bluuebunny/crossref_metadata_2025_split huggingface dataset:
PMON153 Changes in size of pituitary microadenomas, a retrospective cohort study
Authors: Min Le , Hordejuk Dawid 
Published: November 2022

Abstract

Background
The estimated prevalence of pituitary lesions is 22.5% in radiologic studies. The solid and/or cystic lesions are usually described as incidentaloma. Most pituitary incidentalomas are microadenomas (lesion size &lt;1 cm). In 2011, The Endocrine Society published guideline on following incidental pituitary lesion. However, few studies evaluated the dynamic changes in pituitary incidentaloma.
Method: In this retrospective cohort study, patients with pituitary microadenomas were identified from our institution database by the Research Patient Data Registry from 11/2003 to 3/2021. We performed chart review to collect data relevant to demographic and pituitary imaging findings. The study was approved by our institution IRB.The patients with the diagnosis of pituitary microadenoma (tumor size &lt; 10 millimeter (mm)) were included in this study. To eliminate the medication effects on the tumor size, we excluded the patients with diagnosis of prolactinoma and patients on dopamine agonists or somatostatins. We performed linear regression test. We performed Kaplan-Meier survival curve analysis.

Results
Over 15 years, among total 177 subjects, 78 (44%) had unchanged size of the microadenoma, 49 (27%) had increase size, 34 (19%) had decrease in size, and 16 (9%) had both increased and decreased size. Ten (6%) subjects had transsphenoidal pituitary tumor resection. Among 128 female subjects, 53 (41%) had unchanged size, 35 (27%) had increased size, 28 (22%) had decreased size, and 12 (9%) had both increased and decreased size. Seven subjects (5%) had transsphenoidal pituitary tumor resection. Among 49 male subjects, 25 (51%) had unchanged size, 14 (27%) had increased size, 6 (12%) had decreased size, and 4 (8%) had both increased and decreased size. Three patients (6%) had tumor resection. Over the 15 years, the changes in the size of microadenomas are between -6 mm to 6 mm. There were 6 (3%) subjects with tumor size increase into macroadenoma category. The slope by linear analysis was 0.85 (95% CI: -0.28 to 1.99) in percentage change. The slope was 0.02 (95% CI: -0.012 to 0.054) in tumor size change in mm. The slope was not significantly deviated from zero by percentage change (p = 0.14) or size change in mm (p = 0.21). The median time of microadenomas remained unchanged were 6.5, 7.7, and 6.5 years in total, male and female respectively. There was no significant difference in size change among total, male and female (p = 0.947).

Conclusion
Our study has shown that majority of pituitary microadenomas remain unchanged or decreased in the size over 15 years. The maximal size increase was 6 mm. There were no significant changes in tumor size over the study period. Our study suggests that less frequent surveillance pituitary MRI in incidental pituitary microadenomas is safe.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON53 Resistance to weight gain and obesity in mice lacking the IGF-1 receptor in GHRH neurons
Authors: Al-Samerria Sarmed , Nandankar Nimisha , Negrón Ariel , Radovick Sally 
Published: November 2022

Abstract
IGF-1 signaling plays a pivotal role in regulating GH production through a negative feedback mechanism at the level of the hypothalamus and pituitary. We created a transgenic mouse model with ablation of the IGF-1R in GHRH-neurons (GIGFRKO) that exhibited normal linear growth, however, when fed a normal chow diet, began to have a sustained decrease in weight gain velocity. This was associated with greater energy expenditure and a lower body fat mass, with no change in caloric intake. The aim of the current study was to determine whether this metabolic phenotype would be sustained with a high fat diet challenge. At 4 weeks of age, the mice were placed on a 45% fat diet for 16 weeks. The GIGFRKO mouse model fed a HFD had normal linear growth, but at 10 weeks of age, both male and female mice began to have a sustained decrease in weight gain velocity compared to their age and sex-matched controls. The metabolic assessment demonstrated that the GIGFRKO transgenic mice had higher O2 consumption, lower CO2 production, a reduction in body fat mass, an elevation in energy expenditure, and improved glucose tolerance compared to the control mice on HFD. This was not associated with changes in food intake or activity and was present in males and females. In conclusion, the GIGFRKO transgenic mice are resistant to diet-induced obesity due to the critical role of the GHRH-GH axis in controlling energy expenditure and fat metabolism.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON75 Unilateral Galactorrhea in an Elderly Male
Authors: Monsour Elio , Amole Morolake , Xhikola Majlinda , Kadiyala Sushma 
Published: November 2022

Abstract

Introduction/Background
Galactorrhea in men is rare, with a reported prevalence of 5.5%. It tends to occur bilaterally rather than unilaterally. Among the etiologies of galactorrhea, pharmacologic agents, pituitary tumors, and hypothalamic and pituitary-stalk lesions tend to account for most cases. Here we describe a rare cause of unilateral galactorrhea due to previous herpes zoster in the T4 dermatome.

