bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP304 Cyclic Cushing Disease: A Diagnostic Challenge
Authors: Zubiran Rafael , Gómez-Pérez Francisco J , Cuevas-Ramos Daniel 
Published: November 2022

Abstract

Background
Cyclic Cushing syndrome is a clinical challenging diagnosis due to an unpredictable duration of periodic hypercortisolemia shifting with normocortisolemia periods. Only small proportion of such cases are due to a corticotroph pituitary adenoma with cyclic activity. Clinical case: 27-year-old after she stopped nursing her baby, she had no resumption of menses. She then developed mild headache and weight gain of 20kg throughout 3 months. She also developed facial hair, acne, easy bruising and striae. She was evaluated by a local physician where Cushing syndrome (CS) was suspected. Local testing showed the following results: UFC: 1117 and 1572 mcg/24h (&lt;403mcg/24h), low dose DST of 595.8 nmol/l (&lt;50nmol/l) and ACTH 60 pg/mL (10-100pg/mL). An MRI identified a 6 mm pituitary adenoma. The patient was sent to our pituitary clinic under the diagnosis of Cushing disease (CD). Upon examination at our institution, the patient reported asthenia, mood changes, depression and hirsutism. The physical examination revealed classical signs of CS. No other comorbidities were detected. A seven-hour 7mg dex infusion testwas performed (1), with basal cortisol of 187.5 nmol/l, early suppression of 12.6 nmol/l and late suppression of 27.5 nmol/l which is negative for hypercortisolism. As the high suspicion of CS, the patient was followed monthly with UFC and serum cortisol. During this normocortisolemia period the patient lost 10kg of weight, recovered its menses and coloration changes of striae. Laboratory follow up UFC of 67, 71 mcg/24h and serum cortisol of 124, 270, 103.4, 358.6 and 413 nmol/l ACTH 20, 21, 23, 28, 25 pg/mL. After 6 months of no clinical sign of hypercortisolism the patient reached to us as she noticed her striae changed, started gaining weight, lost menses and changed headache frequency. Laboratories revealed UFC was 754.6 mcg/24h and low dose DST was 751.1 nmol/l and ACTH of 70 pg/mL. We conducted another continuous 7mg dex infusion for seven hours with basal cortisol of 669.2 nmol/l, early suppression of 90.2 nmol/l (&gt;50% suppression) and late suppression of 691.5 nmol/l which was compatible with CD. Additional testing was performed, with a 18F-NOTA-Octreotide and a full body CT that did not reveal an ectopic ACTH producing tumor neither an adrenal mass. Patient underwent a transsphenoidal surgery and reached remission of her hypercortisolism.

Conclusion
CD may be difficult to be confirmed but also it is important to consider that some cases showed cyclic activity. As far as we could acknowledged, this is the first case showing a 6-month period of normocortisolemia in a cyclic ACTH-secreting pituitary adenoma.
Bibliography
Biemond P, de Jong FH, Lamberts SW. Continuous dexamethasone infusion for seven hours in patients with the Cushing syndrome. A superior differential diagnostic test. Ann Intern Med. 1990 May 15;112(10): 738–42.
Presentation: No date and time listed
ODP307 Does Size Matter: A Case of a 16cm Pheochromocytoma
Authors: Sotomayor Fiorella , Kroopnick Jeffrey 
Published: November 2022

Abstract

Background
Pheochromocytomas are catecholamine producing tumors that arise from chromaffin cells. The incidence is of 0.6 cases per 100,000 person-year. Although rare, it is an unpredictable and dangerous tumor that can lead to a fatal catecholamine induced cardiovascular accident. Typical symptoms include profuse sweating, palpitations, headaches, paroxysmal hypertension, anxiety, chest pain. Occasionally, the tumor can present as an asymptomatic incidentaloma.

Case
A 55-year-old patient with no significant past medicalor family history presented to the emergency department (ED) with right lower quadrant abdominal pain. CT abdomen/pelvis demonstrated acute appendicitis and an incidental finding of a 15×10×11.8 cm left adrenal mass. The patient denied episodic headaches, palpitations, diaphoresis, chest pain, and anxiety. On exam, patient's vital signs included a blood pressure of 112/77 mmHg and pulse rate of 88 bpm. Further, there was no evidence of hypercortisolism including moon facies, acanthosis, hirsutism, abdominal striae, or proximal muscles weakness. He subsequently underwent biochemical testing which revealed 24-hour urine metanephrines of 1131 ug/d (55-320ug/d), normetanephrine of 6450 ug/g (0-330 ug/g), mildly elevated urine cortisol of 130.6 ug/d (&lt;60 ug/d) and DHEAS of 73 ug/dL (70-130 ug/dL). In preparation for surgery, alpha blockade was initiated. He underwent successful left adrenalectomy with pathology revealing pheochromocytoma of 16 cm, focally invading the extra-adrenal adipose tissue and with a pheochromocytoma of the adrenal gland score (PASS) of 11, suggestive of high-risk disease. Biochemical testing, including a 24-hour urine and serum metanephrines, obtained approximately 6 weeks post-operatively were normal. Genetics evaluation is currently pending.

