bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSAT019 A Rare Case of Massive Bilateral Adrenal Myelolipomas in a Patient with Congenital Adrenal Hyperplasia
Authors: Arasu Aarthi , Patel Reema 
Published: November 2022

Abstract

Background
Myelolipomas are rare, benign tumors of the adrenal gland that consist of adipose and hematopoietic tissue. Most present unilaterally and rarely exceed 4 cm, but bilateral and large myelolipomas have been reported. The development of these neoplasms has been associated with congenital adrenal hyperplasia (CAH) (1).

Clinical Case
A 44-year-old woman with a history of simple virilizing CAH follows in endocrine clinic. She was diagnosed with CAH at birth and underwent vaginoplasty procedures at age 8 and 16. She has been on glucocorticoid therapy with hydrocortisone or prednisone throughout her life, but has had long gaps in treatment (sometimes up to a year) and reports often skipping doses due to concerns regarding facial swelling. She has not had a menstrual cycle for many years and reports shaving her facial hair daily. Her ACTH has been as elevated as 830 pg/mL, 17-alpha-OH-P has been as elevated as 17740 ng/dL, and testosterone as elevated as 401 ng/dL. She now presents for evaluation of an umbilical hernia. She did not have any abdominal or flank discomfort. CT abdomen and pelvis with contrast was obtained and showed bilateral, massive (approximately 25 cm and 18 cm in the largest dimensions on each side) suprarenal masses thought to most likely represent adrenal myelolipomas. She was referred to endocrine surgery and is undergoing discussions regarding possible adrenalectomy. Since the discovery of these adrenal masses, she has been consistently taking prednisone 5 mg daily.

Conclusion
This case illustrates the potential role of poorly-controlled CAH in the development of massive adrenal myelolipomas. Many hypothesize chronic ACTH stimulation can cause metaplasia of adrenocortical cells and lead to the development of myelolipomas. Review of the medical literature reveals no clear consensus on the management of these rare neoplasms (2).

References
(1) Al-Bahri S, Tariq A, Lowentritt B, Nasrallah DV. Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia. Case Rep Surg. 2014;2014: 728198. doi: 10.1155/2014/728198. Epub 2014 Jul 16. PMID: 25140269; PMCID: PMC4124659. (2) German-Mena E, Zibari GB, Levine SN. Adrenal myelolipomas in patients with congenital adrenal hyperplasia: review of the literature and a case report. Endocr Pract. 2011 May-Jun;17(3): 441-7. doi: 10.4158/EP10340.RA. PMID: 21324823.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT022 A Rare Case of Androgen Secreting Adrenal Cortical Carcinoma in a Young Woman
Authors: Javvaji Abhiram , Anastasopoulou Catherine 
Published: November 2022

Abstract

Introduction/Background
Adrenal cortical carcinoma (ACC) is a rare disease occurring in 1 to 2 per million per year. (1) The pure androgen secreting carcinomas are even more rare and occur in only 6% of the cases of ACC. (2) These tumors have an occurrence of age which is usually bimodal either in the first or fifth decade of life. (3) Herein, we report an unusual case of malignant pure androgen secreting adrenal tumor in a woman in her second decade.

Clinical Case
A 19 year old female presented to the ED with abdominal pain and was found to have incidental adrenal tumor and therefore referred to endocrinology. She complained of hirsutism in the upper lip, chest and abdomen, weight gain and amenorrhea for 18 months?. Hormonal work-up revealed elevated DHEAS 755 mcg/dL (normal 27-240), serum testosterone level 306 ng/dL (normal 10-75), whereas cortisol and metanephrines levels were within normal limits. A diagnostic MRI showed a large left 10.5cm adrenal tumor and patient subsequently underwent laparoscopic left total adrenalectomy. Final pathological report revealed low grade adrenocortical carcinoma confined to the adrenal cortex. Oncology was consulted and the patient was started on adjuvant cytotoxic chemotherapy with cisplatin and etoposide followed by radiation, and mitotane therapy. Postoperatively at two months testosterone and DHEAS levels were normalized.

Conclusion
This case illustrates how ACC may present with atypical symptoms of hirsutism, amenorrhea, and hyperandrogenic state. Hypersecretion of both androgen and cortisol is more common occurring approximately 46% of patients with ACC but the presence of hypersecretion of isolated androgens in adrenal tumors has been associated with an increased likelihood of malignancy. (3) Physicians of different specialties should have a high degree of suspicion for adrenal involvement in the evaluation of patients with hirsutism and hyperandrogenism. Work-up should include laboratory testing along with radiographical images to help establish the diagnosis.

