bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT245 Hips Don’t Lie: A Case Of Peri-Prosthetic Pseudotumor Leading To Hypercalcemia After Total Hip Replacement.
Authors: Sotomayor Fiorella , Whitlatch Hilary 
Published: October 2023

Abstract
Disclosure: F. Sotomayor: None. H. Whitlatch: None.
Background: Peri-prosthetic pseudotumors are well described, yet rare complications of total hip replacement. They can present as destructive or granulomatous lesions. We present the first documented case of 1,25 vitamin D-mediated severe hypercalcemia caused by a periprosthetic granuloma. Case: A 62-year-old man with a history of osteoporosis, ankylosing spondylitis presented with hypercalcemia (calcium 12.2 mg/dL) on routine laboratory testing. He had a history of bilateral cement hip arthroplasty in 1981 followed by multiple bilateral revisions - three revisions of left hip arthroplasty, one revision of right hip arthropasty. Biochemical evaluation included PTH 5 pg/mL (8 - 54 pg/mL), PTHrP 2.7 pmol/L (0.0 - 2.3 pmol/L), vitamin D-25 59 ng/mL (20-80 ng/mL), a negative Quantiferon TB Gold, and normal serum protein electrophoresis. 1,25 Vitamin D was elevated at 280.5 pg/mL (19.9-79.3 pg/mL). During investigation of 1,25 vitamin D-mediated hypercalcemia, he received a dose of zoledronic acid with transient improvement in hypercalcemia. ACE was negative and CT chest and abdomen was without evidence of granulomatous disease. A whole-body PET scan showed increased metabolic activity surrounding the right femoral and acetabular components with a broad zone of osteolysis in the proximal femur and increased metabolic activity surrounding the left greater trochanter. These findings were concerning for inflammatory granuloma formation. He was prescribed prednisone 30 mg daily with rapid normalization of serum calcium. Prednisone was gradually tapered to 10 mg daily with maintenance of normocalcemia. Discussion: Pseudotumors are an uncommon complication of total hip arthroplasty. These are described as non-infectious and non-neoplastic adverse soft tissue reactions to implants. They manifest as destructive or granulomatous periprosthetic lesion. They cause osteolysis, erosions, pathological fractures, and dislocations. Their formation is due to foreign body reaction to polyethylene, methylmethacrylate, cement or metal adjacent to the joint implant. Associated inflammation leads to macrophage activation, prostaglandin release, and osteolysis. Histologically, they are characterized by the presence of macrophages, extensive coagulation necrosis, lymphocytes, eosinophilic infiltration and granulomatous reaction. While non-malignant, they can cause extensive bony destruction and may require complex revision surgery. To date, this is the first reported case of hypercalcemia due to excess 1,25 vitamin D caused by a periprosthetic granuloma. Conclusion: Hypercalcemia is a well-described complication of granulomatous diseases, including sarcoidosis, mycobacterium infection, and lymphoma. In patients with a history of arthroplasty, we recommend adding peri-prosthetic pseudotumors to the differential diagnosis of 1,25 vitamin D mediated hypercalcemia.
Presentation: Saturday, June 17, 2023
SAT249 Femur Lysis Calcium Crisis
Authors: Gupta Gunjan , Idriss Setana , Barua Nabonita , Hodge Jordesha , Jamal Issra 
Published: October 2023

Abstract
Disclosure: G. Gupta: None. S. Idriss: None. N. Barua: None. J. Hodge: None. I. Jamal: None.