Conclusions
Although pheochromocytomas are known to manifest as the classic triad of palpitations, sweating and headaches, up to 20% can be asymptomatic. Giant pheochromocytomas, defined as size greater than 10 cm, are commonly asymptomatic, hence biochemical testing should be done regardless of absence of symptoms. References: Kota S et al. Pheochromocytoma: An Uncommon Presentation of an Asymptomatic and Biochemically Silent Adrenal Incidentaloma. Malays J Med Sci. Apr-Jun 2012; 19(2): 86-91. Maharaj R, Parbhu S, Ramcharan W, et al. Giant cystic pheochromocytoma with low risk of malignancy: a case report and literature review. Case Rep Oncol Med 2017; 2017
Presentation: No date and time listed
ODP318 Idiopathic Granulomatous Hypophysitis : A Rare Cause of Hypopituitarism
Authors: Vemparala Pranathi , Zare Ahmad , Choudhry Sara 
Published: November 2022

Abstract

Introduction
Pituitary hypophysitis is an inflammatory disorder classified as primary or secondary. The five histologic subtypes of primary hypophysitis are lymphocytic, granulomatous, xanthomatous, IgG4-related, and necrotizing. Idiopathic granulomatous hypophysitis (IGH) has an incidence of 1 in 10 million and accounts for &lt; 1% of cases involving panhypopituitarism, headache, and visual disturbances. We present the case of IGH in a patient initially suspected to have pituitary adenoma.

Case Presentation
A 54-year-old female with a history of hypertension presented to the emergency department with nausea, vomiting, and acute worsening of a chronic headache of 1-week duration. Her past medical history was significant for a suspected pituitary macroadenoma of 1.7 cm, which was incidentally detected 7 months before the current presentation. She reported a history of 9 lb weight gain in one month, hot flashes, and diplopia, but denied hirsutism, polyuria, polydipsia, and galactorrhea. Prior evaluation revealed normal prolactin, TSH, and visual field testing. Her medication and familial history were unremarkable. Physical exam during the current presentation revealed stable vital signs, left eye exophthalmos, left anisocoria, decreased sensation in the left V1 and V2 trigeminal nerve distribution, and right abducens nerve palsy. Her initial laboratory workup was consistent with panhypopituitarism. Brain Magnetic Resonance Imaging (MRI) revealed an extensive, locally invasive, exuberantly enhancing infiltrative process measuring at least 5.6 cm in maximal transverse diameter involving the pituitary gland with bilateral cavernous sinus and Meckel's caves invasion and extension into bilateral superior orbital fissures. The patient underwent supraorbital craniotomy with subtotal resection of the tumor. Tuberculosis, sarcoidosis, and neoplasm were ruled out by appropriate tests, and the patient was diagnosed to have IGH on histology. Her symptoms improved postoperatively and the patient was discharged on levothyroxine and hydrocortisone.

Conclusion
Clinically and radiologically, IGH is a rare pathology that can closely mimic a pituitary adenoma. Through this case, we highlight the importance of performing a comprehensive evaluation with a full hormonal workup and imaging, with the exclusion of secondary causes while assessing patients with a sellar mass.
Presentation: No date and time listed
ODP320 Immune Organs Enlarged in Acromegaly: Evaluation of Thymus Volume in Patients with Acromegaly
Authors: Nahit Sendur Suleyman , Koylu Nur Yazdali , Basaran Hasbi , Firlatan Busra , Dagdelen Selcuk , Ariyurek Macit , Erbas Tomris 
Published: November 2022

Abstract

Objectives
The thymus is an important immunological organ where T cell maturation takes place, especially in the early stages of life. Animal studies have shown that the structure and functions of the thymus are controlled by hormones. Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) stimulate both thymic epithelial cells and thymocytes. This causes an increase in the number of cells and the secretion of cytokines. These effects of GH and IGF-1 on the thymus have not yet been confirmed in humans. We have hypothesized that, acromegaly with chronic GH and IGF-1 elevation, may change the volume and the functions of the thymus. In this study, we have examined the thymus volume in patients with acromegaly.

