bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSAT122 The Changing Face of Drug-Induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System
Authors: Dalmazi Guido D , Raschi Emanuel , Fusaroli Michele , Massari Francesco , Mollica Veronica , Repaci Andrea , Ardizzoni Andrea , Poluzzi Elisabetta , Pagotto Uberto 
Published: November 2022

Abstract

Importance: Adrenal insufficiency is a life-threatening condition complicating heterogenous disorders across various disciplines, with challenging diagnosis and a notable drug-induced component.

Objective
To describe the spectrum and main features of drug-induced adrenal insufficiency through adverse drug event reports received by the Food and Drug Administration (FDA).
Design: We conducted a retrospective disproportionality analysis within one of the largest publicly accessible spontaneous reporting system.

Setting
The FDA Adverse Event Reporting System (FAERS) collecting more than 15 million reports.
Participants: Adverse event reports extracted from FAERS over the past 2 decades (2000-2020), with a focus on the 2015-2020 period.
Main Outcomes and Measures: Descriptive statistics were used to assess the reporting trend of drug-induced adrenal insufficiency. Cases were selected if they contained any of the preferred terms in the Medical Dictionary for Regulatory Activities describing adrenal hypofunctions. We computed the reporting odds ratio (ROR) with relevant 95% confidence interval (CI) using Bonferroni correction to identify signals of disproportionate reporting for drugs recorded in at least 10 cases as primary suspect.

Results
We identified 8,496 cases (5,282 in the 2015-2020 period), 97.5% being serious and 41.1% requiring hospitalization. We identified 56 drugs (out of 164) associated with significant disproportionality within various pharmacological classes: glucocorticoids (N=1971, constant over time), monoclonal antibodies (1,330 out of 1,644 cases with immune checkpoint inhibitors, reaching 76% in 2020), hormone therapy (N=291), anti-infectives (N=252), drugs used for hypercortisolism or adrenocortical cancer diagnosis and/or treatment (N=169), protein kinase inhibitors (N=138).

Conclusions and Relevance
This comprehensive insight into the evolution of drug-induced adrenal insufficiency highlighted the heterogeneous spectrum of culprit drugs classes, including the consolidated role of topical and systemic corticosteroids and the emerging increased reporting of immune checkpoint inhibitors. Targeted screening and educational programs are needed to urgently identify predictive factors.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT123 Pheochromocytoma Resection and Coronary Artery Bypass Surgery: Chicken or the Egg??? - A Case Report
Authors: Abdelmasih Randa , Abdelmaseih Ramy , Tuna Kubra , Saeed Zainab , Patel Jiger 
Published: November 2022

Abstract

Introduction
Pheochromocytoma (PCC) is a rare catecholamine-secreting neuroendocrine tumor with an incidence of 8 per million person-years. Advanced Coronary artery disease (CAD) and PCC may coexist secondary to chronic sympathetic activation, resulting in irreversible vascular wall growth and accelerated vascular atherosclerosis. The hemodynamic management of this association often represents a challenging dilemma due to the dramatic consequences of the hypertensive crisis caused by excessive catecholamine release. here we present a case of concomitant triple vessel disease and PCC to shed a light on our sequence of management to help guide providers as currently due to the rarity of the disease and the association, the available data regarding the sequence of management is controversial and is decided on a case by case basis.

Case presentation
a 55-year-old male with a history of uncontrolled hypertension, Chronic headaches, and kidney disease presented due to abrupt onset of crushing chest pain and was admitted for further evaluation of hypertensive emergency and NSTEMI with a blood pressure of 260/170 and Troponin of 3.8 ng/L. Coronary Angiography showed significant triple-vessel disease. Due to persistent hypertension and high suspicion of PCC, Serum metanephrine and normetanephrine, and fractioned catecholamines were ordered and showed significant elevation. CT of the abdomen and pelvis showed a 1.5 cm heterogeneous left adrenal mass. Nuclear medicine scan showed increased uptake of radiotracer in the left adrenal gland suggestive of PCC.

Discussion
PCC presents a high risk of morbidity and mortality, especially during surgical procedures if left untreated. The management of concomitant advanced CAD and PCC poses a unique challenge in terms of appropriate sequence and time interval between the two procedures. After a multidisciplinary team discussion including cardiology, cardiothoracic surgery, and endocrinology we decided to perform CABG first with preoperative preparation including Alpha-adrenoreceptor blockage for 1 week prior to surgery, followed by PCC resection at a later stage. The patient underwent coronary revascularization with grafting of three vessels. The perioperative course was uneventful. After three weeks the patient underwent successful PCC resection, with successful gradual down titration of alpha locate therapy.