Introduction: Primary hyperparathyroidism usually presents with symptoms of bone pain, fatigue, polyuria, constipation, and nephrolithiasis. Here we describe a 27-year-old female with a femoral neck fracture and found to have a parathyroid mass. Case: 27 y/o female with autism spectrum, presented to the ED for evaluation of a mechanical fall and was found to have a left femur and pubic ramus fracture. On arrival she was vitally stable, labs were significant for parathyroid hormone-related hypercalcemia corrected Ca 14.8 mg/dL, PTH 911 peaked to 2884 pg/mL, vit D level of 12.7 ng/mL, phosphorus of 2.3 mg/dL. Trauma workup revealed numerous osseous lytic lesions lower extremities. Review of system was negative except for localized pain at fracture site. Family history negative for hypercalcemia or hyperparathyroidism. She was managed with IV fluids, IV Zoledronic Acid 4 mg, SC calcitonin 240 units, and 50K IU D3. During hospitalization, she needed re-dozing with Zoledronic acid and Cinacalcet due to recurrence of significant hypercalcemia, warranting further imaging. CT neck showed mandibular and maxillary bone lesions raising suspicion of hyperparathyroidism jaw tumor syndrome (HPT-JT) vs brown tumors, 3.1 cm lobular mass inferior to the right thyroid lobe suspicious for large parathyroid adenoma vs carcinoma, and other multiple enlarged parathyroids. She underwent left femur cephalomedullary nailing and prophylactic nailing for the impending right femur fracture. Bone pathology showed fragmented bone, adipose, and skeletal muscle with fibrinous debris. She underwent subtotal parathyroidectomy (4-1/2 glands) and intraoperative PTH level declined from 1537 to 75 pg/mL 15 minutes after removal. Pathology showed tissue consistent with multi glandular parathyroid disease without evidence of malignancy. Postop her course was complicated with hungry bone syndrome requiring a few weeks on IV calcium. Discussion: Pathologic conditions in primary hyperparathyroidism include single adenomas (80-90% of the time), multiglandular hyperplasia multiple-gland (three or more glands) accounting for approximately 6%, and parathyroid carcinomas account for 1-2% of cases. Other conditions as with primary hyperparathyroidism include Familial hyperparathyroidism such as MEN 1 & 2A, Familial isolated hyperparathyroidism, and Familial HPT-JT syndrome, previously termed familial cystic parathyroid adenomatosis. Interestingly our pt had multiglandular hyperplasia which is a less common cause, she also demonstrated jaw lesions but didn’t fulfill the criteria for HPT-JT. Conclusion: Our patient had an unusual presentation of large bone fracture and multiple lytic lesions likely representing a brown tumor of the bone due to primary hyperparathyroidism. Most patients with lytic lesions have malignancy, however, endocrine pathologies should also be considered.
Presentation: Saturday, June 17, 2023
THU600 Coronary Calcium Scores In Medical Group Versus Individualized Dietitian-led Visits Group In An Inner-city Setting
Authors: Friedman Theodore C , Duran Petra , Budoff Matthew J , Shaheen Magda 
Published: October 2023

Abstract
Disclosure: T.C. Friedman: None. P. Duran: None. M.J. Budoff: None. M. Shaheen: None.
Obesity is highly prevalent in the U.S., particularly among ethnic minority groups. The purpose was using a randomized trial of 12-months to evaluate if coronary artery calcium (CAC) scores will decline in the medical arm compared to the dietitian-led arm and the control arm. Adult patients were recruited from LAC-DHS and randomized to medical group visit (n=58), dietitian individual visit (n=18) and control (n=50) groups. We measured the total CAC score and left anterior descending [LAD] scores using cardiac computed tomography to quantify CAC. We analyzed data for the change from baseline in the CAC scores between groups using the Kruskal Wallis test. We categorized the total CAC scores into 0-100 (no/mild risk); 101-400 (moderate risk); and &gt; 400 (severe risk) and the LAD score into 0-99 (no/mild risk); 100-300 (moderate risk); and &gt;300 (severe risk) and compared the groups using chi square or fisher exact test. P-value &lt;0.05 was statistically significant. No statistical difference was found between the study groups in the change of the total CAC score. The mean, median and IQR of the change in total CAC score were -26.4, 0.0,3.0 in the dietitian group; 21.6, 0.0, 10.0 in the medical group; 44.6, 3.0, 23.0 in the control group (p=0.10). At baseline and post-intervention, no significant differences were found between the study groups in the total CAC risk (p=0.22). The mean, median and inter-quartile range (IQR) of the change in LAD score were -23.6, 0.0, 2.0 in the dietitian group; 4.7, 0.0, 2.0 in the medical group; 12.5, 1.0, 9.8 in the control group (p=0.036). Significant improvements were found between the dietitian group and control group (p=0.039) and the medical group and control group (p=0.027). For LAD risk groups at baseline, 10%, 11.1% and 10.3% of the control, dietitian, and medical groups, respectively, had moderate risk; and 10.0%, 5.6%, and 1.7%, respectively, had severe risk (p=0.069). Post intervention, there was a reduction in the percent with moderate risk in the dietitian (-5.5%) and the medical (-1.7%) groups relative to control group (2.0%). For the severe risk, there was a reduction of 5.6% in the dietitian group, with no change in the medical group relative to 2% increase in the control group (p=0.013). Our study showed significant improvement in the LAD score and its risk groups in the dietitian group relative to the control and medical groups indicating that the dietitian intervention was able to attenuate the progression of atherosclerosis. The implications of our study is that lifestyle obesity interventions have the potential to reduce cardiovascular disease.
