bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP078 An Unsolved Mystery of Hyperparathyroidism for 12 Years
Authors: Pant Nicole , Oktaei Hooman 
Published: November 2022

Abstract

Introduction
Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone (PTH). It results from excessive secretion of PTH from one or more of the parathyroid glands. The number and location of the parathyroid glands can be variable. The organogenesis of the parathyroids determines the definitive location in adulthood. We hereby present an interesting case of primary hyperparathyroidism caused by the ectopic parathyroid gland. Clinical case 85-year-old Black female with papillary thyroid cancer status post total thyroidectomy and RAI in 2011, hypertension, hyperlipidemia, osteoporosis, long standing PHPT referred to ER for hypercalcemia from a physician's office. A review of the system was significant for unintentional 40 lb. weight loss over the past several months and increased urinary frequency. She denied confusion, abdominal pain, constipation, paresthesia. On physical exam she was afebrile, BP 144/63 mm Hg, pulse 56/min and respiratory rate of 18. The rest of the detailed physical examination was unremarkable. She was initially diagnosed with primary hyperparathyroidism in 2009 based on PTH- 196 pg /ml (n 10-65 pg/ml), and corrected calcium- 11. 0 mg/dl (n 8.5-10.1 mg/dL) . Laboratory on this admission (2021) revealed PTH - 411.8 pg/ml (n 10-65 pg/ml), corrected calcium - 12.9 mg/dL (n 8.5-10.1 mg/dL) with albumin 4 g/dl (3.4-5. 0 g/dL), ionized calcium-7.30 mg/dL (n 4.5-5.3 mg/dL), 1,25-(OH) 2 vitamin D level -50.2 pg /mL (n 20-82 pg/mL),25-(OH) vitamin D level of 37.2 ng/mL (n 30-100 ng/mL) and GFR-40 mL/min/1.73m 2 (n &gt;=60. 0 mL/min/1.73m 2). She underwent a total of 4 Sestamibi scans and 1 MRI chest with and without contrast since 2009 that failed to localize defective parathyroid gland . But on this admission an incidental finding of right neck mass measuring 3. 0×1.2×2.7 cm was noted in MRI cervical spine that led to US head and neck soft tissue. It showed a solid and cystic mass with a concern for ectopic parathyroid gland posterior to the right submandibular gland. ENT was consulted, and the patient underwent right neck exploration with the removal of the neck mass. Pathology resulted as hyperplastic parathyroid tissue most congruent with a parathyroid adenoma.

Conclusion
Ectopic parathyroid glands occur in approximately 15% of patients with PHPT. Embryologically, the third pharyngeal pouch gives rise to the inferior parathyroid glands, and the superior parathyroids arise from the fourth pharyngeal pouch. It can occur from the angle of the mandible to the mediastinum according to the developmental and migratory aberrations. Parathyroidectomy remains the definitive cure for PHPT and is recommended in all symptomatic patients.
Presentation: No date and time listed
ODP085 Denosumab Induced Severe Hypophosphatemia
Authors: Del Mar Morales Hernandez Maria , Castellanos-Diaz Jessica , Kadiyala Sushma , Xhikola Majlinda 
Published: November 2022

Abstract

Introduction
Denosumab is a receptor activator of nuclear factor kappa-B (RANK) ligand inhibitor used for treatment of osteoporosis and bone metastases in patients with solid tumors. Denosumab induced hypophosphatemia has been reported in less than 1% of patients, and in most cases described as mild to moderate in severity. We present a case of severe hypophosphatemia after denosumab treatment for diffuse bone metastases due to prostate cancer.

