bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP082 Bone mass and body composition analysis in transgender women: a 1 year follow up.
Authors: Oliveira Otavio D , dos Santos Livia Marcela , de Oliveira Otãvio Lima , Orozco Bruno Marcos Mazoca , Haddad João Magliari , de Amori Alessandra Toledo , de Macedo Luciana Pereira 
Published: November 2022

Abstract

Introduction
Sex steroid hormones play a key role in bone health, however medical therapies for gender dysphoria lead to hormonal changes.

Purpose
Understanding the changes in bone mass and body composition is extremely important, because this treatment will be carried out over a long period of time.

Methods
In a prospective study, we included 19 trans women (male-to-female trans persons) before and after 1 year of therapy with estrogen and cyproterone acetate. Bone densitometry model Hologic-Discovery performed at baseline and after 6, 12 months of therapy. All participants signed the TCLE, project approved by CEP-CAAE: 36823220.6. 0000. 0062.

Results
Analysis of 19 transgender women with a mean age of 25 years +/- 10 years. LS-BMD (lumbar spine) at initial time (0m) 1,070±0,155g/cm2 and after 6 months (6m) 0,995±0,092g/cm2 and 12 months (12m) after 1,020±0,096 g/cm2, p=0,04; FN-BMD (Femur Neck) 0m= 1. 047±0.205g/cm2; 6m= 0.917±0.127g/cm2 and 12m= 0.909±0.120 g/cm2; p=0. 01. TH-BMD (Total Hip) 0m= 1.100±0.162 g/cm2; and 6m= 1. 021±0. 099g/cm2; 12m= 1. 015±0.119g/cm2; p=0. 02. About body composition: the percentage of body fat: 0m= 30.2±8. 0%, 6m= 31.3±7.9%; 12m= 33.2±10.2%; p=0.10; android/gynecoid ratio: 1. 00±0.26, 6m= 0.95±0.22; 12m= 1. 00±0.39; p=0,76, VAT mass (cm3) 411.8±252.1, 6m= 357.6±145.3, 12m= 395.5±167.7 p= 0,67 and Lean/Height2 (kg/m2) 0m= 17. 03±2.98, 6m= 15.94±1.8, 12m= 16.74±2.10; p=0.46 and Appen. Lean/Height2 (kg/m2) 7.89±1.67, 6m= 7.42±1.10 and 12m= 7.52±1. 01; p=0.90 Conclusion: In 1 year of hormone therapy with estrogen and cyproterone acetate, we found decrease in bone mass in the analyzed sites and no change in body fat and lean mass.
Presentation: No date and time listed
ODP091 Giant Parathyroid Adenoma Presenting with Pseudoclubbing - A Case Report
Authors: Deb Prasun , Devarasetty Madhu , Vulpala Alekya , Nalla Smitha 
Published: November 2022

Abstract
Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing &gt;3.5 grams. Although it presents with primary hyperparathyroidism,the clinical and laboratory findings are more profound. Bone changes are common in long standing hyperparathyroidism but presentation with clubbing is rare. Here,we report a case of 60 year male with history of finger deformities and swelling in neck,who on evaluation had hypercalcemia with high PTH levels. He underwent parathyroidectomy for the gaint parathyroid adenoma but had eventful postoperative period with prolonged hypocalcemia. This emphasizes the importance of timely management of hyperparathyroidism to prevent untoward consequences.
Presentation: No date and time listed
ODP098 Hyperparathyroidism Caused by Two Large Water Clear Cell Adenomas
Authors: Ali Rafal , Miller Eli , Al-Sudani Hussein , Kuo Lindsay 
Published: November 2022

Abstract

Background
In ambulatory settings, primary hyperparathyroidism is the most prevalent cause of hypercalcemia. Approximately 85% of primary hyperparathyroidism cases are caused by a solitary parathyroid adenoma; other causes include diffuse parathyroid hyperplasia, multiple parathyroid adenomas, and parathyroid cancer. Chief cell adenomas are the most prevalent; adenomas can also consist of oxyphil cell adenomas, lipoadenomas, or mixed cell adenomas. Water clear cell adenoma (WCCA) is a rare tumor formed of large clear cells with foamy pink cytoplasm. Fewer than 30 cases have been recorded in the literature.