References
Angelousi A, Kassi E, Kaltsas GA. Adrenocortical Carcinoma. [Updated 2018 Oct 2]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278924/
Abiven G, Coste J, Groussin L, Anract P, Tissier F, Legmann P, Dousset B, Bertagna X, Bertherat J. Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endocrinol Metab. 2006 Jul;91(7): 2650-5. doi: 10.1210/jc.2005-2730. Epub 2006 May 2. PMID: 16670169.
Cavlan D, Bharwani N, Grossman A. Androgen- and estrogen-secreting adrenal cancers. Semin Oncol. 2010 Dec;37(6): 638-48. doi: 10.1053/j.seminoncol.2010.10.016. PMID: 21167382.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
OR20-2 Bilateral Primary Aldosteronism Is Not Excluded by High Adrenal Vein Sampling Lateralization Indices
Authors: Giordano Thomas , Konzen Sonja , Rainey William , Salman Zara , Tezuka Yuta , Udager Aaron , Turcu Adina F 
Published: November 2022

Abstract

Background
Primary aldosteronism (PA) is broadly divided into unilateral and bilateral forms, and the most reliable subtyping tool available is adrenal vein sampling (AVS). Unilateral PA is generally diagnosed based on AVS lateralization indices (LI=[aldosterone/cortisol] ratio between the dominant and contralateral adrenal vein) ≥4, or even ≥2 when AVS is performed without cosyntopin stimulation. Long-term follow-up data from patients with PA treated with unilateral adrenalectomy have been minimal.

Objective
To assess the rates of residual and recurrent PA after AVS-guided unilateral adrenalectomy.

Methods
We enrolled patients with PA who underwent unilateral adrenalectomy between 09/2017 and 08/2021 in a single tertiary referral center and followed them longitudinally. Demographics, laboratory, imaging, and pathology data were collected. Aldosterone synthase (CYP11B2) immunohistochemistry and next generation sequencing were performed on available formalin-fixed paraffin-embedded adrenal tissue blocks.

Results
During the study period, 80 patients (52 men) with median age 53 (range, 19-76) years underwent unilateral adenectomy, and were followed for a median 80 days (range, 6-653 days). In total 14 (17.5%) patients had evidence of residual PA following surgery, including 3 who had complete biochemical failure, and 1 who had apparent cure of PA immediately post-operatively. All 14 patients had severe PA, with baseline plasma aldosterone concentrations between 23.4 and 496 ng/dL and suppressed renin. Baseline and post-cosyntropin stimulation LIs ranged from 2.7- 187.5 and 1.3-53.7. The LI was &gt;4 only at baseline in 3 cases, and only after cosyntropin stimulation in 2 cases. Histology showed single adenomas, ranging from 0.7-5.3 cm in 7 (50%) patients, and multiple adenomas and/or nodular hyperplasia in 7 (50%) patients. Of the 7 cases analyzed for aldosterone-driver mutations so far, 4 harbored CACNA1D mutations, 2 ATP1A1 mutations, and 1 a KCNJ5 mutation.

Conclusions
Patients with severe PA and frank AVS aldosterone lateralization might have multifocal, bilateral disease. Long-term follow up and targeted medical therapy should be pursued after unilateral adrenalectomy for presumed unilateral PA.
Presentation: Monday, June 13, 2022 11:15 a.m. - 11:30 a.m.
PSUN246 Pilot Study: Impact of discharge follow up care at endocrine clinic on glycemic control and re-admission rate in a community hospital
Authors: Gangavarapu Praveen , Mon Sann Y 
Published: November 2022

Abstract

Introduction
The burden of diabetes among hospitalized patients is growing and 30-day readmission rates for those with DM are reported to be 5.9 to 9.2% higher than the rate for all hospitalized patients. We offered follow-up care at a community hospital-based endocrine clinic within 30 days after discharge for those with uncontrolled DM and analyzed its impact on glycemic control and 30 days re-admission rate.

Methods
This is a single-centered, retrospective study of 29 patients with DM who were hospitalized in our community hospital and were offered a follow-up Endocrine clinic appointment.