Presentation: Thursday, June 15, 2023
FRI094 Case Report: Treatment Of Sitosterolemia With Ezetimibe - 17 Years Of Follow-up
Authors: Vieira Coutinho Jean Gabriel , Santos Costa Ana Carolina , Moura Issa Milka Maria , Pereira Paim Neiva , Quedas Elisangela P S , Sutti Nunes Valeria , Lima Jorge Alexander Augusto , Regina Nakandakare Edna , Faria Carrilho Alexandre Jose 
Published: October 2023

Abstract
Disclosure: J.V. Coutinho: None. A.S. Costa: None. M.M. Issa: None. N.P. Paim: None. E.P. Quedas: None. V.S. Nunes: None. A.L. Jorge: None. E.R. Nakandakare: None. A.F. Carrilho: None.
Background: Sitosterolemia is a rare autosomal recessive disease caused by inactivating mutations in the ABCG5 or ABCG8 genes. It is characterized by the accumulation of plant sterols in tissues in the form of xanthomas and vascular atheroma. Ezetimibe has been used to decrease serum sterol levels, but its role in xanthomas and arterial atherosclerosis progression remains undetermined. We present a patient diagnosed with sitosterolemia done at age 23 years and followed for 17 years on treatment with ezetimibe 20 mg daily. Clinical case: A 23-year-old man showed typical xanthomas on the extensor surfaces of his hands and Achilles tendons, in addition to splenomegaly and thrombocytopenia. Serum cholesterol and triglyceride levels were normal and sitosterolemia was suspected by a tendon biopsy. The diagnosis was confirmed by high serum concentrations of β-sitosterol and campesterol, and the patient was advised to follow a low plant-sterol diet and to take ezetimibe 20 mg daily. Seven years later, there was no change in xanthoma size, abdominal ultrasound showed normal spleen, and plasma lipid levels were: total cholesterol (TC) 147 mg/dL, HDL cholesterol (HDL) 44 mg/dL, LDL cholesterol (LDL) 61 mg/dL, triglycerides (Tg) 206 mg/dL, desmosterol 0. 137 µg/mL (n &lt; 1.6 µg/mL), lanosterol 0.368 µg/mL (n &lt; 2.2 µg/mL), campesterol 39.65 µg/mL (n &lt; 5.5 µg/mL), β-sitosterol 87.53 µg/mL (n &lt; 1.7 µg/mL) and platelet count 109,000/mL. Seventeen years after diagnosis, at age 40, there was no significant change in xanthoma size and the patient remained without cardiovascular symptoms (normal echocardiography and exercise stress test), however ultrasound showed bilateral carotid-intimal-medial thickening (0.1 on the right and 0.17 on the left, n &lt; 0.1) and serum lipid concentrations were: TC 203 mg/dL, LDL 130 mg/dL, HDL 46 mg/dL, Tg 145 mg/dL, campesterol 21.34 µg/mL (n &lt; 5.5 µg/mL) and β-sitosterol 65.13 µg/mL (n &lt; 1.7 µg/mL). Then, atorvastatin 20 mg daily was added to ezetimibe. In addition, genomic DNA sequencing revealed a compound heterozygous mutation of the ABCG5 gene (NM_022436:exon1:c.64C&gt;T:p.Q22* and NM_022436:exon9:c.1217G&gt;A:p.R406Q). Conclusion: treatment with ezetimibe prevented the growth of xanthomas, however it was not able to normalize plasma levels of campesterol and β-sitosterol. Furthermore, the small carotid intimal-medial thickening found raised the question about the role of plant sterols in atherosclerosis.