Materials and Methods
In this single center study, 393 patients with acromegaly were retrospectively evaluated to identify patients who underwent chest CT for any reason before and/or after pituitary surgery. Since 64 patients in the acromegaly group had chest CT, we also selected 64 patients as an age- and sex-matched control group among trauma patients without any known disease who admitted to the emergency department. All chest CT images were reassessed by a radiologist to detect the thymus gland and calculate its volume (if visible) who was unaware of clinical data. The frequencies and volumes of visible thymus glands were compared between acromegaly and control groups.

Results
Mean (±SD) age was 49.9±13.8 years in acromegaly group and 51.7±14.1 years in control group(p= 0.32). Twenty-seven patients (42.2%) from each group were female. Median (IQR) GH levels were 10. 0 (21.1) ng/mL and mean±SD IGF-1 levels were 729.5±283.5 ng/mL. While 51 patients (79.7%) had a visible thymus gland at chest CT in acromegaly group, only 29 patients (45.3%) had a visible thymus gland in control group (p&lt;0. 001). Median (IQR) values for the volumes of visible thymus glands in acromegaly and control groups were 13. 0 (9.4) cm 3 and 10.3 (7.6) cm 3, respectively (p=0. 014). There was no correlation between thymus gland volume and GH(r=-0. 02; p= 0.91) and IGF-1(r=0.11; p=0.49) levels. In acromegaly group, six patients had a visible thymus gland on both preoperative and postoperative chest CTs. After surgery, hormonal remission was achieved in four patients and thymus gland volume decreased in three of them (Patient 1: 15.26 to 17.23, Patient 2: 22.66 to 15.88, Patient 3: 19. 00 to 11.80 and Patient 4: 17.78 to 12. 07 cm 3). Volume increase was observed in two uncontrolled patients (Patients 5: 12.45 to 15.42, Patient 6: 6. 05 to 19.59 cm 3).

Conclusion
This study has firstly shown that, the thymus is enlarged in patients with acromegaly. Effective control of the disease reduces thymus volume. Further research is needed to elucidate this association and its putative clinical implications.
Presentation: No date and time listed
ODP321 Impact of a Maternal High-Sucrose Diet in Rats on Fetal Physiology and the Placenta
Authors: Seib Desiree R , Kachkovski George V , Rutledge Griffin S , Jung Minseon M , Chen Hui W , Bodnar Tamara S , Price Hayley R , Collier Abby C , Soma Kiran K 
Published: November 2022

Abstract
Consumption of sucrose (table sugar) is high in much of the world. The effects of maternal sucrose intake on the placenta and fetal brain remain unknown. In rats, maternal consumption of sucrose at a human-relevant level alters the mother's physiology and steroids, as well as the adult offspring's brain and behavior. Effects in mothers are impaired glucose tolerance, increased liver lipids, increased adipose inflammation, and decreased corticosterone levels in the blood but not in the brain. In contrast, in adult female offspring, maternal sucrose intake increases corticosterone levels in the blood and the brain. In adult male offspring, maternal sucrose intake increases preference for high-sucrose and high-fat diets as well as motivation for sugar rewards in a progressive ratio task. In this study, we investigate the underlying mechanisms of the observed behavioral and endocrine effects in the adult offspring. We examine anti-inflammatory steroids, steroidogenic enzymes and cytokines in the placenta, amniotic fluid, fetal blood and brain. In our model, we feed rat dams either a high-sucrose diet (26% of kCal) or an isocaloric, matched, control diet (1% sucrose) 10 weeks prior to and during gestation. At embryonic day 19 (E19), we collected maternal serum, placenta, amniotic fluid, fetal blood, and fetal brain. We used Palkovits punch to microdissect the placenta and fetal brain. Next, we used liquid chromatography-tandem mass spectrometry (LC-MS/MS), which is highly sensitive and specific, to measure multiple steroids (e. g. corticosterone, estrone, allopregnanolone). We examined multiple regions of the fetal brain (e. g. prefrontal cortex, nucleus accumbens, hypothalamus, hippocampus). We will also examine neuronal proliferation, microglia and tyrosine hydroxylase immunoreactivity in the fetal brain. Maternal high-sucrose diet increased 11-dehydrocorticosterone (inactive metabolite of corticosterone) and aldosterone in maternal serum and amniotic fluid. Testosterone and androstenedione were significantly higher in the amniotic fluid of male fetuses than female fetuses. Placental steroidogenic enzymes 3β-HSD and CYP19 were not affected by maternal diet or fetal sex; however, 3β-HSD activity was higher in the decidua than in the fetal part of the placenta. Steroid and cytokine data from the placenta, fetal blood and fetal brain are currently being analyzed. Ongoing analyses examine how a maternal high-sucrose diet affects brain development possibly by increasing inflammation.
Presentation: No date and time listed
ODP327 Joint Pain Score is Higher in Acromegaly Patients Despite Pain Relief Therapy and Joint Surgeries.
Authors: Ahmad Syed , Clarke David , Constance Chik , Ladouceur Michel , Stan VanUum , Tramble Lisa , Chen Kevin , Imran Syed , Wang Yuqi , Title Michaela , Steeves Keillor , Ibrahim Aisha 
Published: November 2022