Results
We analyzed a total of 29 discharged patients’ chart with predominantly male (65.51%), T2DM (93%), mean age 58.9±15.7 yrs, BMI 31.35±-9.5 kg/m2, 72.4% on insulin therapy, 79.3% with at least one microvascular complication, and 37.9% with at least once macrovascular complication. A1C 3 8% on admission was observed in 27 patients (93.1%). Although all patients were offered a follow-up appointment, only 23 patients (79.3%) showed up for their follow-up appointments (G1) and 6 patients did not show up (G2).In G1, 4 out of 16 patients (25%) who were on insulin therapy were able to discontinue insulin therapy after endocrine clinic follow-up appointments.In G1, 15 patients (65.21%) achieved A1C &lt; 8% at 3 months. In G1, mean A1C on admission was 11.8 ± 2.8% and improved to 7.7±2.5% whereas mean A1C remained the same for G2. (P= 0.6)The 30 days readmission rate was 21.73% in G1 although reasons for readmission were not directly related to diabetes, whereas no readmission was observed in G2.

Conclusion
Although our study failed to prove a reduction in 30 days of hospitalization by offering endocrine outpatient care, it has shown improvement in glycemic control.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN263 Diagnosis of Latent Autoimmune Diabetes of Adulthood Unveiled After Initiation of an SGLT2 Inhibitor
Authors: Patel Goonja , Kaur Komaldeep , Gandikota Praveena 
Published: November 2022

Abstract
SGLT2-inhibitors have revolutionized treatment for Type II diabetes (T2DM) due to their numerous benefits including improved glycemic control, cardioprotective properties, reduction of high blood pressure, and mitigation of disease progression in CKD.ew studies have investigated the benefits of this medication class on patients with Type 1 DM (T1DM). Herein we describe a case in which the diagnosis of latent autoimmune diabetes of adulthood (LADA) was unmasked following the use of an SGLT2-inhibitor.
A 56-year-old female with a history of T2DM diagnosed 10 years ago presented to the endocrine clinic for management of her poorly controlled diabetes. Her medications then included insulin detemir, insulin lispro, metformin, and repaglinide, but she still had an HbA1c of 11.3% (n&lt;5.7%). She was tried on glipizide early in her disease course but it was discontinued due to fluid retention. She had a sedentary lifestyle with a BMI of 31.27 kg/m2. She was requiring increased doses of insulin over time with minimal improvement in her HbA1c. Two years later she was started on liraglutide with increasing dosages. Her HbA1c continued to decrease down to 8.7% and her BMI had decreased to 26.83 kg/m2. Over the next year, her HbA1c began to again increase up to 9.8%. At this time canagliflozin was added to her medication regimen. She responded very well to this medication initially with a drop in her HbA1c to 7.5% and a decrease in her BMI to 24.01 kg/m2. Unfortunately, one year after initiation of the SGLT2-inhibitor she was hospitalized for DKA and pancreatitis. At this time all her medications, except for insulin and metformin, were discontinued. A GAD65 antibody (&gt;250 IU/mL; n&lt;5.0 IU/mL) and c-peptide (&lt;0.1 ng/mL; n = 1.1-4.4 ng/mL) levels were checked at this time which revealed the diagnosis of LADA approximately 16 years after her initial diagnosis of T2DM. She was transitioned to an insulin pump and managed according to protocol.
SGLT2 inhibitors have been studied as an adjuvant treatment with insulin for T1DM due to their ability to increase urinary glucose excretion but are currently not approved for T1DM. Despite their recorded benefits, they have also been shown to significantly increase the risk of DKA when used in patients with T1DM. Our patient, who was mistakenly treated as T2DM for almost two decades, was diagnosed with LADA after initiation of an SGLT2 inhibitor led to hospitalization for DKA. Further research is needed to assess the safety of SGLT2 inhibitors in T1DM, and caution must be taken when prescribing this medication to patients who may have underlying LADA.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN274 Chlorthalidone-Induced Diabetic Ketoacidosis.
Authors: Zafar Rafia , Syeda Javeria , Saber Suzan 
Published: November 2022

Abstract

Introduction
A variety of pharmacological agents affect glucose homeostasis resulting in hypo- or hyperglycemia. Several antihypertensives, including thiazide diuretics, are implicated in hyperglycemia.