Case report
A 78-year-old male patient with history of diffuse bone metastases due to prostate cancer, schizophrenia on treatment and intermittent alcohol use, presented to the hospital with suicidal ideation and worsening fatigue. Patient was found to have a phosphorus levels of &lt;1. 0 mg/dL (2.5-4.6 mg/dL), corrected calcium of 8.2 mg/dL (8.4-10.5 mg/dl), vitamin D 25 OH of 36.34 ng/mL (30-100 ng/mL), magnesium of 2.3 mg/dL (1.7-2.5 mg/dL), parathyroid hormone (iPTH) level of 379 pg/mL (10-65pg/mL) and serum creatinine of 1.1 mg/dL (0.5-1.2 mg/dL). Urinary studies showed 24 hour urinary phosphate 1282 mg/24h (360-1600 mg/24h), urine creatinine 1570 mg/24h (500-2150 mg/24h). There was no evidence of acidosis, chronic kidney disease, preexisting osteomalacia or vitamin D deficiency. The patient had no recent alcohol consumption and his alcohol level was undetectable. After reviewing the outside medical records it was noted that the patient had received denosumab 120 mg, 11 days prior to the hospital admission, as part of the management of bone metastases due to prostate cancer. The patient's baseline phosphorus prior to denosumab was in the low normal range. The severe hypophosphatemia and secondary hyperparathyroidism were attributed to denosumab administration. Patient was initially treated with intravenous phosphate and then transitioned to oral phosphate along with elemental calcium and calcitriol during the course of his hospitalization. Patient's phosphorus improved to 2.3 mg/dL by the time of discharge.

Discussion
In patients treated with denosumab, the primary concern is potential post-treatment hypocalcemia, however, our case brings attention to severe hypophosphatemia as a serious side effect to treatment with denosumab. Multiple specialties are involved in the treatment of osteoporosis and metastatic bone lesions, and each should be aware that denosumab can lead to lower serum phosphate levels due to its effects on bone resorption and reduction of proximal tubular reabsorption of the phosphate resulting in clinical symptoms of muscle weakness, bone pain, fractures and even stupor, coma and death. We therefore conclude that monitoring phosphate levels should be part of the pre- and post-treatment evaluation in patients who are candidates for treatment with denosumab, particularly high-dose denosumab.
Presentation: No date and time listed
ODP087 Dose-dependent effect of long-term statin use on risk of osteoporotic fracture in elderly patients
Authors: Ahn Seong Hee , Hong Seongbin , Suh Young J , Seo Da Hea , Jeong Yujin , Cho Yongin , Kim So Hun 
Published: November 2022

Abstract

Introduction
Studies have been conducted to assess the association between the use of statin and risk of new onset osteoporosis or osteoporotic fractures, however, they have shown conflicting results. We aimed to investigate the association between statin use and the risk of major osteoporotic fractures in elderly population.

Methods
In this population cohort study with Korean National Health Insurance Service-Senior Cohort database, a total of 365,656 elderly (≥60 years) without previous history of osteoporosis were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to December 2012. Incidences of major osteoporotic fractures and site specific fractures were compared using the Cox proportional hazards model with use the inverse probability weighting method.

Results
During years follow-up period, 54,959 major osteoporotic fractures occurred; the risk of major osteoporotic fractures was significantly reduced (OR,0.769; 95% CI,0.716-0.826) in statin users compared with that in non-users. Among subtypes of major osteoporotic fracture, a risk reduction with statin therapy was significant for both vertebral fracture (OR,0.701; 95% CI,0.641-0.767) and non-vertebral fracture (OR,0.807; 95% CI,0.726-0.898). Longer duration and higher cumulative dose of statin, defined by cumulative daily defined dose, were negatively associated with the risk of major osteoporotic fracture.

Conclusion
In this population-based cohort study, the use of statin was associated with significant reduction in the risk of osteoporotic fractures in elderly patients without previous history of osteoporosis.
Presentation: No date and time listed
ODP090 Fragility Fractures and Osteoporosis Screening in Patients with Chronic Lymphocytic Leukemia
Authors: Petty Lloyd , Stephens Deborah , Sharma Anu 
Published: November 2022

