domains to define QoL deficits in AI. An AI disease-specific QoL survey, the AddiQoL has also been validated. We evaluated the AddiQol and SF-36 for distinguishing the health status of AI patients in terms of diagnosis, medication use and risk of crisis using a patient registry.
Methods: We identified 344 individuals from the MyAI patient registry who had provided responses to both the AddiQoL and SF-36. We compared the AddiQoL overall score with three domains of the SF-36: physical function, role physical, vitality, and the physical and mental component scores (PCS and MCS).
Results: Respondents were from all 50 US states with 83% female and mean (SD) age of 50 (15) years. AI diagnosis was Primary 63%, Central 32% and congenital adrenal hyperplasia 5% based on self-report and confirmation with medical records. Both the SF-36 and AddiQoL identified reduced QoL in the AI participants and were significantly correlated: PCS to AddiQoL 0.73 and MCS to AddiQoL 0.63. Role Physical, Vitality and General Health were the most reduced domains with mean values of 38.4 (43.5), 35.6 (24.5) and 40.8 (24.7) respectively. Primary AI showed significantly better QoL than Central AI by both SF-36 and AddiQol [80.3(15.1) vs 69.9 (14.2), p&lt;0.001]. Respondents who reported an adrenal crisis within the past year had significantly lower AddiQol [72.8(15.4) vs 82.3 (15.4), p&lt;0.001] and SF-36 scores. Respondents who were currently treated with hydrocortisone (HC) had better QoL than those on Prednisone [HC 78.1 (15.2), Prednisone 74.1 (15.9), p=0.02 adjusted for diagnosis group].
Conclusions: In a geographically broad cohort of US AI patients, we confirm significant reductions in QoL in spite of treatment. Both the SF-36 and AddiQoL were able to distinguish differences in QoL by diagnosis, risk of adrenal crisis and medication. Further work to define specific patterns of high-risk symptoms may improve early diagnosis of impending crisis.
Presentation: Saturday, June 17, 2023
SAT321 Ectopic ACTH Cushing's Syndrome Caused By A Large-cell Neuroendocrine Lung Carcinoma Responding To Desmopressin
Authors: Larose Stephanie , Rioux Dany , Albadine Roula , Lacroix André 
Published: October 2023

Abstract
Disclosure: S. Larose: None. D. Rioux: None. R. Albadine: None. A. Lacroix: None.
Background: Ectopic ACTH secretion (EAS) is a less frequent cause of ACTH-dependent Cushing’s syndrome (CS), most often caused by a thoracic neuroendocrine tumor (NET). Large-cell neuroendocrine carcinomas (LCNEC) with EAS are rare and usually present a more severe phenotype of ACTH secretion and hypercortisolism. Clinical Case: We report the case of a 44-yo non-smoking man, who presented clinical and biochemical evidence of ACTH-dependent severe CS complicated by pulmonary emboli. In the context of an initial equivocal pituitary MRI, desmopressin and CRH stimulation tests were performed. Desmopressin produced a 157% increase in ACTH (basal: 59.0 pmol/L to peak: 151.9 pmol/L) and a 25% increase in cortisol from baseline; there was no stimulation of ACTH or cortisol during a CRH test and no suppression with high dose dexamethasone tests. Repeat pituitary MRI identified a 5 mm lesion, but inferior petrosal venous sinus sampling (IPSS) under desmopressin did not identify a central ACTH source. Thorax and abdominal imaging including Indium-111 octreoscan identified a left lung 3 mm micronodule which became more evident when pulmonary emboli resolved. In this context of probable ectopic ACTH secretion, the patient was treated with left inferior lung lobectomy for a suspected NET. Pathological studies confirmed a lung LCNEC with morphologic features of carcinoid tumor and strongly positive ACTH immunohistochemistry (IHC) in the primary lesion and lymph node metastasis. The patient was in CS remission after surgery and adjuvant chemotherapy, but developed a CS recurrence 9.5 years later, with a morning
ACTH of 56.9 pmol/L, (N &lt;11.0 pmol/L), a non-suppressed AM cortisol of 633 nmol/L after 1mg of dexamethasone overnight and urinary free cortisol of 1717 nmol/24 hours (N:&lt; 789). Imaging showed signs of recurrence, with a hypermetabolic, 14 x 11 mm left hilar lymph node lesion on a TEP-DOTATATE scan in the left lung, near the surgical suture. An endobronchial ultrasound-guided biopsy confirmed the recurrence of the LCNEC. Surgery was performed and demonstrated again positive ACTH IHC of the lesion. The patient achieved remission of CS with secondary adrenal insufficiency, treated with hydrocortisone. Six months later, there was no response of ACTH or cortisol to a desmopressin test. Conclusion: This is the first report of LCNEC with morphologic feature of carcinoid tumor of the lung with ectopic ACTH secretion stimulated by desmopressin. Long delay prior to metastatic recurrence indicates relatively indolent NET. This case report indicates that response to desmopressin can occur in malignant LCNEC. Combining the desmopressin test with other dynamic tests, sellar MRI, IPSS and thoraco-abdominal functional imaging improves diagnostic accuracy of ectopic ACTH source.
Presentation: Saturday, June 17, 2023
OR30-06 Hospitalisation, Intensive Care And Death Due To COVID-19 In Swedish Patients With Adrenal Insufficiency
Authors: Bergthorsdottir Ragnhildur , Esposito Daniela , Johannsson Gudmundur , Ragnarsson Oskar , Dahlqvist Per , Bensing Sophie , Nåtman Jonatan , Nyberg Fredrik 
Published: October 2023