Presentation: Friday, June 16, 2023
FRI096 Efficacy Of Pemafibrate In Patients With Dyslipidemia: A Systematic Review And Meta - Analysis Of Randomized Controlled Trials
Authors: Caroline Cristine Almeida Balieiro , Romero Nakajima Noah , Mizuhira Gobbo Marcela , Assunes Gonçalves Beatriz Polachini , Amaral Peixoto Natália Araujo do , Teixeira Sirena Eduardo Cesar , Barbosa Moreira Matheus José 
Published: October 2023

Abstract
Disclosure: C.A. Balieiro: None. N.R. Nakajima: None. M.M. Gobbo: None. B.A. Gonçalves: None. N.D. Peixoto: None. E.T. Sirena: None. M.B. Moreira: None.
In individuals with dyslipidemia, which is a well-known risk factor for cardiovascular events, pemafibrate may improve lipid abnormalities. We aimed to perform a systematic review and meta-analysis of randomized clinical trials (RCT) comparing pemafibrate to either placebo or fenofibrate in patients with hypertriglyceridemia. The PubMed, Cochrane, and Embase databases were searched for RCTs only. Data were extracted from published reports, and quality assessment was performed according to PRISMA guidelines. We used a random-effects model to calculate the mean difference (MD) and the 95% confidence interval (CI). The primary endpoints of interest were percent changes in triglycerides (TG) and non-HDL cholesterol. The review protocol is registered at PROSPERO, under the number CRD42022374852. Nine studies involving 12,644 patients were included. Of all participants, 6,699 (53%) received the intervention. There was a higher percentage of decrease in serum TG in the pemafibrate group at the dose of 0.4 mg/day (MD −48.29 [−61.45, −35.13], 95% CI; P &lt; 0.0001, I2 = 93%), in comparison to placebo. In addition, non-HDL levels were significantly lower in patients treated with pemafibrate at the dose of 0.4 mg/day when compared to placebo (MD - 6.35, [−10.62, −2.08], 95% CI; P &lt; 0.0001, I2 = 82%). There was no significant percent change in TG between patients treated with pemafibrate 0.2 mg/day compared when compared to fenofibrate 200 mg/day (MD −2.90 [−12.90, 7.11], 95% CI; P = 0.003, I2 = 83%), neither in the pemafibrate groups at the doses of 0.1 mg/day (MD 43.72 [-53.51, -33.93], 95% CI; P = 0.06, I2 = 60%) and 0.2 mg/day (MD −47.30 [−53.99, −40.60] , 95% CI; P = 0.11, I2 = 47%) when compared to placebo. Decrease of non-HDL levels were not significantly different when comparing pemafibrate and placebo, neither at the dose of 0.1 mg/day (MD -7.11 [−10.71, - 3.50], 95% CI; P = 0.26, I2 = 25%) nor 0.2 mg/day (MD - 7.70 [-10.66, −4.74], 95% CI; P = 0.20, I2 = 33%). Our meta-analysis demonstrates that pemafibrate is effective in lowering triglycerides and non-HDL levels in patients with dyslipidemia compared to placebo. Furthermore, the difference in reduction between pemafibrate and fenofibrate was not statistically significant. This study represents the most current evidence. Keywords: Dyslipidemia, Pemafibrate, Triglycerides
Presentation: Friday, June 16, 2023
FRI101 Marked Reduction In Severe Resistant Hypertriglyceridemia On PCSK9 Inhibitor
Authors: Kaul Sabrina , Gupta Ankur 
Published: October 2023

Abstract
Disclosure: S. Kaul: None. A. Gupta: None.