Clinical Case
A 76-year-old male with history of hypertension, Crohn's disease, and chronic migraine headaches presented to the Endocrine clinic for evaluation of intermittent unilateral galactorrhea, which had been ongoing for the past 5 years. The patient had no known precipitating events, but he had noticed that galactorrhea was more pronounced in the spring-summer seasons, during which time he used to work outdoors more. No history of cancer, hypothalamic-pituitary disease, or other endocrinopathies. The patient was a former smoker and denied marijuana or alcohol use. He reported a family history of breast cancer in his maternal grandmother. He had no biological children. Active medications included sumatriptan as needed for migraines. Physical examination was notable for gynecomastia that was more prominent on the left. Tenderness to palpation was noticed over the left breast with no exudate expressed from the nipples. Genital exam revealed decreased testicular volume at approximately 10 ml each.
Laboratory evaluation revealed normal renal function, prolactin, estradiol, β-HCG, TSH, and normal male karyotype. Testosterone level was low with elevated LH and FSH, suggesting primary hypogonadism. Mammogram and US of the breast were not concerning for malignancy. MRI brain was without pituitary abnormalities. After a detailed discussion on a subsequent follow-up visit, the patient recalled an episode of herpes zoster infection over his left breast about 5 years ago and since had been experiencing left breast pain and nipple discharge.

Discussion and conclusion
We present a unique case of post-herpetic galactorrhea in an elderly male patient. In the literature, there are case reports that describe galactorrhea in patients post chest wall injuries or chest surgeries, and there was one case report of galactorrhea in a postmenopausal female post zoster infection. A possible mechanism of galactorrhea is thought to be stimulation of the lactational neural arch, and in our case, possibly stimulated by the zoster infection. Prior herpes zoster infection and post-herpetic neuralgia are likely causes for underlying intermittent unilateral galactorrhea. Albeit rare, clinicians should be aware of this etiology when comprehensively evaluating for galactorrhea.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON79 Supraphysiologic vasopressin-induced receptor desensitization; a case report
Authors: Rabiei Samaneh , Jaffa Matthew , Kantorovich Vitaly 
Published: November 2022

Abstract

Background
Arginine vasopressin (AVP) is a nonapeptide released from the neurohypophysis in response to increases in plasma osmolality, hypovolemia, hypotension, and angiotensin II. V2 receptors, expressed on the basolateral membrane of the renal collecting ducts coupled to the adenylyl cyclase-cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA) pathway. PKA increases the synthesis and shuttling of aquaporin 2 water channel containing vesicles (AQMCV) from cytoplasmic vesicles to the luminal surface of the renal collecting ducts (and inhibits the endocytosis of the vesicles), where they are inserted into the apical cell membrane. As a result, AVP increases free water reabsorption from the filtrate and decreases serum osmolality.
There are different protocols for CDI management in post neurosurgical patient, including IV or SQ injections as well as continuous vasopressin drip. Here we discussed a case where prolonged IV drip could probably have caused loss of response to IV DDAVP injections.

Case
Patient is a 46-year-old male admitted with AMS with imaging revealed ruptured anterior communicating artery aneurysm associated with subarachnoid and intra parenchymal hemorrhage. The patient underwent emergent aneurysm coiling and EVD placed. The patient was subsequently started on heparin infusion due to a large frontal lobe clot which was found on cerebral angiogram. The next day, the patient developed acute diabetes insipidus with hypernatremia and polyuria. Repeat head CT demonstrated increased cerebral edema around the frontal clot. The patient underwent right frontal craniotomy for clot evacuation. He patient was subsequently started on vasopressin infusion (ranging from 0.5-6 units/hour) by neurosurgery team for urinary output less than 200 mL/hour. ​Urinary output and sodium level improved and remained stable on infusion. When endocrinology attempted transition to DDAVP IV injections patient responded with severe polyuria to initial 0.5 mcg injection. Eventually patient required 1 mcg IV every 4 hours dosing to maintain normal urine output and required a slow wean off to the standard dose of 0.5 mcg every 8 hours over 14 days.