Abstract
Disclosure: R. Bergthorsdottir: None. D. Esposito: None. G. Johannsson: None. O. Ragnarsson: None. P. Dahlqvist: None. S. Bensing: None. J. Nåtman: None. F. Nyberg: None.
Background: Patients with adrenal insufficiency (AI) have increased risk for morbidity and mortality related to infectious disorders. Whether patients with AI have an increased risk for infection with Coronavirus disease 2019 (COVID-19), need of hospitalisation, intensive care or death in COVID-19 disease is still unknown. Methods: Swedish national register-based cohort study. Patients with primary and secondary AI were identified in linked Swedish national healthcare registers and followed from 2020-01-01 until 2021-02-28, and were compared to controls from the general population, matched 10:1 for age and sex. The following COVID-19 outcomes were studied: hospitalisation, intensive care and death. Findings: We identified 5430 patients with AI, and 54300 controls; 47.6% females, with a mean (±SD) age of 57.1 (±18.1) years. The prevalence of positive COVID-19 testing and diagnosis were similar in patients with AI and controls. The rate of hospitalisation (2.1% vs 0.8%), intensive care (0.3% vs 0.1%) and death (0.8% vs 0.2%) for COVID-19 were higher in AI patients than controls, respectively. After adjustment for socioeconomic factors and comorbidities, the hazard ratio (95% confidence interval) for hospitalisation was 1.96 (1.59-2.43), for intensive care admission it was 2.76 (1.49-5.09) and for death 2.29 (1.60-3.28). Interpretation: Patients with AI have an increased risk for severe and fatal COVID-19 infection and should therefore be prioritised for vaccination, early antiviral and supportive treatment to prevent hospitalisation and death.
Presentation: Sunday, June 18, 2023
THU404 Classical Symptoms Masquerading As A Surprising Clinical Picture
Authors: Syal Arshi , Arya Yajur , Teja Sathi Sri Ram , Prater Janna 
Published: October 2023

Abstract
Disclosure: A. Syal: None. Y. Arya: None. S. Teja Sathi: None. J. Prater: None.
Introduction: Primary hyperparathyroidism commonly presents in the setting of a parathyroid adenoma or hyperplasia, although it can rarely be caused parathyroid carcinoma, often accounting for &lt;1% of cases. Markedly elevated PTH levels, along with predominant uniglandular involvement should increase the suspicion of an underlying parathyroid carcinoma, given that multiglandular involvement is rarely encountered. Surgical resection with histopathological confirmation remains the mainstay of diagnosis. Case presentation: We describe the case of a female in her late 50s who was brought to the emergency department by her family with complaints of altered mental status, hallucinations, delusions, anxiety, increased urination, constipation, and decreased appetite for the past month. Her laboratory evaluation was significant for hypercalcemia with a corrected calcium of 13.4 mg/dL. She was started on intravenous fluids and calcitonin, with improvement in her clinical condition. Further workup for her hypercalcemia revealed that the serum parathyroid hormone (PTH) was significantly elevated at 1846.4 pg/mL (normal low: 9, normal high: 73). Her serum phosphorus was low, and 25-hydroxy vitamin D was high-normal. This was consistent with a picture of primary hyperparathyroidism. The severely elevated PTH raised concern for parathyroid carcinoma, a rare clinical entity. The patient underwent a nuclear medicine parathyroid scan (technetium 99m sestamibi), which revealed abnormal focal uptake in the inferior right thyroid bed. Ultrasound of the neck revealed a hypoechoic avascular nodule inferior to the right thyroid lobe corresponding to the area of increased sestamibi activity on nuclear medicine scan. After much discussion with the patient’s family, surgical intervention was deferred to a later date, with a focus on stabilization in the acute setting. The patient was started on cinacalcet for her hypercalcemia. Bisphosphonates were initially held in anticipation for surgery but were eventually started. Discussion: Parathyroid carcinoma is a rare malignancy, which can occur both sporadically and as part of the hereditary hyperparathyroidism-jaw tumor syndrome. In clinical practice, subtle clues which increase the suspicion for a parathyroid carcinoma include severely elevated PTH, sometimes up to 10 times the upper limit of normal, increasing adenoma size, and a presentation outside of the commonly inherited MEN-1 syndromes.[1] We rely solely on post-operative pathology to establish the diagnosis of parathyroid carcinoma, given that there are no well-defined features or criteria that can establish the diagnosis on imaging.
References: 1.Singh Ospina N, Sebo TJ, Thompson GB, et al. Prevalence of parathyroid carcinoma in 348 patients with multiple endocrine neoplasia type 1 - case report and review of the literature. Clin Endocrinol (Oxf). 2016;84(2):244-249.
Presentation: Thursday, June 15, 2023
THU409 Relationship Between Bone Loss And Oral Health Among Post-menopausal Women With And Without Diabetes
Authors: Ahmad Sophie , Nauman Rafae , Batra Kavita , Gupta Ashok , Izuora Kenneth E 
Published: October 2023

