bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP086 Detecting Primary Hyperparathyroidism with Image Discordant Findings
Authors: Nikjoo Arya , Rashid Hytham , Hogan Connor , Raghavan Rajeev 
Published: November 2022

Abstract

Introduction
Primary hyperparathyroidism is a common cause of hypercalcemia, with 80-85% of cases being due to a single gland adenoma. The sensitivity of imaging modalities varies, with ultrasound at 76%, sestamibi scintigraphy at 63%, and 4-dimensional computed tomography (CT) scan at 89%.

Clinical Case
A 48-year-old woman with a remote history of iron deficiency anemia presented with 2 weeks of dry cough. She reported associated body aches and fatigue, but review of systems was otherwise negative. Family history was notable for a maternal grandmother with an unknown thyroid disease. On presentation, her blood pressure was 115/74 mm Hg, temperature was 37.1 Celsius, pulse was 64 beats per minute, with a respiratory rate of 16 breaths per minute, and oxygen saturation of 100 percent on room air. On exam, there was no thyromegaly, and there were decreased breath sounds. Initial labs were notable for calcium of 11.4 mg/dL (reference range: 8.4-10.2 mg/dL). Her rapid Covid antigen test was negative. A chest x-ray showed bilateral opacifications, suggestive of community acquired pneumonia. She was started on isotonic intravenous (IV) fluids, as well as ceftriaxone and azithromycin. The calcium remained persistently elevated and peaked at 12.6 mg/dL. Creatinine levels remained between 0.7-1. 0 mg/dL (reference range: 0.5-1. 0 mg/dL). Phosphorus level was 3.6 mg/dL (reference range: 2.5-4.5 mg/dL). Parathyroid hormone level was 174.6 pg/mL (reference range: 37.87-83.87 pg/mL). 24-hour urinary calcium was 660 mg (reference range: 0-320 mg). Ultrasound of the neck showed multiple mildly suspicious thyroid nodules, but no notable findings for the parathyroid gland. Subsequent nuclear medicine sestamibi scan revealed no discrete parathyroid adenomas. The 4-dimensional CT scan did not mention parathyroid pathology on the report. However upon review by a head and neck surgeon, a suspicious lesion was identified adjacent to the right thyroid lobe. Intervention was indicated given her age (&lt;50), serum calcium &gt; 1 mg/dL above the upper limit of normal, and 24-hour urinary calcium &gt; 400 mg. The patient underwent a right neck exploration, and a right superior parathyroidectomy was performed.

Conclusion
The patient met the criteria for primary hyperparathyroidism based on her normal kidney function, elevated serum calcium, and elevated parathyroid hormone. While imaging is frequently ordered, it is important to note that it does not have a role in confirming or ruling out the diagnosis of primary hyperparathyroidism. It should instead be used to localize abnormal parathyroid glands for operative planning. This case highlights the importance of surgical consultation in primary hyperparathyroidism, especially in the setting of negative or conflicting imaging results.
Presentation: No date and time listed
ODP094 Hypercalcemia caused by Mycobacterium Avium Complex, with Excellent Response to Intravenous Pamidronate.
Authors: Khthir Rodhan 
Published: November 2022

Abstract

Background
Hypercalcemia caused by granulomatous diseases such as sarcoidosis and tuberculosis, is a well-recognized entity. The pathophysiology of hypercalcemia associated with granulomatous diseases is related to increase conversion of 25 hydroxyvitamin D to its active form, 1,25 dihydroxyvitamin D, via extra-renal 1 -α hydroxylase activity. We present a patient with moderately sever hypercalcemia caused byMycobacterium Avium complex (MAC) infection in association with Human Immunodeficiency Virus (HIV) infection.