Conclusion
A two-stage approach of CABG was PCC the section at a later stage under optimal preoperative preparation appears to be a safe and feasible modality in patients with advanced CAD and PCC.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN17 Magnetic iron oxide nanoparticles for the delivery of thermal therapy for the treatment of primary aldosteronism
Authors: Sorushanova Anna 
Published: November 2022

Abstract
To minimize damage to surrounding tissues, targeted delivery of therapeutics to the tumor is highly desirable, and the development of nanotechnology has shown promising results. Magnetic iron oxide nanoparticles (MIONPs) have been gaining traction over the years for applications such as drug delivery, molecular imaging and delivering hyperthermia for treatment of various cancers (1). MIONPs have great therapeutic potential as they can be produced in various sizes and shapes, with the ability to modify the surface by coating the nanoparticles. MIONPs have the ability to be activated by external magnetic field to generate heat and to cause hyperthermia (2).
Translationally, the delivery of thermal therapy offers an option for minimally invasive definitive treatment of primary aldosteronism, an endocrinopathy of aldosterone excess/dysregulation which represents the commonest secondary form of hypertension. In this study, MIONPs have been used at different concentrations to evaluate nanoparticle uptake and rate of uptake by adrenal cortical and endothelial cells, as well as gain understanding of the location of nanoparticles within the cell.
Magnetic iron oxide nanoparticles (MIONPs) were provided by Kansas University. Adrenal Cortical cell-lines (MUC1, H295R and HAC15) and Endothelial cell-line (HUVEC) were used in this study. MIONPs were added at concentrations of 0.5, 5, 10, 20 and 50 µg/ml to the cells and incubated overnight. MIONP uptake efficiency, rate of uptake and cytotoxicity was assessed by Flow Cytometry. Confocal Microscopy was used to image the cells following MIONP incubation. Cellular proliferation was assessed by Xcelligence system and alamarBlue. Cellular respiration was assessed by "Seahorse" technology. MIONP location within the cells was assessed by transmission electron microscopy (TEM).
Following overnight incubation with MIONPs, Flow Cytometry showed significant uptake by MUC1, HAC15 and HUVEC cells at 10 µg/ml MIONP concentration. Confocal Microscopy and Transmission Electron Microscopy (TEM) images revealed MIONPs in the cytoplasm and in the vesicles for all cell types. Live Confocal imaging showed MIONP phagocytosis specific uptake by the HAC15 cells.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN19 One-step serum screening for discriminating subtypes of congenital adrenal hyperplasia in metabolic signatures of adrenal steroids
Authors: Choi Man-Ho , Shim Jaeyoon , Ho Ahn Chang , Lee Chaelin , Noh Jongsung , Lee Sang Won , Kim Jung Hee 
Published: November 2022

Abstract
Various metabolic signatures may be associated with individual subtypes of congenital adrenal hyperplasia (CAH). However, the ability of commonly used antibody-based immunoassays is limited to discriminate the different subtypes. To address this, liquid chromatography-mass spectrometry (LC-MS) based quantitative profiling of 34 serum adrenal steroids was developed. The validated LC-MS assay has been then applied to serum samples obtained from 67 CAH patients and 38 healthy subjects to characterize their different subtypes. The significantly increased serum levels of 17α-hydroxyprogesterone (17α-OH-Prog; AUC = 0.997, P &lt; 1×10-16) and 21-deoxycortisol (21-deoxyF; AUC = 0.993, P &lt; 1×10-15) and the increased their metabolic ratios to cortisol (AUC = 1.0, P &lt; 1×10-16 for both) were observed in 21-hydroxylase deficiency (21-OHD; N=63), while the 11-deoxyF/17α-OH-Prog could also be practical marker (AUC = 1.0, P &lt; 1×10-16). Higher levels of mineralocorticoids, including corticosterone (B), 18-hydroxyB, and pregnenolone sulfate (Preg-S) and lower levels of dehydroepiandrosterone sulfate (DHEA-S) indicated 17α-hydroxylase deficiency (17α-OHD; N=3), which was associated with significantly decreased metabolic ratios of 17α-OH-Prog/Prog and DHEA-S/Preg-S. The patient with 11β-hydroxylase deficiency (11β-OHD; N=1) showed remarkably increased levels of 11-deoxyF and tetrahydro-11-deoxyF, while the metabolic ratios of 11β-hydroxytestosterone/testosterone and 11β-hydroxyandrostenedione/androstenedione were characterized. Although both 17α-OHD and 11β-OHD groups included a small number of patients, the present LC-MS screening panel with proposed individual steroids and their metabolic ratios could be valuable for assessing different CAH subtypes in clinical practice through a single run.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN43 Anti-phospholipid syndrome presenting with bilateral adrenal hemorrhage in a young female
Authors: Abdelrahim Baha , Alam Mustafa , Singavi Arun , Horani Mohamad 
Published: November 2022