Clinical Case
A 56 years old African American male with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia presented to the emergency department with diabetic ketoacidosis 3 weeks after initiation of chlorthalidone. His HbA1c at the time of chlorthalidone initiation was 6.8%. On presentation, his serum glucose was 870 mg/dL, beta-hydroxybutyrate was 34.70 (0.02–0.27), and HbA1c was 15.5%. The patient received aggressive IV fluid resuscitation and insulin infusion. Twenty hours later, DKA resolved and subcutaneous insulin was started. He was discharged home on MDI of insulin and chlorthalidone was discontinued. Metformin was restarted while insulin was tapered and stopped. Of note, the patient was diagnosed with diabetes mellitus 7 years before this presentation after an episode of DKA. After his first DKA, LADA was ruled out. His C-peptide level was intact and he was switched from MDI of insulin to metformin. The patient was maintained on metformin 1000 mg twice daily for 7 years with his HbA1c ranging from 6.1% to 6.4%. One year after his second DKA episode, he was still on metformin monotherapy with HbA1c of 6.8%. This is a case of DKA-prone diabetes and we believe that the use of thiazides precipitated his second episode due to the temporal relation and the lack of other contributing factors. There are several suggested mechanisms for thiazide diuretic-related hyperglycemia and other metabolic adverse effects. Genome Wide Association Study (GWAS) identifies the HMGCS2 locus to be associated with chlorthalidone induced glucose increase in hypertensive patients. Thiazide diuretics, especially chlorthalidone-associated DKA is not well documented and this entity may need further research. We found only one case report in the literature search.

Conclusion
Thiazide diuretics can worsen diabetes control in diabetic patients and may even lead to hyperglycemic emergencies, such as DKA in susceptible individuals. Patients should be closely monitored for some time after initiation of such medications to avoid hyperglycemia and related complications.

References
Qiao, X., & Moses, L. (2018). AN INTERESTING CAUSE OF DIABETIC KETOACIDOSIS: CASE REPORT, REVIEW OF LITERATURE AND POSSIBLE PATHOPHYSIOLOGY OF THIAZIDE DIURETICS-INDUCED DKA. Chest, 154(4), 265A.)
Singh, S., McDonough, C. W., Gong, Y., Alghamdi, W. A., Arwood, M. J., Bargal, S. A., … & Johnson, J. A. (2018). Genome wide association study identifies the HMGCS2 locus to be associated with chlorthalidone induced glucose increase in hypertensive patients. Journal of the American Heart Association, 7(6), e007339.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
RF04 | PSUN297 Genetic Knockout of Intestinal Hexokinase Domain Containing Protein-1 Affects Enterocyte Glucose Transport in Mice Fed High Fat Diet
Authors: Zapater Joseph , Wicksteed Barton , Layden Brian 
Published: November 2022

Abstract
Hexokinase domain containing protein-1, or HKDC1, is a widely expressed novel hexokinase that is genetically associated with elevated 2-hour gestational blood glucose levels during an oral glucose tolerance test, suggesting a role for HKDC1 in postprandial glucose regulation during pregnancy. Our earlier studies utilizing transgenic mice containing whole-body HKDC1 knockdown, or mice in which hepatic HKDC1 was overexpressed or knocked out, indicated that HKDC1 is important for whole-body glucose homeostasis in aging and pregnancy, through modulation of glucose tolerance, peripheral tissue glucose utilization, and hepatic energy storage. However, our knowledge of the precise mechanisms by which HKDC1 regulates postprandial glucose homeostasis under normal and diabetic conditions is lacking. As the intestine is the main entry portal for dietary glucose, and since HKDC1 is highly expressed within the intestine, in this study we assessed and characterized the in vivo significance of intestine-specific HKDC1 in regulating glucose homeostasis under normal and obesogenic conditions. We developed an intestine-specific HKDC1 knockout mouse model, HKDC1Int-/-, utilizing Cre-mediated recombination of HKDC1 in which Cre was expressed under the control of the villin gene promoter, leading to genetic knockout of HKDC1 solely within the intestinal epithelium. Mice were maintained until 28 weeks of age on either a normal chow diet or a high fat diet to develop obesity, hyperglycemia, and insulin resistance. While no overt glycemic phenotype was observed, 28-week-old HKDC1Int-/- mice fed a high fat diet exhibited an increased glucose excursion following an oral glucose load compared to mice expressing intestinal HKDC1. This finding was not due to differences in insulin levels, whole-body insulin tolerance, or gluconeogenesis, nor was it a result of alterations in enterocyte glucose utilization or a reduction in peripheral skeletal muscle glucose uptake. Furthermore, the enhanced glucose excursion was related to transport of glucose through the intestinal epithelium, as mice administered an intraperitoneal glucose load did not exhibit alterations in post-load glycemic excursion. Assessment of intestinal glucose transporters in high fat diet-fed HKDC1Int-/- mice indicated an increased expression of GLUT2 in the enterocyte apical membrane in the fasting state. Taken together, our results indicate that intestine-specific HKDC1 contributes to postprandial glycemic regulation by modulating dietary glucose transport across the intestinal epithelium under conditions of enhanced metabolic stress, such as obesity, hyperglycemia, and diabetes.
Presentation: Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP272 ROUNDUP IS AN IMPORTANT DISRUPTOR THAT CAUSES PROLIFERATIVE EFFECTS ON NORMAL AND ON CANCER THYROID CELLS
Authors: Ward Laura Sterian , Rabi Larissa Teodoro , de Souza Teixeira Elisângela , de Oliveira Sarah Domingos , dos Santos da Silva Juliana Gabrielle , Peres Karina Colombera , Nascimento Matheus , Bufalo Natassia Elena , Bó Cruz Izabela Fernanda Dal’ 
Published: November 2022