Case Presentation
The patient is 53-year-old male with longstanding HIV infection since 2003. He was referred to the endocrine clinic after an acute presentation to a local hospital in August 2021 with pancytopenia, lymphadenopathy, and hypercalcemia (corrected total calcium 13.8 mg/dl) with acute kidney injury. He was treated with intravenous fluids and subcutaneous Calcitonin injection. Endocrine work up showed low parathyroid hormone (PTH) at 3 pg/ml (14-95 pg/ml) and Parathyroid related peptide (PTHrP) level was &lt;0.4 pmol/l. His 1,25 dihydroxy-vitamin D was elevated at 172 pg/ml (18-64 pg/ml) . Computed Tomography (CT) study for neck, chest and abdomen showed hepatosplenomegaly, generalized lymphadenopathy involving the left cervical area, left supraclavicular area, mediastinal, retroperitoneal, mesenteric and inguinal lymphadenopathy. Bone marrow study from August 2021 showed no evidence of leukemia, lymphoma, tuberculosis or other bone marrow inflammatory or infiltrative processes. Left sided neck lymph node biopsy showed diffuse granulomatous disease and numerous acid-fast organism consistent with Mycobacterium Avium complex (MAC) He was treated with azithromycin 250 mg daily, ethambutol 1200 mg daily, and rifabutin 300 mg daily in addition to anti-retroviral therapy (bictegravir/emtricitabine/tenofovir). Hypercalcemia was treated with one dose of pamidronate 90 mg which normalized serum calcium within one week. Glucocorticoids was not considered due to concerns over sever immunosuppression due to HIV/ AIDS and pancytopenia. Denosumab, ketoconazole and hydroxychloroquine were also not considered due to concerns over side effects. His 1,25 dihydroxy-vitamin D level normalized after four months from starting treatment with anti MAC therapy. Most recent calcium level 9.1 mg/dl, with 1,25 dihydroxy-vitamin D level of 31 pg/ml.

Conclusion
Mycobacterium Avium Complex infection is a possible cause of hypercalcemia, especially in immunocompromised individuals. Glucocorticoids, usually the first line treatment for acute hypercalcemia induced by 1,25 dihydroxyvitamin D overproduction, might not be appropriate in all patients. Alternatives include hydroxychloroquine, ketoconazole and parenteral bone anti- resorptive agents. Our patient had an excellent response to one dose of pamidronate. Ultimately his1,25 dihydroxy-vitamin D normalized with effective anti MAC therapy.
Presentation: No date and time listed
ODP104 Isolated familial hypoparathyroidism with Tbx1 mutation in Korea
Authors: Lee Seunghyun , Hong Namki , Shin Sungjae , Rhee Yumie 
Published: November 2022

Abstract

Background
Non-surgical hypoparathyroidism due to lack of PTH secretion or action is uncommon disorder characterized by hypocalcemia and hyperphosphatemia. Familial hypoparathyroidism is classified into syndromic hypoparathyroidism, including DiGeorge syndrome and isolated familial hypoparathyroidism. Deletion of Tbx1 is the cause of DiGeorge syndrome characterized by hypoparathyroidism, immunodeficiency, and congenital heart disease. Most cases of isolated familial hypoparathyroidism are caused by GCM2, SOX3, CASR, Gα11, and PTH. Isolated familial hypoparathyroidism also can be caused by mutations in TBX1 genes(1). In this study, we also identified a splice-altering mutation in TBX1 (c.1009+1G. C), leading to skipping of exon 8 in an idiopathic hypoparathyroidism patient in Korea.

Case
A 35-year-old woman was referred to our hospital in March 2016 for hypocalcemia. It had been detected after recurrent abortion and seizure during exercise. Her second older brother was diagnosed as idiopathic hypoparathyroidism with no abnormalities in the TUPLE1 FISH test and chromosome test eight years ago. Initial laboratory studies showed low corrected calcium (7.4 mg/dL, normal range: 8.5-10.5), hyperphosphatemia (4.7 mg/dL, normal range: 2.5-4.1), inappropriately normal parathyroid hormone (18.4 pg/mL, normal range: 15-65), corresponded to hypoparathyroidism. A brain computed tomography showed bilateral globus pallidi calcification. She had no history of renal stones or cataracts. She did not show congenital anomaly including cleft palate, facial dysmorphism, conotruncal heart defects, and immunodeficiency, and neither did her brother. Molecular diagnoses were analyzed by whole-exome sequencing, identifying the heterozygous TBX1 mutation (c.1009+2T/A). She was treated with conventional therapy such as calcium and calcitriol. The patient gave birth 18 months after referring to our hospital, and the child did not show any abnormalities in calcium or phosphorus. During a follow-up of 6 years, the patient had no additional symptoms related to hypocalcemia with the lower normal range of calcium and normal phosphorous.