Abstract

Patient is a 29-year-old female with PCOS and morbid obesity and recent admission for abdominal pain is found to have bilateral adrenal hemorrhage and prolonged PTT. Patient was found to be anemic with hemoglobin of 6.1 a week prior to presentation, attributed to dysfunctional uterine bleeding and was treated with subsequent transfusion. She presents a week after her initial presentation with recurrent constant sharp pulsating abdominal pain, and reported pain was worse in mid-epigastric area radiating into her back, with a temperature of 38.2 and heart rate of 135, troponin level 2.64, with a negative CT for PE, but incidental bilateral adrenal hemorrhage absent on CTA from last week, with a CBC showing WBC 21.7 RBC 3.5 Hgb 8.6 MCV 76.9 MCH 24.7 RDW 17.6, with normal folate and B12. Patient was monitored closely and was started on IV hydrocortisone 50 mg every six hours, her PTT was found to be 88 and PT of 17.5, so antiphospholipid syndrome was suspected and confirmed with positive lupus anti-coagulant (LAC) and anticardiolipin IgG ab, and B2 glycoprotein. Patient had no evidence of adrenal infract that could have converted to hemorrhage.

Objectives
Antiphospholipid syndrome (APS) is an autoimmune systemic disorder characterized by persistent antiphospholipid antibodies including lupus anticoagulant, anticardiolipin or anti B2- glycoprotein I antibodies, presenting with arterial venous or small vessel thrombosis or recurrent early pregnancy loss. Other manifestation including livedo reticularis, cutaneous ulceration, thrombocytopenia, and hemolytic anemia, valvular heart disease and nephropathy. In our case, the patient APS was confirmed by the presence of the markers, but no evidence of adrenal infracts what could have converted to hemorrhage was found.

Conclusions
Although APS leads to a hypercoagulable state which can lead to adrenal vein thrombosis, leading to adrenal hemorrhage which can be fatal. Screening for antiphospholipid antibodies should be considered in all patients with unknown etiology of adrenal hemorrhage to promote diagnosis and timely management.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
RF09 | PSAT94 Challenging the Status Quo: Are Routine Post-Operative Day 1 Non-Endocrine Labs Necessary After Adrenalectomy?
Authors: Shariq Omair , McKenna Nicholas , Glasgow Amy , Foster Trenton , Dy Benzon , Lyden Melanie , Habermann Elizabeth , McKenzie Travis 
Published: November 2022

Abstract

Background
The Choosing Wisely campaign from the American Board of Internal Medicine (ABIM) Foundation has scrutinized the practice of routinely ordering tests that offer limited or no benefit to patients, and have the potential to cause harm. Although postoperative day 1 (POD1) hormonal testing is necessary for certain patients who undergo adrenalectomy (i.e. those with functional tumors), the clinical utility of routinely checking POD1 non-endocrine labs is unclear, particularly in patients with non-functional adenomas. We sought to investigate how often these non-endocrine labs were abnormal after adrenalectomy and whether they represent value-added care.

Methods
Patients who underwent open or laparoscopic adrenalectomy at our institution from 2011-2020 were identified, and those with non-endocrine serum labs (hemoglobin, potassium, creatinine, or glucose) obtained before 0800 on POD1 were analysed. The frequency of abnormal labs, and any associated intervention(s), was recorded. Exclusion criteria varied by lab type and included: preoperative hemoglobin &lt;8 g/dL or intraoperative blood transfusion (hemoglobin analysis), presence of chronic kidney disease (potassium and creatinine analyses), diagnosis of primary aldosteronism (potassium analysis), and pheochromocytoma or diabetes mellitus (glucose analysis). Costs were calculated using the 2020 Medicare Clinical Laboratory Fee Schedule.