Abstract

Objective
Arthropathy is common in acromegaly (ACRO) and profoundly impacts patients’ quality of life. The aim of this study was to compare joint pain score, usage of pain relief therapy and history of joint surgery between patients with history of ACRO and patients with non-functioning pituitary adenoma (NFA) who had previously undergone surgery.

Methods
Sex- and age-matched participants (n=34 for both groups) were recruited from the Halifax Neuropituitary Program to complete an online survey. All ACRO patients were in remission with or without medical therapy. An anchored visual analog scale (0-100 mm) was employed to assess joint pain, and additional questions assessed usage of pain relief therapy and history of joint surgeries. Demographic and joint pain data were compared using paired t-tests, whereas usage of pain relief therapy and history of joint surgeries were compared using exact McNemar's tests.

Results
Height and weight were not significantly different between the ACRO and NFA groups; (height: 171.2±11.3 cm vs. 171.9±9.6 cm, p=0.796; weight: 88.9±20.6 kg vs. 94.2±27.8 kg, p=0.350), respectively. At the time of original presentation, ACRO patients were significantly younger than NFA patients (44.4±13. 0 yrs vs55.9±10.5 yrs, p &lt;0. 001). Joint pain scores were significantly higher for ACRO than for NFA for shoulder (23.6±30.1 mm vs. 8.3±17.2 mm, p=0. 013), back (38.5±34.5 mm vs. 20. 0±25.9 mm, p=0. 012), hip (27.4±27.7 mm vs. 9.2±17.1 mm, p=0. 004), and knee (25. 0±27. 0 mm vs. 11.9±20.1 mm, p=0. 026), while no significant differences were found for the hand/wrist, elbows, neck, and ankle/foot. Despite these differences in joint pain scores, usage of pain relief therapy was not significantly different between groups (p=0.143), and no significant differences in joint surgery history were found for any joint (hand/wrist, elbow, shoulder, neck, back, hip, knee, ankle/foot: Range p: 0.25-1). Similarly, no significant differences were revealed between groups for number of patients with surgery on 1 joint (p=0.581), 2 joints (p=1), &gt;3joints (p=1) or no history of joint surgery (p=0.815).

Conclusion
Patients with ACRO had higher pain scores for shoulder, hips, knees and back despite no differences in usage of pain relief therapy or history of joint surgeries when compared with NFA. This raises the question if ACRO patients are potentially being undertreated for joint symptoms. Additionally, the pattern of joint involvement is somewhat distinct in ACRO such that larger and proximal joints are more typically involved.
Presentation: No date and time listed
ODP329 Long-term Effect of Daily Growth Hormone Replacement Therapy on Glucose Tolerance in Adult growth Hormone Deficiency
Authors: Bando Hironori , Fukuoka Hidenori , Iguchi Genzo , Kanie Keitaro , Ogawa Wataru , Shichi Hiroki , Suzuki Masaki , Takahashi Michiko , Takahashi Yutaka , Urai Shin , Yamamoto Naoki , Oi Yuka , Yamamoto Masaaki , Sasaki Yuriko 
Published: November 2022

Abstract

Background
Growth hormone replacement therapy (GHRT) in adults with growth hormone deficiency (AGHD) has shown to improve body composition, lipid and bone metabolism, and quality of life (QOL), but its effect on glucose tolerance can be bidirectional.

Objective
To investigate the long-term effect of GHRT on glucose tolerance in AGHD patients.