Introduction: PCKS9 inhibitors, such as evolocumab, have been shown to lower triglyceride levels by approximately 10-20% (1). However, there have not been any reports of PCSK9 inhibitors lowering triglyceride levels by more than 100%. Clinical Case: A 35-year-old white man presented with hypertriglyceridemia for more than eight years. Past medical history was significant for recurrent pancreatitis and diabetes mellitus type 2 with recent HbA1c of 7.6% (normal range &lt;5.7%) on metformin 1 gram BID and insulin glargine 15 units daily. He had multiple hospitalizations for pancreatitis requiring insulin drip. His triglycerides remained elevated on fenofibrate, atorvastatin, and icosapent ethyl despite alcohol avoidance and changes in diet with progressive elevation to 5000 mg/dL (normal range 0-150 mg/dL) requiring four sessions of plasmapheresis and hospitalization requiring intravenous insulin drip. His family history also included hypertriglyceridemia in his mother. He was started on evolocumab 140 mg subcutaneously every 2 weeks and noted to have drastic improvement of triglycerides down to a normal level of 138 mg/dL. On recent labs, his triglyceride level was noted to be 921 mg/dL with HbA1c at 8.0%. He did admit non-compliance to diet but did not require any more hospitalizations for pancreatitis since starting evolocumab. Conclusions: This is the first reported case of an unexplored potential of evolocumab in patients with severe hypertriglyceridemia. Reference: (1) Warden BA, Fazio S, Shapiro MD. The PCSK9 revolution: Current status, controversies, and future directions. Trends Cardiovasc Med. 2020;30(3):179-185. doi:10.1016/j.tcm.2019.05.007
Presentation: Friday, June 16, 2023
FRI104 A Case Of Nephrotic Syndrome Presenting With Hyperlipidemia
Authors: Romao Isabela J , Taranto Viktoria , Howard Shanik Michael 
Published: October 2023

Abstract
Disclosure: I.J. Romao: None. V. Taranto: None. M.H. Shanik: None.
Introduction: Nephrotic syndrome is associated with increased risk of atherosclerosis, stroke and thromboembolism (1). These complications can be linked to an increase in total cholesterol, LDL and triglycerides levels that are seen in nephrotic syndrome. The aim of this presentation is to highlight the importance of considering nephrotic syndrome in the differential diagnosis of a significantly elevated lipid profile. Case presentation: A 40-year-old woman with a history of anxiety and hypothyroidism presented for evaluation of hyperlipidemia. Blood work revealed a total cholesterol of 636 mg/dL (&lt;200), LDL was 502 mg/dL (&lt;130), triglycerides 325 mg/dL (&lt;150) and HDL 69 mg/dL (&gt;40). She was started on Atorvastatin 80 mg daily. She developed nausea and achiness and was changed to Rosuvastatin 10 mg daily. The lipid profile improved but remained elevated with a total cholesterol of 351 mg/dL and LDL of 215 mg/dL. She was also noted to have elevated blood pressure and leg edema for the past 2 months. She was treated with Hydrochlorothiazide 12.5 mg daily that significantly helped with the leg swelling and weight loss. She was taking levothyroxine 100 mcg and her TSH was 1.95 uIU/mL (0.35-4.9). She did not have a family history of thyroid disease or hyperlipidemia. On exam her blood pressure was 136/100, pulse 108, weight 245 lbs., height 5’7”, respiratory rate 12. She had trace edema of her lower extremities. The significant elevation in cholesterol levels and her history of leg edema were suspicious for protein loss. A urine analysis showed elevated protein in the urine at 87 mg/dL (&lt;15). She completed a 24-hour urine for protein that was markedly high at 16,740 mg/24 hours (&lt;150) consistent with nephrotic syndrome. She was evaluated by a nephrologist who performed a renal biopsy that showed membranous glomerulonephritis and tubular atrophy. No secondary causes were found. Her diuretic was changed to Torsemide 10 mg daily and Lisinopril 10 mg daily was added. After several months her blood pressure normalized to 120/80 and her total cholesterol improved to 202 mg/dL, LDL was 98 mg/dL, triglycerides 229 mg/dL. Albumin level went from 1.8 to 3.8 g/dL (3.5-5.7). She had a marked decrease of protein in the urine from 216 to 35 mg/dL (&lt;15). Conclusion: Nephrotic syndrome should be part of the differential diagnosis of any patient who has a history of significant hyperlipidemia. The abnormalities of serum lipids seen in nephrotic syndrome are largely due to the impaired clearance rather than biosynthesis and can lead to multiple complications. Making the diagnosis of nephrotic syndrome is very important as it is associated with significant cardiovascular and renal disease. 1. Agrawal S, Zaritsky JJ, Fornoni A, Smoyer WE, Dyslipidemia in nephrotic syndrome: mechanism and treatment. Shipra Agrawal, et al. Nature Reviews Nephrology 2018; 14:57.