Results
Of 936 patients (56% female) who underwent adrenalectomy (92% laparoscopic), 91% (n=847) had ≥1 POD1 non-endocrine lab drawn. Only 0.4% (n=3) of 785 eligible patients had an abnormal POD1 hemoglobin (&lt;8 g/dL), and 1 patient received a blood transfusion. Potassium abnormalities were present in 3.4% (n=21) of 624 eligible patients, including 9 with hypokalemia (&lt;3.5 mmol/L) and 12 with mild hyperkalemia (5.5-5.9 mmol/L). Specific interventions for hypo/hyperkalemia were required in 5 patients (0.8% of all potassium values). AKI (creatinine increase of 0.3 g/dL or ≥1.5x baseline) was diagnosed in 4% of 759 eligible patients (n=28) and all were stage 1. Hyperglycemia (&gt;180 mg/dL) was identified in 1% (n=6) of 577 eligible patients, and 1 patient received short-acting insulin. Of a total of 2,745 lab values, while only 2% were abnormal, the total aggregate cost of routine POD1 labs was ∼$17,000 during the study period.

Conclusions
Routine POD1 hemoglobin and creatinine testing are rarely abnormal after adrenalectomy and infrequently impact clinical management. Although patients with functional disease may require monitoring of electrolytes and/or glucose on POD1, in the current era of value-based healthcare, routine ordering of these labs may be unnecessary in selected patients with non-functioning tumors.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:18 p.m. - 1:23 p.m.
LBODP020 Treatment Of Hypercalcemia Due To Prolonged, Excessive Vitamin D Intake
Authors: Abdelrahman Houda , Martinez-Palmer Meaghan , Muammar Ahmad , Merolli Alisa 
Published: November 2022

Abstract

Case
A 66-year-old man with history of anxiety, depression, and complex regional pain syndrome presented to a psychiatric hospital with suicidal ideation. Admission laboratory studies demonstrated hypercalcemia (Ca 14.2 mg/dL) with kidney injury (Cr 3.26). He endorsed taking 5 to 16 (average 8-9) tablets of 1000 IU Vitamin D daily for 10 years. He had heard about the health benefits of Vitamin D and believed it gave him a euphoric effect. Work-up demonstrated elevated ionized calcium (1.63 mmol/L), normal serum phosphorus (3.8 mg/dL), low total protein (6.24 g/dL), normal total albumin (3.42 g/dL), and negative serum protein electrophoresis. Intravenous hydration with normal saline at 200 cc/hr was initiated along with intravenous furosemide. Additional work up demonstrated a suppressed parathyroid hormone level (10pg/ml). 25-hydroxyvitamin D3 (25-(OH)D3) levels were elevated beyond the measurable range (&gt; 155.9 pg/mL). The plasma 1α,25-dihydroxyvitamin D3 (1α,25 (OH)2D3) was normal at 44 pg/mL (range 18-64 pg/mL). With intravenous fluid administration, the patient's ionized calcium level decreased and his creatinine improved. However, 48 hours after the fluids were discontinued on hospital day 3, the ionized calcium and serum creatinine rose once again. Due to the long half-life of Vitamin D and the up-trending calcium levels, he received 60mg of intravenous Pamidronate on hospital day 8. On discharge on hospital day 11, his renal function was stable (Cr 2.24) with normal ionized calcium (1.27 mmol/L). His psychiatric symptoms had resolved.

Discussion
The two most common causes of hypercalcemia are primary hyperparathyroidism and malignancy. Less commonly, vitamin D-mediated hypercalcemia may result from ectopic 1,25-dihydroxyvitamin D production or excessive Vitamin D ingestion. The known upper limit of daily Vitamin D intake in an adult that will cause no adverse risk is 4000 IU per day. Vitamin D is a fat-soluble vitamin with a half-life of approximately 2 months. The liver converts Vitamin D3 to the metabolite 25-(OH)D3, which has a half-life of 15 days, and the kidney further metabolizes this to 1α,25 (OH)2D3, which has a half-life of 15 hours. Therefore, this patient's 25-(OH)D3 was expected to remain at toxic levels for an unknown time period, placing him at risk of prolonged hypercalcemia with further deterioration of his renal function. There is no standard of care established for patients with vitamin D toxicity. Pamidronate, normally contraindicated for GFR &lt;30 mL/min, was administered after nephrology consultation. Information about vitamin D toxicity is primarily gleaned from case reports and series. This case report serves as a model for study of Vitamin D toxicity in humans for understanding the long-term management in patients with chronic vitamin D toxicosis presenting with renal failure.
Presentation: No date and time listed
LBSAT131 Extended-release Calcifediol Reduced Ipth And Normalized 1,25-dihydroxyvitamin D In Esrd.
Authors: Ashfaq Akhtar , Strugnell Stephen , Tabash Samir , Johnson Laura , Bishop Charles W 
Published: November 2022

Abstract

Background
Extended-release calcifediol (ERC) has been shown in randomized clinical trials to effectively and safely treat secondary hyperparathyroidism (SHPT) in adults with stage 3-4 chronic kidney disease (CKD) and vitamin D insufficiency when administered at 210 or 420 mcg per week (30 or 60 mcg/day), doses which gradually raise serum total 25-hydroxyvitamin D (25D) to mean steady-state levels of 50-56 ng/mL.