Conclusion
We identified a rare heterozygous TBX1 mutation in a patient with isolated familial hypoparathyroidism in Korea. References1. Li D, Gordon CT, Oufadem M, et al. Heterozygous Mutations in TBX1 as a Cause of Isolated Hypoparathyroidism. The Journal of Clinical Endocrinology & Metabolism.2018;103(11): 4023-4032.
Presentation: No date and time listed
ODP105 Long-Term Bone Mineral Density Changes for Amputees Following Transcutaneous Osseointegration
Authors: Vrazas Elisabeth , Hoellwarth Jason , Chavan Anuj , Alam Shafaf , Lu William , Oomatia Atiya , Muderis Munjed A , Preda Veronica 
Published: November 2022

Abstract

Background
Transcutaneous osseointegration (OI) is an emerging rehabilitation alternative for amputees who have difficulty with traditional socket prostheses. OI inserts a metal implant into an amputated extremity's bone, through a permanent skin stoma, allowing direct connection of a prosthetic limb to the patient's skeleton. OI implants have been shown to provide better mobility, quality of life, and address issues such as poor prosthesis fit, dermatitis, and excessive sweating. (Kunutsor et al, 2018) Direct skeletal loading facilitated by OI should improve bone health, but this question has not been evaluated over the long term.

Aim
This study compared the preoperative and minimum five-year postoperative femoral neck bone mineral density (BMD) change in amputees, measured on the amputated and intact side, using dual-energy X-ray absorptiometry (DEXA).

Methods
A retrospective cohort review identified 45 lower limb amputees who had DEXA evaluation prior to transfemoral or transtibial OI implants. Six patients had follow-up DEXA performed at least five years postoperatively. These six patients’ charts were retrospectively reviewed for demographic data, FRAX specific criteria, and adverse outcomes which could have impacted time spent using the OI prosthesis. Bone density, T-scores, and Z-scores were evaluated for all BMD measurements. Comparison of mean values was assessed using Student's t-test.

Results
(Note: Of the 45-patient cohort, 6 patients have had a 5-year DEXA recorded at the time of abstract submission. Data collection is ongoing and is expected to be at least 15 patients at study completion) This cohort includes three males and three females, five transfemoral and one transtibial, aged between 50 and 68 (mean = 51 ± 13) years at the time of implant surgery. For the amputated limb, there was a non-significant increase from0.540 ±0.155 g/cm 2 to 0.707 ±0. 094 g/cm 2 (p = 0.105) . The Z-score increased -3. 067 ±1. 089 g/cm 2 to -1.200 ±0.540 g/cm 2 (p = 0. 024). The T-score increased from -3.933 ±1.193 g/cm 2 to -2.333 ±1.193 g/cm 2 (p = 0. 049).

Conclusions
Although this is a small cohort, there were statistically significant increases of the Z-score and T-score when measured at least five years after osseointegration.
Presentation: No date and time listed
PSAT173 Evaluation of efficacy and safety of different doses of cholecalciferol supplementation in healthy adults- a single blind randomized control trial.
Authors: Sidana Shivani , Ganie Mohammad Ashraf , Bhat Moomin Hussain 
Published: November 2022

Abstract

Background
Vitamin-D (VD) has been shown to be associated various skeletal and non-skeletal benefits. Despite synthesis in the body, 70-80% of population has been found to be VD deficient, due to poor sunlight exposure, increasing environmental pollution, indoor habits etc. Institute of medicine recommended daily allowance (RDA) of 600 IU/day, while Endocrine society recommends a daily intake of 1500-2000 IU/day for age group 19-70 years. In the absence of mandatory food fortification with VD, supplementation is an effective alternate strategy to mitigate the issue of VD deficiency. Optimal supplementation dose for achieving and maintaining sufficient VD levels in Indian adults is still not known.

Aim
To evaluate optimal dose of oral cholecalciferol supplementation to achieve and maintain serum hydroxy vitamin D [25(OH)D] sufficiency in Indian adults.

Methodology
In this single center blinded randomized control study, a total of 168 healthy subjects age (18-60 years) were randomized in four groups (A, B, C and D). Subjects were supplemented with 600, 1000, 2000 IU/day and 60,000 IU/month of cholecalciferol to group A, B, C and D in two phases, winter phase and summer phase of three months each with a washout period of three months in between. Serum 25(OH)D, iPTH, calcium, phosphorus, alkaline phosphatase levels and urine calcium/creatinine ratio was assessed at baseline, 12 weeks, 24 weeks and 36 weeks.