Case
A 52-year-old male with polyuria and polydipsia, diagnosed with hypercalcemia was referred to an endocrinologist. His calcium was 10.9 mg/dl, corresponding parathyroid hormone (PTH) 74 pg/ml, 24-hour urine calcium 818 mg/24hr, vitamin D 25–hydroxy 24.2 ng/ml. He was referred to an endocrine surgeon. A 4-dimensional CT scan revealed soft tissue masses posterior to the thyroid and in the tracheoesophageal groove, consistent with potential parathyroid masses. In the operating room, baseline intraoperative PTH (ioPTH) was 371 pg/ml. A large left superior gland was removed from its normal position, and the ioPTH dropped to 104 pg/ml at 10 minutes post-resection, followed by a rise to 525 pg/ml. A large descended (ectopic) right superior gland was then identified and resected, and the ioPTH decreased to 72, 44, and 57 pg/ml at 10, 15 and 20 minutes post-resection. The remaining parathyroid glands were not identified due to adipose tissue in the neck and likely gland suppression in the setting of high PTH. The pathology report of the two excised glands (left superior 3.2×1.7×0.5cm and 3.703g, right superior 3.4×1.3×0.4cm and 1.86g) demonstrated water clear cell tissue. Post-operatively, patient's polyuria and polydipsia resolved. Labs collected 3 months after surgery demonstrated normalization of the calcium and PTH. The patient was advised to continue follow up every six months.

Conclusion
Water clear cell parathyroid adenomas are extremely rare. Water clear-cell lesions are considered indolent because excised adenomas are markedly larger than conventional adenomas and grow to a considerable size before becoming biochemically active and diagnosed. Clinical presentation of water clear cell parathyroid lesion is like other causes of primary hyperparathyroidism. The only way to diagnose is via histopathological examination. In rare cases, clear cell renal carcinoma can metastasize to the parathyroid gland causing a similar presentation. Additionally, the rate of hypercalcemia recurrence is higher in WCCA as compared to chief cell adenoma. Therefore, closer follow up of these patients is recommended. Reporting additional cases will aid in our understanding of this uncommon entity, elucidating possible causes/associations, natural history, typical appearances, and post-treatment prognosis.
Presentation: No date and time listed
ODP099 Hyperparathyroidism Causing life Threatening Hypercalcaemia in Pregnancy
Authors: Lee Jessica , Casey Edel , Otigbah Miss Chineze , Tompsett Miss Kathryn , Pittathankal Mr Antony , Sirkova Dr Aneliya , Stojanovic Dr Nemanja 
Published: November 2022

Abstract
31 year old woman (G2P0) 14 weeks pregnant was admitted for investigation of acute renal failure. Her creatinine was 171umol/L (normal: 45-84umol/L). Prior to her admission, patient was under investigation for a small for gestational age (SGA) baby, and had amniocentesis for suspected triplody. However, the result was normal. On admission, the patient gave a history of severe nausea and vomiting that started at 6 weeks gestation. There was also a history of constipation, lethargy and weakness. Admission blood tests showed a severe primary hyperparathyroidisim with corrected calcium level of 4.1mmol/L (normal: 2.2-2.6mmol/L), PTH=36.9 (1.6-6.9pmol/L), and thyrotoxicosis (TSH&lt;0. 01, FT4=32.2 (12-22pmol/L). Her 24hour Urinary calcium was raised at 19.1mmol (normal: 2.5-7.5mmol/24hours) and 25 OH Vitamin D3 was 64nmol/L (Vitamin D &gt;50 considered replete). On examination, there was a palpable nodule in the region of the left thyroid lobe. The patient was treated with 6 hourly IV fluids and carbimazole 20mg OD. Ultrasound of the neck showed a heterogenous vascularised lesion along the inferior aspect of the left thyroid lobe, 21×22×26mm in size. The lesion was thought to be a large atypical parathyroid adenoma (APA), although a parathyroid carcinoma could not be ruled out on ultrasound. Meanwhile, the patient remained hypercalcaemic with corrected calcium of 3.2mmol/L, despite aggressive IV fluids and cinacalcet 60mg BD. Her renal function improved, creatinine=110umol/L. The patient was also noted to be hypertensive, with BP ranging between 150/80 to 160/110mmHg. She was still having GI symptoms, namely retching and vomiting. In light of biochemical and clinical findings, parathyroidectomy was done in the second trimester of pregnancy. The surgery was uneventful. Cinacalcet was stopped and Ad Calcium was normal within 48hours of surgery. Ad cal=2.58, PTH low at 0.7. Patient was discharged after parathyroidectomy. The histology report was in keeping with atypical parathyroid adenoma (APA). Ultimately, our patient had a spontaneous vertex delivery of a male infant at 35+2. The baby was SGA and spent time in SCBU with fits and hypocalcaemia (Ad Cal=1.8). Baby was seen by neonatologist post discharge, and has normal development at the time of writing.
Presentation: No date and time listed
ODP102 Indicators for the effects of calcimimetics on hypercalcemia in the elderly patients with primary hyperparathyroidism.
Authors: Yamamoto Koichro , Nakano Yasuhiro , Tokumasu Kazuki , Honda Hiroyuki , Hasegawa Kou , Obika Mikako , Hanayama Yoshihisa , Otsuka Fumio 
Published: November 2022