Clinical Case
A 41-year-old male Caucasian with end-stage renal disease (ESRD) requiring regular hemodialysis (HD) experienced an overdose during participation in a phase 2 study of ERC for treating SHPT. Medical history included hypertension, type II diabetes, glomerulonephritis, bilateral lower extremity edema, muscle cramps, pruritus, shortness of breath, sporadic hypercalcemia and hyperphosphatemia, and iron deficiency anemia. Treatment with ERC began at an incorrect dosage of 2,700 mcg per week (900 mcg per HD) for 10 weeks as the study coordinator misunderstood the protocol-specified dose of 900 mcg per week. A 2.5% calcium dialysate was used during the study. Serum 25D gradually increased from 19 to 339 ng/mL (32-100), serum total 1,25-dihydroxyvitamin D (1,25D) increased from 6.3 to 137 pg/mL (24-86), plasma iPTH decreased from 440 to 146 pg/mL (15-65), and corrected serum calcium (Ca) decreased from 9.3 to 9.1 mg/dL (8.6-10.4). The subject remained asymptomatic throughout. Discovery of the overdose was delayed due to limited monitoring access during the pandemic and occurred when the ERC supply was prematurely exhausted. A physical exam and retrospective review of study records were promptly undertaken with no abnormalities noted. ERC administration, after a 1-dose hiatus, resumed at the correct dose (900 mcg per week). Serum 25D decreased over the next 4 weeks to 251 ng/mL, 1,25D decreased to 46. 0 pg/mL, iPTH increased to 186 pg/mL, and Ca remained stable (9. 0 mg/dL). The subject completed the full 6-month treatment period without adverse events.

Clinical Lessons
Gradual elevation of serum 25D and 1,25D with ERC to high levels had no impact on serum Ca or adverse events in the described subject suggesting that hypercalcemia observed with other vitamin D therapies used during HD results from abrupt increases in these metabolites. Serum 1,25D normalized with 25D elevation despite the lack of functional kidneys, indicating that extra-renal 1,25D production can become sufficient to control increased iPTH in ESRD when serum 25D is elevated well above the current clinical practice target of 30 ng/mL.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
ODP080 Bisphosphonate treatment for osteoporosis in children with Gorham-Stout syndrome: a case report
Authors: Ahn Moon Bae , Shin Chungwoo 
Published: November 2022

Abstract

Background
Gorham-Stout disease (GSD) is a rare disease defined by progressive bone disappearance due to massive unicentric or multicentric osteolysis with proliferation of vascular structures. Symptoms and signs vary depending on the site of invasion. Including some self-limiting GSD, most treatments are palliative and limited to symptom management. Various treatments have been tried for GSD, but there are no standardized treatment protocols. Treatment includes radiological treatment, surgery, and medications such as bone absorption inhibitors (calcitonin, bisphosphonate (BP)), vitamin D and immune modulators (interferon alpha-2b, Sirolimus) Case presentation: A 4-year-old female patient presented with prolonged back pain after a fall. Pathologic compression fracture in T9, L1 vertebrae identified in simple spine image, and GSD was confirmed by MRI and biopsy finding as hemangioma in vertebrae. This patient has been treated with a combination therapy of Sirolimus and BP for 1 year. BP treatment consist with oral BP (Alendronate) between 3 intravenous BP (Pamidronate) every 4 months. After a year of treatment, BMD improved from initial -1.3 TBLH (z-score) to -0.5/0.4/0.6 Spine/Both femur (z-score), but MRI findings suggest mild aggravation of multiple compression fractures of spines of T9-L5. After 1-year of treatment, at present, the girl is alive and staying with tolerable condition.

Conclusions
Combination treatment with bisphosphonate and Sirolimus for childhood GSD can be helpful in slowing the demineralization of GSD without any significant adverse effect.
Presentation: No date and time listed