Abstract
Glyphosate has long be suspected to promote endocrine disruptive and even carcinogenic effects, but little is known about its effect at different concentrations on normal and on cancer thyroid cells. Since the endocrine system responds to low chemical concentrations and abnormal cells may have different sensitivity, it is essential to determine the effects of this compound at different levels, including the Acceptable Occupational Exposure Level (AOEL) and the Acceptable Daily Intake (IDA) doses. We used two human thyroid-derived cell lines strains, Nthy-ori 3-1 (from thyroid normal follicular cells) and TPC-1 (from papillary carcinoma) to test 15 different concentrations of Roundup® Original DI, ranging from 6.5 µg/L to 6.500 µg/L, including AOEL and IDA according to the Technical Note Process No. 25351. 056754/2013-17 of the National Health Surveillance Agency (ANVISA) in Brazil. Trypan blue assay and Cell Counting Kit – 8 (CCK-8) were employed to evaluate cell viability and cytotoxicity. Exposures were made for 24 and 48 hours in technical and biological triplicates. We observed a decrease in the number of viable cells at the 24h exposure compared to 48h in both strains. Exposure of Nthy-ori 3-1 and TPC-1 cells for 24h at the AOEL concentration (160µg/L) caused death of 52% and 58% of the cells, respectively, whereas IDA (830µg/L) resulted in 43% e 58% cell death. These data evidence an important disruptive effect of Roundup Original DI® at the acceptable concentrations. After 48h of exposure, AOEL and IDA concentrations caused a lower number of Nthy-ori 3-1 (19% e 15%) and TPC-1 (29% e 23%) dead cells, respectively, suggesting both thyroid strains have compensatory mechanisms that protect them from longer exposures to the herbicide. The CCK-8 assay, on the contrary, showed a proliferative effect on small concentrations: 6.5 µg/L increased the number of viable Nthy-ori 3-1 and TPC-1 cells to 113% and 118%, respectively, at 24h, and this stimulatory effect persisted after 48h of exposure. In contrast, AOEL and IDA concentrations produced a reduction in the number of both strains cells, likewise observed with the Trypan blue assay. Our data demonstrate that thyroid cells exposed to Roundup Original DI® present a non-monotone dose-response curve, which is a well-known characteristic of an endocrine disruptor. The proliferative effect produced on thyroid cells, especially TPC-1 mutant cells, by very low concentrations of this glyphosate-based herbicide widely used around the world, suggests that it may play a role in the increasing incidence rate of thyroid nodules and/or cancer that have been observed worldwide.
Presentation: No date and time listed
ODP577 A Qualitative Exploration of Internal Medicine Resident Experiences with Telemedicine During the COVID-19 Pandemic
Authors: Dolmans Diana , Saeed Omar , Yu Catherine , Wang Yiqiao (Daniel) 
Published: November 2022

Abstract
Telemedicine has become the cornerstone of health care delivery in the COVID-19 pandemic, as it allows patients to be cared for at a distance. This descriptive qualitative study sought to (1) explore internal medicine resident experiences with telehealth patient encounters during the COVID-19 pandemic, and (2) understand resident experiences with virtually reviewing cases with their supervisors. From November 2020 to March 2021, the authors conducted 20 semi-structured interviews with internal medicine residents who have completed ambulatory rotations such as endocrinology. Perceived benefits in patient encounters included increased efficiency. Challenges included a deficiency of nonverbal cues to use for building rapport with patients and confirming their understanding, inability to confidently form an impression of a patient and their disease severity, the lack of physical examination, and technical audio-visual challenges. While most residents preferred in-person to virtual review with their supervisors, the benefits of the virtual review included a supportive learning environment, and a high level of autonomy for senior residents. However, residents felt that feedback over a virtual platform was generic and not constructive, and junior trainees did not have opportunities to observe staff demonstrate essential skills needed for telemedicine care.
Presentation: No date and time listed