Presentation: Friday, June 16, 2023
FRI111 Venous Thromboembolism In Cushing Syndrome - A Call For Standardized Anticoagulation Regimen In Hypercortisolism
Authors: Minasyan Mari , Bryk-Wiazania Agata , Rzepka Ewelina , Bogusławska Anna , Hubalewska-Dydejczyk Alicja , Gilis-Januszewska Aleksandra 
Published: October 2023

Abstract
Disclosure: M. Minasyan: None. A. Bryk-Wiazania: None. E. Rzepka: None. A. Bogusławska: None. A. Hubalewska-Dydejczyk: None. A. Gilis-Januszewska: None.
Venous thromboembolism in Cushing Syndrome - a call for standardized anticoagulation regimen in hypercortisolism. Cushing Syndrome (CS) is associated with a 18-fold higher risk of venous thromboembolism (VTE) when compared to the general population with the similar demographic characteristics. Despite numerous studies on hypercoagulability in CS, the unequivocal recommendations regarding timing and dosing of thromboprophylaxis in hypercortisolism are still lacking. We present a case series of patients with CS and VTE, hospitalized in the Endocrinology Department of University Hospital in Krakow. Among 135 patients with CS, we found 7cases of VTE (5.19%), aged 35-65 years, mostly females (n=6). The etiology of CS was predominately pituitary (n=3), the other tissue origins of CS were: adrenal (n=2), ectopic(n=1) and adrenal carcinoma (n=1). Pulmonary embolism (PE) was found in 3 patients, deep venous thrombosis (DVT) in 2 patients, while 2 patients suffered from concomitant DVT and PE. We found that one patient had VTE 5 months before inducing the biochemical remission by a transsphenoidal surgery, while 2 patients within the 30 days after inducing the biochemical remission by either a transsphenoidal surgery in one, or metyrapone treatment in 2nd case. In the remaining 4 patients, VTE episode preceded the diagnosis of CS, ranging from 1 year to 2 months prior to the diagnosis. Among them, 2 PE episodes were associated with other predisposing factors, such as (1) postpartum PE in a 36-year-old women, who was subsequently diagnosed with Cushing disease, and (2) combined oral contraceptive in a 35-year-old woman, who suffered from the peripheral PE, and was eventually diagnosed with adrenal CS. Of note, at the time of VTE episode, 1 patient was treated with warfarin (international normalized ratio at the time of VTE, 1.66), another one took apixaban. One fatal PE occurred on the thromboprophylaxis with low molecular weight heparin, in the hypocortisolemia following metyrapone implementation. To summarize, VTE episode: 1. may be the first, life-threatening presentation of CS; 2. may occur after treatment of hypercortisolism; 3. may happen in patients on thromboprophylaxis or anticoagulant treatment; 4. should be included in the differential diagnosis of a thrombotic event despite coexisting transient factor (e.g. oral contraceptive, delivery). 5. Further multicenter studies are essential to understand the hypercoagulability in CS, and to create the recommendations on this topic.
Presentation: Friday, June 16, 2023