Abstract
Chronic lymphocytic leukemia (CLL) and osteoporosis are diseases of older adults with high prevalence rates. CLL infiltrates the bone marrow, increasing bone resorption and demineralization which contribute to the pathophysiology of osteoporosis. Despite this, there are limited clinical data describing the association of CLL with osteoporosis and fracture risk. We hypothesized that osteoporosis and fragility fractures (FF) are common in patients with CLL. The Huntsman Cancer Institute (HCI) has a CLL database which includes all patients diagnosed with CLL since January 1, 2000 and received care at the HCI. Patients included were identified from the CLL database with ICD-9 and 10 codes associated with osteopenia, osteoporosis and/or presence of a FF. Of the 57 patients included, 67% were female (n=38) with a mean age of 69 ± 10 years and 93% Caucasian. 60% (n=34) had RAI stage of 0-1 with genetic changes noted as follows: Del(13q) 46% (n=26), Del(17p) 7% (n=4), Del(11q) 5% (n=3), and Trisomy 12 14% (n=8). IGVH mutation was present in 31.6% of patients (n=18). 47% (n=25) of patients were treated with chemotherapy, of which Rituximab (n=14), Bendamustine (n=7), Cyclophosphamide (n=5), and Ibrutinib (n=5) were the most frequently used. 58.5% (n=32) had a history of FF, with 84% occurring in the spine (n=27/32). Assessment for Vitamin D deficiency and hyperparathyroidism were performed in 54% (n=31) and 21% (n=12) of the cohort respectively. Even though every patient in the study either had a diagnosis of osteoporosis by ICD code or FF, only 44% (n=25) of patients had an available DXA scan for our review, and only 31% (n=18) received treatment for osteoporosis. Of those with a DXA, the worst T score was in the right femoral neck (T score -1.9, IQR -1.5 to -2.5) with 44% (n=14/32) either having T scores in the normal or osteopenic range. Interestingly, FF was associated with higher T scores in the spine (FF spine T score -1. 0±1.5 vs no FF T score -2.2±0.8, p=0. 03). Clinical factors associated with FF were male sex (83% men vs 46% women, p&lt;0. 01) and positive smoking history (93% smokers vs 46% non-smokers, p&lt;0. 01). Use of chemotherapy and hip T scores were not associated with FF. The data from our study suggests that patients with CLL are predisposed to axial fragility fractures despite non-osteoporotic T scores. In addition, osteoporosis screening with DXA is under-utilized in the CLL population, despite meeting age-appropriate screening guidelines. Increased awareness and screening for axial fragility fractures, especially in men and smokers, should be recommended in the long term follow up of patients with CLL. Further study is needed to understand the pathophysiology of osteoporosis and FF in patients with CLL to develop improved methods for prevention of these morbid fractures.
Presentation: No date and time listed
ODP100 Hypoparathyroidism in the Setting of COVID-19: Increasingly Common Phenomenon
Authors: Markov Alexander , Krutilova Petra , Salam Maamoun 
Published: November 2022

Abstract

Background
Acquired hypoparathyroidism (HPT) in adults is most commonly caused by post-surgical or autoimmune damage to the parathyroid glands. Genetic defects causing abnormal gland development, impaired parathyroid hormone (PTH) production or action are rare and typically diagnosed in childhood. Recent literature suggests surprisingly high prevalence of hypocalcemia in patients with SARS-CoV-2 infection and this finding is associated with poor outcomes. [1] We present a case of new onset HPT in a patient admitted with respiratory failure due to COVID-19.

Case presentation
A 63-year-old woman with history of obesity, GERD, asthma, presented to the ED with fever, cough, dyspnea, and diarrhea. She was found to have low O2 saturation, CXR revealed multifocal interstitial and airspace opacities. Her PCR SARS-CoV-2 test was positive and she was admitted to ICU. She was incidentally found to have severe hypocalcemia Ca 5.2 mg/dL (8.5 - 10.3 mg/dL), ionized Ca 2.46 mg/dL (4.50 - 5.10 mg/dL), albumin 3.7 g/dL (3.5 - 5. 0 g/dL). She denied any history of neck surgery, radiation or trauma and personal or family history of autoimmune or calcium disorders. Her calcium levels were normal over the past 4 years. She denied symptoms of hypocalcemia prior to presentation and reported leg cramps and finger numbness in the ED. Further work-up revealed PTH 13 pg/mL (15 - 65 pg/mL), 25-OH vitamin D 16 ng/mL (30 - 80 ng/mL), Mg 1.2 mg/dL (1.4 - 2.5 mg/dL), phosphorus 4.9 mg/dL (2.3 - 4.5 mg/dL), bicarbonate 26 mmol/L (22 - 32 mmol/L). Patient was started on Ca (IV and PO), Mg, and vitamin D replacement. PTH reassessment on days 6, 14, and 19 showed persistently low/inappropriately normal PTH (22, 14, and 8 pg/mL respectively) despite normalization of magnesium levels. Patient was discharged on Ca, Mg, and vitamin D supplementation with follow-up in Endocrinology clinic for further evaluation of her hypoparathyroidism progression.