Abstract
Primary hyperparathyroidism (PHPT) is the most common disorder causing hypercalcemia, in which parathyroid hormone (PTH) is excessively secreted from a parathyroid tumor. PHPT occurs mainly in elderly women, and patient with PHPT present symptoms including nephrolithiasis, bone fracture, and cognitive impairment or can be asymptomatic. Excessive secretion of PTH leads to elevated serum levels of alkaline phosphatase as well as calcium and decreased serum inorganic phosphate level. Parathyroid surgery is the only established treatment, and the treatment reduces elevated serum levels of calcium and PTH, increases bone mineral density, reduces the occurrence of bone fractures, and decreases the risk of renal stones. However, some PHPT patients, especially elderly patients, refuse to undergo surgical therapy for various reasons including perceived risk. Calcimimetic treatment, including cinacalcet and evocalcet administration, has also been reported to be effective for reducing serum calcium level in patients with PHPT. However, the relationship between the efficacy of calcimimetic treatment for PHPT and patient characteristics related to the effectiveness of calcimimetics remains to be elucidated. To investigate the relevance of clinical parameters to the effectiveness of calcimimetics for PHPT, we retrospectively analyzed patients with PHPT who received calcimimetic treatment in our department. We included nine patients including 8 females (88.9%) and one male (11.1%) in the study. The median age of the patients was 81 years (interquartile range (IQR): 61-86 years). Laboratory tests before calcimimetic treatment revealed that median level of serum corrected calcium (cCa) was high (11.1 (IQR: 10.5-12.7) mg/dL), serum inorganic phosphate was low (2.3 (2.3-2.4) mg/dL), and plasma intact PTH was high (251. 0 (198.3-498.5) pg/mL). The fractional excretion of calcium was higher than 1% (1.3% (1.12-1.48%)), %tubular reabsorption of phosphate was low (79.9% (77.1-83.9%)), nephrogenous cyclic adenosine monophosphate (cAMP) was high (3.4 (2.4-4. 0) nmoL/dL GF), and urinary cAMP was normal (4.3 (4. 0-5.3) μmoL/day). Median reduction rate of serum cCa level due to calcimimetic treatment was 5.8% (0-13.4%) at the first follow-up (median treatment duration: 22 (20-29) days). Notably, reduction rate of serum cCa level had significant correlations with age (R=0.95), dual energy X-ray absorptiometry % young adult mean (DEXA %YAM) in the femoral neck (R=-0.92), and urinary cAMP level (R=-0.85). Thus, the present study suggested that elevated serum cCa levels may be reduced by treatment with calcimimetics more effectively in PHPT patients of relatively advanced age, patients with low DEXA %YAM, and patients with low urinary cAMP.
Presentation: No date and time listed
PSAT157 Efficacy of Bisphosphanate Treatment in Pediatric Patients with Osteoporosis Due to Immobilization
Authors: Lee Myeongseob 
Published: November 2022

Abstract

Introduction
Osteoporosis is medical condition commonly associated with immobilization in children, which can lead to a vicious cycle of disability, worsening osteoporosis, and recurrent fractures. Currently, bisphosphonates are widely used as a standard therapy in children with osteoporosis, but there are limited data on efficacy according to its dosage and duration. We aimed to evaluate efficacy of bisphosphonate treatment according to the dosage and duration in pediatric patients with osteoporosis due to immobilization.METHOD: We reviewed medical records of pediatric patients who were diagnosed with osteoporosis due to immobilization rated as Gross Motor Function Classification System (GMFCS) grade V, and who received bisphosphonate therapy with regular check-up for at least 1 year. The dosage and duration of the treatment, biochemical laboratory measurements, data of bone densitometry, and the occurrence of side effects were collected.