Abstract
Disclosure: S. Ahmad: None. R. Nauman: None. K. Batra: None. A. Gupta: None. K.E. Izuora: Research Investigator; Self; Novo Nordisk.
Background: There is a high prevalence of periodontal disease (PD) and bone loss (osteopenia and osteoporosis) among patients with diabetes. Understanding the relationship between these conditions in the context of type 2 diabetes (T2DM) as a risk factor will help better understand their pathophysiology and provide guidance for more appropriate care. Methods: This was a cross-sectional study that enrolled post-menopausal women presenting for routine bone density evaluation. Following informed consent, we obtained information about their demographics, diabetes status, and dental history using an investigator-administered questionnaire. We measured their height and weight with a stadiometer and inspected their oral cavity for teeth loss and PD. We then obtained their bone density assessment after interpretation by the radiologist. Data were analyzed using chi-square and logistic regression tests with the significance level set at 5%. Results: Among 66 eligible participants, the mean age and body mass index (BMI) were 67.67 ± 8.1 years and 29.76 ± 5.45 kg/m2 respectively. Twelve participants (18.2%) had T2DM, 19 (28.8%) had &lt; 20 natural teeth and 17 (25.8%) had normal bone mineral density. Using a binary logistic regression, significant predictors of bone loss included age (OR 1.217, p=0.008), BMI (OR 0.827, p=0.04), and a diagnosis of T2DM (OR 0.056, p=0.033). The number of natural teeth, number of broken or decayed teeth, and presence of periodontal disease were not associated with bone loss. Conclusion: Among our population of post-menopausal women, clinical variables associated with bone loss included older age and lower BMI. Having T2DM was associated with a higher bone mineral density which does not translate to stronger bones according to previous reports. Oral health outcomes were not associated with bone loss and may reflect the similarity in the risk factors for the two conditions.
Presentation: Thursday, June 15, 2023
THU414 Asthma And Cardiometabolic Diseases As Major Risk Factors For Fractures In Women With Osteopenia: Nationwide Cohort Study
Authors: Kong Sung Hye , Jo Ae Jeong , Park Chan Mi , Park Kyun Ik , Yun Ji Eun , Kim Jung Hee , Kim Sang Wan , Shin Chan Soo 
Published: October 2023

Abstract
Disclosure: S. Kong: None. A. Jo: None. C. Park: None. K. Park: None. J. Yun: None. J. Kim: None. S. Kim: None. C. Shin: None.
Background: The study aimed to demonstrate the risk factors for fractures and to develop prediction models for major osteoporotic and hip fractures in osteopenic patients using the nationwide cohort study in South Korea. Methods: The study was a retrospective nationwide study using the national screening program for transitional ages from the National Health Insurance Services database in Korea from 2008 to 2019. Primary outcomes were incident fracture events of major osteoporotic and hip fractures. Major osteoporotic and hip fracture events were defined as diagnostic and procedural codes. Patients were followed until the fragility fractures, death, or 2019, whichever came first. Results: All participants were 66-year-old females, with a mean body mass index was 25.0±3.1 kg/m2. During a median follow-up of 10.5 years, 26.9% and 6.7% of participants experienced major osteoporotic and hip fractures. In multivariate analysis, a history of fracture, asthma/chronic obstructive pulmonary disease (COPD), falls, diabetes mellitus and cerebrovascular diseases were significant risk factors for major osteoporotic (hazard ratio [HR] 2.35 for a history of fracture; 1.17 for asthma/COPD; 1.10 for falls; 1.12 for diabetes mellitus; 1.11 for cerebrovascular disease) and hip fractures (HR 1.75 for a history of fracture; 1.54 for diabetes mellitus; 1.27 for cerebrovascular disease; 1.17 for fall; 1.15 for asthma/COPD). The performances of the prediction models were area under the receiver operating curve of 0.73 and 0.75 for major osteoporotic and hip fractures. Conclusion: The study presented prediction models of major osteoporotic and hip fractures for osteopenia patients using simple clinical features, and showed that asthma and cardiometabolic diseases are major risk factors for fractures in women with osteopenia.
Presentation: Thursday, June 15, 2023