Conclusion
SARS-CoV-2 infection causes a hypersensitive immune reaction and widespread inflammation. Emerging evidence suggests that this cytokine-mediated reaction and hypoxia associated with COVID-19 can affect the parathyroid glands, resulting in impaired PTH secretion. Furthermore, direct parathyroid tissue invasion and destruction by means of entry via angiotensin-converting enzyme 2 receptors has also been proposed [2]. Hypocalcemia in our patient could be multifactorial, however we believe that COVID-19 induced HPT was the leading mechanism. We hope that further research explores this hypothesis and elucidates the underlying pathophysiology. References: [1] Martha JW, Pranata R. Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis. Diabetes Metab Syndr. 2021 Jan-Feb;15(1): 337-342. [2] Abobaker A, Alzwi A. The effect of COVID-19 on parathyroid glands. J Infect Public Health. 2021;14(6): 724-725.
Presentation: No date and time listed
ODP103 IPN60130 for the Treatment of Fibrodysplasia Ossificans Progressiva: Methodology of the Randomized, Double-Blind, Placebo-Controlled Phase II FALKON Trial
Authors: Karimian Negar , Powell Christine , Shih Fei 
Published: November 2022

Abstract

Objectives
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder caused by activin receptor-like kinase-2/activin A receptor type 1(ALK2/ACVR1) mutation and characterized by heterotopic ossification (HO) inducing progressive restriction of mobility. IPN60130 is a selective ALK2/ACVR1 inhibitor, currently being investigated for the treatment of FOP. 1 Here, we describe methodology of the FALKON trial (NCT05039515) designed to compare efficacy and safety of IPN60130 with placebo in patients with FOP.

Methods
Patients will be randomized to oral placebo, or low or high dose IPN60130 for 12 months; patients receiving placebo will then transition to IPN60130 for 12 months. Patients will be randomized to receive placebo, or low or high dose IPN60130 orally for 24months. Enrollment criteria include: age of ≥5years, clinical FOP diagnosis with a disease-causing mutation, and either a flare-up, new HO, new joint ankylosis, or increase in Cumulative Analogue Joint Involvement Scale (CAJIS) score in the prior year. Recruitment is ongoing to enroll 90 patients. The primary efficacy outcome will be the annualized change from Baseline (CfB) in HO volume to Month 12, assessed using low-dose whole-body computed tomography (CT). Secondary efficacy outcomes to be compared with placebo at Month 12 include: CfB in volume of new HO lesions, CfB in number of HO lesions, flare-up rate and number of flare-up days, number of body regions with new HO, CfB in pain intensity, and the proportion of patients with any new HO. Additional secondary endpoints include CfB in HO volume in treated patients versus placebo and participants receiving standard of care in a FOP natural history study (NCT02322255) at Month 24. Safety will be assessed via the incidence of adverse events (AEs) and serious AEs over 25 months. Patients aged ≥15 years will be eligible for a sub-study assessing HO using [ 18 F]NaF positron emission tomography-CT.

Summary
Results from the FALKON trial, expected to complete in August 2025, will enable evaluation of the efficacy and safety of IPN60130 in patients with FOP.

References
1. Davis A et al. J Bone Miner Res 2019;34(Suppl 1): 290Funding: Sponsored by Ipsen
Presentation: No date and time listed
ODP112 Post-infusion ECG Changes in Patients Receiving Intravenous Bisphosphonates: a Systematic Review and Meta-Analysis
Authors: Shoung Alex , Rodriguez Alexander J 
Published: November 2022