Results
Subjects were 21 children. The average duration of bisphosphonate treatment was 2.0 ± 0.9 years, and mean cumulative dose per body weight of bisphosphonate was 7.7 ± 2.5 (mg/kg/year). After the treatment, mean lumbar spine bone mineral contents (BMC) significantly increased from 14.20 ± 8.58 (g) to 19.38 ± 9.89 (g) (p&lt;0.05), lumbar spine bone mineral density (BMD) significantly increased from 0.40 ± 0.14 (g/cm2) to 0.49 ± 0.14 (g/cm2) (p&lt;0.05), and height-adjusted lumbar spine BMD Z-score also showed improvement from -2.66 ± 1.66 to -1.66 ± 1.38 with statistical significance (p&lt;0.05). The cumulative dose and the duration of treatment were not related to its efficacy, but increasing average dose per body weight in each cycle (mg/kg/cycle) showed significant effects on increasing change in height-adjusted lumbar spine BMD z-score (β = 1.065, p &lt;0.05).

Discussion
BMC, BMD, and height-adjusted BMD z-score significantly increased after bisphosphonate treatment in pediatric patient with osteoporosis due to immobilization. Independent of cumulative dosage and duration, the efficacy of bisphosphonate treatment increased significantly as average dose per body weight in each cycle increased. Further studies with sufficient number of subjects and long term follow-up observation are needed.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT185 Pseudohypoparathyroidism Type 1B: A Medication Compliance Challenge
Authors: Barreiro Sacco Susana , Echegoyen Francisco Barrera , Lagari-Libhaber Violet 
Published: November 2022

Abstract

Introduction
Pseudohypoparathyroidism (PHP) encompasses five metabolic disorders characterized by target organ PTH resistance. The focus of this paper is PHP Type 1B (PHP1B), a disease that typically presents in children with symptomatic hypocalcemia. Only 15-20% of cases are genetic, making our case of Familial PHP1B even rarer.

Case Presentation
A 23-year-old African-American female with hypothyroidism and PHP1B diagnosed in 2005 presented to the emergency department with symptomatic hypocalcemia. As a child, she was evaluated for progressive femur, tibia, radius, and ulna bowing in the setting of short stature without phenotypic features of Albright's Hereditary Osteodystrophy. Her biochemical profile was consistent with pseudohypoparathyroidism and imaging showed costochondral junction enlargement. Genetic testing revealed STX mutation confirming PHP1B diagnosis. Extensive studies of her family revealed several affected members, including one of her two children.Patient has history of multiple hospitalizations for symptomatic hypocalcemia. During this admission, her laboratories demonstrated: calcium 4.4 mg/dL (8.6-10.3 mg/dL), phosphorus 7.3 mg/dL (2.5-4.5 mg/dL), PTH 574 pg/mL (16-65 pg/mL), 1,25-dihyroxyvitamin D &lt; 8 ng/mL (18-78 ng/mL), and 25-hydroxyvitamin D 7.6 ng/mL (30-100 ng/mL).She has an extensive history of non-compliance with medications and endocrinology appointments. During the last visit, she complained of ostealgia, particularly in long bones. While discussing the importance of maintaining adequate calcium levels, the patient expressed feeling overwhelmed by her regimen (calcitriol 1 mcg QAM and 0.5 mcg QHS, calcium carbonate 1,200 mg TID). After a lengthy conversation regarding the need for long-term medical therapy, she became increasingly distraught.

Conclusion
When normocalcemia is achieved with high doses of calcium and calcitriol, patients with PHP1B have an average life expectancy. Given that patients are typically diagnosed in childhood, taking several medications multiple times a day can be challenging and lead to poor compliance. When this occurs, PHP1B becomes a life-altering disease with a significant decrease in quality of life.In 2018 Wierenga et al. reported that being emotionally overwhelmed by chronic disease prevents a patient from appropriately caring for themselves. Their research shows that older males with higher levels of education have better emotional regulation than young females with low educational levels. Providing patients at high risk of psychological stress with a multidisciplinary team including cognitive-behavioral therapists can improve their quality of life and compliance while decreasing the healthcare costs associated with poorly controlled chronic diseases.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT197 Treatment of Paget's Disease of the Skull With Denosumab: A Case Report
Authors: Torfah Maisoon , Shams Elham , Correia Marcelo 
Published: November 2022