Results
The mean increase in serum 25(OH)D following supplementation was 21.67±6.54, 32.50±7.33 and 27.72±5.64 ng/ml after three months, 25.96±7.95, 31.52±8.95, 48.05±9.88 and 40.73±12.96 ng/ml after six months of supplementation in group A, B, C and D respectively, with 9.1%, 16.2%, 50% and 39.5% of subjects achieved levels of &gt;30ng/ml after three months and 27.3%, 59.5%, 93.8% and 76.3% after six month of VD supplementation in group A, B, C and D respectively. Supplementation with VD at various doses raised serum 25(OH)D levels in a dose dependent manner, with an average rate constant of 1.79±0.79 ng/ml/100IU/day. Higher BMI and baseline serum 25(OH)D levels negatively associated with gain in serum VD levels. Overall, secondary hyperparathyroidism decreased from 29.3 to 8·6% post-supplementation. No significant difference in urinary Ca/Cr ratio between baseline and post supplementation was noted.

Conclusion
In accordance with the level of treatment, various oral cholecalciferol regimens improved serum 25(OH)D levels in all the subjects, but the 2000 IU/day achieved the best results while being safe. Daily supplementation with 2000 IU of oral cholecalciferol does meet the RDA requirement of achieving serum 25(OH)D of &gt;30ng/ml in 94% subjects. Whether RDA of 600 IU/day, recommended by IOM is sufficient to combat VD deficiency in our population, is debatable.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT179 Hypercalcemia Associated with Antibiotic-Impregnated Calcium Sulfate Beads
Authors: Abrams Jennifer , Decamps Scarlett , Gliwa Agnieszka , Singh Shikha 
Published: November 2022

Abstract

Introduction
Hypercalcemia is an electrolyte disturbance with a wide spectrum of symptoms ranging from asymptomatic, to coma and arrhythmia. Primary hyperparathyroidism and malignancy are the most common causes of hypercalcemia, accounting for up to 90% of cases. Here we discuss transient hypercalcemia associated with Stimulan antibiotic-impregnated calcium sulfate (AICS) beads implanted after an orthopedic procedure.

Case
A 63 year old female with a past medical history of hypertension and type 2 diabetes mellitus presented to the hospital with signs and symptoms of infection of her left prosthetic hip which had been inserted a few weeks earlier. She was admitted for an orthopedic procedure to replace the prosthetic joint and insert antibiotic-impregnated calcium sulfate beads. The procedure was successful and the patient was admitted to the Medicine Floor for monitoring. The day after the procedure the patient was noted to be lethargic. CT head was unrevealing and after de-escalation of narcotics, the patient remained alert but difficult to arouse. Further workup revealed a Calcium of 14.5 (15.1 corrected for Albumin of 3.3). She reported bone pain, constipation, and abdominal discomfort. The patient was immediately treated with intravenous hydration as well as Calcitonin 300 mg within the first 48 hours. Initial workup revealed non-PTH-mediated hypercalcemia. Parathyroid Hormone Related Peptide, Vitamin D, Serum Protein Electrophoresis, and Angiotensin-Converting Enzyme were all normal. Sarcoidosis, Multiple Myeloma, and malignancy were ruled out. Given an unrevealing workup, this transient hypercalcemia was determined to be caused by AICS beads. Over the course of 6 days, following IV fluid resuscitation and calcitonin the patient's mental status and calcium level and her symptoms resolved.

Discussion
AICS beads are a well-accepted adjuvant therapy in preventing and treating prosthetic joint infections. There are few reported cases of transient hypercalcemia due to AICS beads, more commonly seen with a higher number of beads used. While hypercalcemia seems to be a rare side effect, if severe it has the potential to be life-threatening. Severe cases of hypercalcemia may lead to cardiovascular compromise, altered mental status, encephalopathy, and pancreatitis. Patients with calcium levels greater than 14 or greater than 12 with symptoms should be treated aggressively to avoid serious complications. Initial management is aimed at elimination of calcium, decreased absorption of calcium, and repletion of intravascular volume.Awareness of the risk of hypercalcemia associated with AICS bead use and careful post-operative monitoring can assist in early identification and management of this potentially fatal adverse effect.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT180 Fibrodysplasia Ossificans Progressiva (FOP) A Case Series
Authors: Almonaei Khulod , M’Hiri Iman , Al-Ali Dalal , Dandurand Karel , Khan Aliya A 
Published: November 2022