Abstract
Bisphosphonates are the first-line treatment for several bone and mineral disorders. Randomized trials and cohort studies have reported increased rates of atrial fibrillation in patients receiving bisphosphonates, however, uncertainty remains as to whether other electrical disturbances are precipitated by bisphosphonates. We aimed to review the literature for studies reporting ECG findings in patients receiving intravenous bisphosphonates for any indication. We searched MEDLINE and EMBASE on 06/01/2022 for studies reporting ECG parameters following administration of intravenous bisphosphonates. We excluded studies that only reported atrial fibrillation, case reports and animal or cell-based studies. Study quality was assessed using the Newcastle-Ottawa Scale. Continuous data were meta-analysed if reported in at least two studies. Random-effects models were fitted and reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI). Heterogeneity was determined by the I 2 statistic. All data were computed using R (4.1.1). We found 1,123 records of which six met our inclusion and exclusion criteria, of which five had data for meta-analysis. Studies were of low to moderate quality. Five studies used zoledronic acid while one study used pamidronate. Most studies [n=4] were conducted in postmenopausal women with osteoporosis, one study was conducted in patients with bone metastases and one study was conducted in children with cerebral palsy and osteoporosis. Most studies [n=4] reported outcomes in the sub-acute (&gt;24 hours) phase. Study populations ranged from n=15 to n=116. There was a significant difference in QTc dispersion (SMD= -0.456 milliseconds [95%CI: -0.800 to -0.113]; I 2 = 0%; n= 67 patients; k= 2 studies) but no differences in heart rate, P wave (maximum), P wave (minimum), P wave dispersion, PR interval, QRS duration, QTc (maximum), QTc (minimum), or QTc. The correlation between pre- and post-infusion QTc dispersion was rho= 0.981 (p=0.866). Results were unchanged when analysing studies reporting acute or sub-acute phase ECG changes. Overall, there is insufficient and low quality evidence to support an association between intravenous bisphosphonate administration and acute phase dysrhythmias. These data underscore the importance of performing a pre-infusion ECG to evaluate potentially unreported conduction abnormalities.
Presentation: No date and time listed
ODP133 Rare Case of Primary Hyperparathyroidism Causing Hypercalcemic crisis in Systemic Lupus Erythematosus (SLE)
Authors: Kedarisetti Sreekari , Rajmohan Divya , Simon Nicole 
Published: November 2022

Abstract

Introduction
Hyperparathyroid crisis is a rare endocrine emergency with a high mortality. Primary hyperparathyroidism (PHP) can present as severe hypercalcemia. There are very few cases documented in literature of patients with concomitant SLE and PHP. We present a case of hypercalcemic crisis in a patient with untreated primary hyperparathyroidism with a history of SLE.

Case description
A 46 year old woman was found to have hypercalcemia of 12.9 mg/dl on routine lab work. Her medical history is significant for SLE (diagnosed 9 years prior) and osteoarthritis. She had no physical complaints. Further workup confirmed primary hyperparathyroidism with PTH of 322.8 pg/ml and findings consistent with parathyroid adenoma on Sestamibi scintigraphy. Parathyroidectomy was strongly recommended however the patient refused. She was then offered medical management but did not show up for any follow up appointments. Two years later, she presented to the emergency department with altered mentation, lethargy, poor oral intake and abdominal pain for 2 days. She was found to have severe hypercalcemia with a serum calcium of &gt; 24.8 mg/dl and was in acute renal failure. On admission, EKG changes suggestive of pseudoinfarct pattern from severe hypercalcemia were present. She was managed in the intensive care unit with intravenous hydration, calcitonin, zoledronic acid and hemodialysis. Shortly after initiation of hemodialysis, the patient succumbed to a cardiac arrest.

Conclusion
Hyperparathyroid crisis when untreated has a 100% mortality rate. Early management with surgical intervention is the only confirmed cure for PHP. There are only 18 cases reported in literature of hypercalcemia in SLE. Mechanisms involved are believed to be stimulatory PTH antibodies, PTHrP and osteoclastic activity due to inflammatory cytokines. To our best knowledge this is the 6th case report of a patient with concomitant SLE and PHP. A prospective study by Norman et. al 1 done in 10000 PHP patients demonstrated a Gaussian distribution with the average calcium concentration being 10.9 ± 0.6 mg/dL and the average parathyroid hormone concentration being 105.8 ± 48 pg/ml . Her baseline calcium at diagnosis was 13mg/dl and intact PTH was 322.8 pg/ml which is higher than seen in the normograms as per the study. In our patient, we believe SLE could have exacerbated the hypercalcemia caused by PHP. It is important to perform further studies to identify if any association exists between the two conditions. Physicians must recognize their concomitant occurrence as prompt management of hypercalcemia becomes even more crucial in these cases. References: 1) Norman J, Goodman A, Politz D. Calcium, parathyroid hormone, and vitamin D in patients with primary hyperparathyroidism: normograms developed from 10,000 cases. Endocr Pract. 2011 May-Jun;17(3): 384-94. doi: 10.4158/EP09346. OR. PMID: 21134884.
Presentation: No date and time listed