Abstract

Background
Paget's disease of bone (PDB) is a common skeletal disorder characterized by increased osteoclastic activity and bone resorption followed by increased osteoblastic bone formation leading to an abnormality in modeling and remodeling of bone. Bisphosphonates are the most common treatments for PDB, with zoledronic acid being the most effective medication, but treatment would be difficult if bisphosphonates are contraindicated.
Clinical case: We report a case of PDB of the skull in a 75-year-old woman presenting with a persistent headache that was successfully treated with denosumab. The patient had been complaining of severe headaches since December 2020. Her skull x-ray and laboratory results [calcium 8.2 mg/dL (range: 8.5-10.5 mg/dL), albumin 4 g/dL (range: 3.4- 4.8 g/dL), alkaline phosphatase 132 U/L (range: 35-104 U/L)] were consistent with PDB. Brain MRI and bone scintigraphy also showed skull changes consistent with PDB. Importantly, a DXA scan from July 2020 showed osteopenia, and her primary care provider treated it with denosumab in the first week of December 2020. At the time of PDB diagnosis in January 2021, zoledronic acid could not be administered because of mild hypocalcemia that was corrected with calcium carbonate. However, the headaches resolved, alkaline phosphatase normalized, and zoledronic acid was put on hold. Up until January 2022, she remains asymptomatic and alkaline phosphatase remains normal.

Conclusion
This case illustrates the successful management of PDB of the skull with denosumab, a human monoclonal antibody against RANKL. To the best of our knowledge, there have not been reported cases of full recovery of PBD with denosumab. Although PBD pathophysiology remains poorly understood, this case suggests that increased RANKL activity might mediate PBD directly or indirectly. Thereby, denosumab might be an effective treatment for some cases of PDB.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT205 A Case of Persistent Primary Hyperparathyroidism Secondary to an Occult Supernumerary Parathyroid Adenoma
Authors: Cruz Maria Nikki , Ong-Ramos Celeste 
Published: November 2022

Abstract

Background
Persistent primary hyperparathyroidism accounts for the vast majority of patients who require reexploration. With the advancements in preoperative localization, surgical outcomes have improved over time. However, in patients with failed reoperative parathyroid exploration, an occult supernumerary parathyroid adenoma should be considered.

Clinical Case
A 60 year-old female diagnosed with primary hyperparathyroidism presented with recurrent nephrolithiasis, osteoporosis and declining eGFR. Initial laboratory evaluation showed elevated serum calcium (1.54 mmol/L, normal 1.09-1.30) and intact PTH (146 pg/mL, normal 18.50-88.0). 99mTc-sestamibi scintigraphy showed a sestamibi-avid focus in the inferior aspect of the right lobe hence, she underwent radionuclide-guided focused right parathyroidectomy. Post-operatively, her intact PTH level was still elevated (171.2 pg/mL). Histopathologic examination showed a normocellular parathyroid gland and a multifocal papillary thyroid carcinoma. The failed 1st surgery was attributed to the false positive scintigraphy from the papillary thyroid carcinoma. She then underwent total thyroidectomy with central neck dissection and 3½ parathyroidectomy with intraoperative parathyroid hormone assay. However, serial PTH monitoring after exploration and parathyroidectomy failed to decrease the PTH level by 50%. Histopathologic examination showed normocellular parathyroid glands. The bilateral carotid sheath, retropharyngeal region and superior mediastinum were explored but no ectopic parathyroid tissues were seen. Post-operatively, calcium and PTH were still elevated (1.48 mmol/L and 200.5 pg/mL, respectively). FDG PET CT imaging failed to show any ectopic parathyroid gland or adenoma. No further surgical intervention was done and she was medically managed with Cinacalcet 30 mg twice daily. 15 months after her parathyroid gland exploration, calcium and PTH were still elevated (1.46 mmol/L and 156.80 pg/mL, respectively). F18 Choline PET CT imaging was done showing a small hypoenhancing persistently FCH-positive focus in the left thyroid bed and sliver of enhancing tissue relating to a parathyroid adenoma.

Conclusion
This case highlights the diagnostic and therapeutic challenges in a patient with persistent primary hyperparathyroidism after a failed 2nd surgery. Occult parathyroid adenomas can cause significant symptoms regardless of its size and its imperceptible nature on imaging. The role of medical management is emphasized in this case when surgical management was not possible. Furthermore, re-evaluation for growth of the possible occult parathyroid adenoma should be done, which in this case took 15 months until its detection.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.