Abstract
Case 1 (TTD 30yrs): 71-year-old female presented with decreased mobility over the past 15years. She had malformations of the great toes. She developed "golf ball" sized calcified lumps in the upper ribs, clavicle and sternum which began to form at the age of 32 and were removed surgically. Calcified soft tissue was noted over the shoulders, spine and thighs. No history of hearing impairment. Radiographs showed areas of abnormal bone growth. CT scan of abdomen showed calcifications within the gluteal and thigh muscles The lab profile was normal. DNA analysis in process.Case 2 (TTD 13yrs): A 53-year-old female with symmetric malformations of the great toes presented with a lump behind her knee in her 40's with histopathology consistent with calcium deposition. She was diagnosed initially with dermatomyositis and treated with steroids. No hearing impairment The lab profile and abdominal CT scan were unremarkable. DNA analysis in the process.Case 3: (TTD 25yrs) A 66 yr old female presented with multiple lesions of heterotopic ossification lesions which began at the age of 41 at sites of trauma in the right deltoid, right hip, right calf. These were surgically removed. Also had a malformation of the great toes bilaterally. Received radiation post excision of the calcified lesion in April 2021. A skeletal survey showed myositis ossificans. DNA analysis in the process. References 1. Pignolo, R.J., Shore, E.M., Kaplan, F.S., 2013 Pediatric Endocrinology Reviews 10902) 437-448. Fibrodysplasia Ossificans Progressiva: Diagnosis, Management and Therapeutic Horizons2. Therapeutic advances for blocking heterotopic ossification in fibrodysplasia ossificans progressiva.Wentworth KL, Masharani U, Hsiao EC.Br J Clin Pharmacol. 2019 Jun;85(6): 1180-1187. doi: 10.1111/bcp.13823. Epub 2019 Jan 6.3. Fibrodysplasia ossificans progressiva: lessons learned from a rare disease.Akyuz G, Gencer-Atalay K, Ata P.Curr Opin Pediatr. 2019 Dec;31(6): 716-722.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT187 Bone Mineral Density Normalization in a Young Patient With a Physician Guided Nutrition and Exercise Intervention.
Authors: Caputi Rafael , Valderrãbano Rodrigo 
Published: November 2022

Abstract
Lack of consensus on the type and amount of exercise to safely increase bone mineral density (BMD) prevents many clinicians from providing detailed recommendations on how to increase physical activity. We present a young man with low bone density, who was initiated on a non-pharmacologic regimen of physician-directed high intensity resistance exercise (HIRE) and adequate nutrition support.
A 28-year-old male was found to have a low bone density attributed to autoimmune hepatitis, chronic systemic glucocorticoids used for 7 years and poor lifestyle habits. Despite stopping steroids since 2014, his BMD was worsening in the femoral neck (FN) to 0.723 g/cm2 (Z-score -2.7) in 2018, representing a 3% loss from the prior year. His BMD in the total hip (TH) site also decreased from 0.775 g/cm2 (Z-score -2.1) to 0.751 g/cm2 (Z-score -2.3) in the same 1-year period (3.1% loss). The patient had no personal or family history of fractures, smoking or alcohol use, but did have a sedentary lifestyle and ate highly processed foods with poor nutritional value.
After unremarkable evaluation for further causes of ongoing bone loss, in 09/2018 we initiated a tailored progressive high intensity resistance exercise (HIRE) program. Major compound movements such as squats, deadlifts, military press, and dynamic impact exercises such as medicine ball throws, jumps and farmers carry were performed 3 times a week, maintaining an intensity of &gt;80% 1-repetition maximum with 5 repetitions. The HIRE program was modified every 3 months at endocrinology clinics. After the first year, one on one training with expert kinesiologist was introduced to correct exercise form. Nutrition recommendations were simple, focused on increasing weight, adequate dairy intake, and protein intake at 1.6g/kg of body mass. He maintained adherence to exercise and diet throughout 2018-2021.
BMD measured by the same Lunar iDXA increased by 10.8% at the FN from 09/2018 to 09/2019. As often occurs in clinical practice, the patient had bone density scans performed at various centers throughout his years of care. Using BMD standardization algorithms, we estimate that after initiation of our HIRE and nutrition intervention, BMD increased at all sites (LS +9.7%, FN +17.7%, TH +12.7%) when compared to pre-intervention values. His most recent DXA scan on 12/2020 (Hologic Discovery) revealed a Z-score of -1.7 (LS), -1.5 (FN) and -1.5 (TH).
We conclude that our HIRE and nutrition intervention lead to clinically significant bone density increases which are expected to lead to a reduction in fracture risk. Additionally, improved lifestyle habits and nutrition are expected to have multiple benefits beyond bone health. It is important that clinicians learn about different types of exercise programs to properly guide patients which could benefit. A HIRE program should be considered in select, able bodied patients with low bone density.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.