Patients and Methods
We conducted a retrospective single-center study at Kobe University Hospital. One hundred twenty-five AGHD patients who had visited our department since January 2011 to September 2021 were enrolled. The exclusion criteria was as follows: Patients 1) who never received GHRT 2) whose HbA1c was 6.5% or higher, or under antidiabetic drugs before GHRT, 3) not available data on HbA1c at baseline or after GHRT 4) with functional pituitary adenomas, 5) who had initiated GHRT at childhood and had discontinued GH for less than 1year due to transition, 6) who receiving supraphysiological doses of steroid therapy, 7) GHRT interruption period for more than 1 year or its initiation from less than 2 months. Fifty-three AGHD patients eventually met the inclusion criteria. We collected data at baseline, 3, 6, 12 months after treatment, and at each patients’ last visit. The influence of GHRT on glucose metabolism and its associated factors were analyzed. All data were presented as median [interquartile range].

Results
Fifty-three patients (27 female (51. 0%), 14 childhood onset (26.4%), age at GH initiation was 45 [32 - 60] years, the duration of GHRT was 4 [2 - 6] years) were analyzed. Both IGF-I levels and IGF-I SDS increased at the last visit compared to baseline: 56 [38 - 88] to 119 [84.5 - 181] ng/mL (P&lt;0. 01), and -3.4 [-5.1 - -2.4] to -0.2 [-1.8 - 1.1] (P&lt;0. 01), respectively. Waist circumference and BMI remained unchanged: 85 [78 - 90.5]cm to 78.5 [72.1 - 86. 0]cm (P=0.18), 23.1 [21.3 - 26.3] kg/m 2 to 22.9 [21.9 - 26.8] kg/m 2 (P=0.53), respectively. HbA1c at baseline, 3, 6, 12 months after treatment, and the last visit were unchanged: 5.7[5.4 - 5.9]%, 5.7 [5.5 - 5.9]%, 5.8 [5.5 - 6. 0]%, 5.7 [5.5 - 6. 0]%, and 5.7 [5.5 - 6. 0]% (P=0.27). Based on the amount of change in HbA1c (ΔHbA1c) between baseline and at the last visit, we divided into two groups; Elevated/ Unchanged (E/U), and Reduced (R). Interestingly, the amount of change in BMI increased in E/U group but decreased in R group (0.9[-0.1–1.8] vs. -1.2[-1.4 - -0.1], P=0. 02).

Conclusions
Overall, GHRT was safely used in regard with impaired glucose tolerance at least non-diabetes mellitus patients with AGHD. Among them, cases with impaired glucose tolerance during GHRT were associated with increased BMI.
Presentation: No date and time listed
ODP344 Pituitary lymphoma: A case series in a referral center in Mexico City
Authors: Cuenca Dalia , Tovar-Mendez Victor Hugo , Gómez-Pérez Francisco , Toy Brandon Altar-Trejo , Cuevas-Ramos Daniel 
Published: November 2022

Abstract
Malignant lymphoma of the pituitary gland is extremely rare. The most common form of CNS involvement in lymphoma is leptomeningeal metastases, but it can also affect the spine or the cerebral parenchyma. Pituitary involvement usually presents as diabetes insipidus but can also present as hypopituitarism if there is adenohypophyseal destruction and may also present as bitemporal hemianopsia. (1)We present a case series of four patients with metastatic lymphomas to the pituitary gland that presented with diabetes insipidus to a tertiary center in Mexico City. Our investigation identified 4 patients with a previous diagnosis of lymphoma (3 B cell non-Hodgkin and 1 Hodgkin lymphoma) that were admitted into the endocrinology clinic with evidence of pituitary involvement and metastases to the pituitary gland. The average age of the cases was 54.5 years. 1 of the 4 patients had a diagnosis of HIV infections prior to the diagnosis of the lymphoma. Diabetes insipidus was present in 100% of the patients, while headache (75%) and visual field defects (50%) were the most common findings at presentation. Two of the patients also had involvement of the adenohypophysis and had hypocortisolism and central hypothyroidism that required hormone replacement therapy. All cases were documented by a lesion in the contrast enhancing lesion on MRI. Lymphoma involving the pituitary gland is particularly rare. In our series, involvement of the posterior pituitary was the most common form of presentation in contrast to the reported in other series, but the clinical presentation can be heterogenous, hence, it is important to perform an extensive endocrinological examination when pituitary involvement is suspected.1. Mathiasen RA, Jarrahy R, Cha ST, et al. Pituitary lymphoma: a case report and literature review. Pituitary. 2000;2(4): 283-287. doi: 10.1023/a: 1009969417380
Presentation: No date and time listed