Discussion
we are presenting a case of CDI associated to SAH who was started on IV infusion of vasopressin, required slow weaning. phenomenon called for slow re-sensitization of the receptors with gradual decreasing of DDAVP dosing. Animal studies have shown that V1 and V2 receptors levels are sensitive to hormone-induced downregulation of hormone receptors. Hypervasopressinemia in rats whose blood vasopressin concentration was experimentally elevated by IV infusion to extraphysiologic levels caused significant desensitization of kidney vasopressin receptors. In another study, IM injection of DDAVP to rats led to a total loss of kidney V receptors. Thus, it is likely that administration of high dose DDAVP IV in this patient induced downregulation of kidney V2 receptors.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON96 A Curious Case of Isolated Oculomotor Nerve Palsy From a Non-Functional Gonadotroph Adenoma
Authors: Iqbal Qasim Zafar , Moran Heberth , Harmson Jeremy , Grissett Bryan , Dendy Jared 
Published: November 2022

Abstract

Introduction
Pituitary adenoma typically presents with signs and symptoms of hormone hypersecretion and only 30% of cases present clinically as nonfunctioning adenomas. Furthermore, amongst these less than 5% are associated with ocular nerve palsies. We report a rare case of isolated, unilateral oculomotor nerve palsy due to a non-functional gonadotroph adenoma expanding into the left cavernous sinus.

Case
48 years old male with a pertinent medical history of Type 2 Diabetes Mellitus presented to the ER with 3 days of intractable generalized headache associated with double vision, nausea, and increased lethargy. On initial examination, he had findings of oculomotor nerve palsy on the left eye (ptosis, the eye being down and out, and non-reactive pupil to direct or consensual light stimulation) while the rest of his examination was normal. His initial blood work was non-revealing and normal. He underwent extensive imaging including an initial CT scan showing a pituitary macroadenoma, followed by a pituitary-focused MRI brain revealing a hyperplastic pituitary lesion measuring 17.8 mm×22.5 mm in axial axis and 16.4 mm×14.4 mm in sagittal axis with extension into the left cavernous sinus. Biochemical workup was done to evaluate the pituitary function and it revealed a low total testosterone level (95 ng/ml) with a suppressed LH (2.1IU/l) and FSH (1.76 mIU/ml), a low fT4 (0.58 ng/dl) with a suppressed TSH (0.68 mIU/l), low cortisol (1.2 mcg/dl) with a suppressed ACTH of &lt; 5 pg/ml and normal IGF-1 and prolactin levels. He was given stress dose steroids and underwent transsphenoidal resection of the pituitary mass. Pathology of the specimen showed immunoreactivity for SF1 and ASU which was suggestive of a gonadotroph adenoma. The patient showed no signs or symptoms of diabetes insipidus post-operatively, however, was managed for secondary adrenal insufficiency, hypothyroidism, and hypogonadism. He was discharged home on hydrocortisone, levothyroxine, and metformin. He followed up at the Neuroendocrine clinic within a week of discharge and maintained a regular outpatient follow-up where he showed gradual improvement in his symptoms.

Conclusion
Visual impairment from a non-secreting pituitary adenoma is usually from chiasmal compression. Very rarely, pituitary macroadenoma expands laterally into the cavernous sinus and compresses the oculomotor nerve causing signs and symptoms of third nerve palsy. This case highlights the importance of recognizing different presentations of nonfunctional pituitary adenoma early as this could improve both the morbidity and mortality associated with them.

Reference
Choong, K., Lee, S L. Pituitary Macroadenoma with invasion into the cavernous sinus, cranial nerve palsies (Endocrine Today)
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON99 A Rare Case of an Intrasellar Epidermoid Cyst And Panhypopituitarism
Authors: Azmath Misbah , Rivera Luisa Bernacet , Bulsara Ketan , Madhavan Parvathy , Tendler Beatriz 
Published: November 2022

Abstract

Introduction
Epidermoid cysts are rare intracranially occurring mainly in subarachnoid spaces such as parasellar cisterns, middle fossa and cerebellopontine angle. Only few cases of infundibular/sellar epidermoid cysts have been described. We present the case of a large sellar epidermoid cyst resulting in panhypopituitarism.

Case
49 year old male with history of obesity and hypertension presented to the emergency department with acute onset progressively worsening headaches. He denied vision changes, nausea, vomiting or dizziness. Examination showed stable vital signs and ophthalmologic exam did not reveal any visual deficits. Further, he did not have any signs of pituitary hormone excess including hypercortisolemia or acromegaly. Brain MRI with and without IV contrast revealed a peripherally enhancing multilobulated cystic pituitary mass measuring 19.5 mm×17 mm×20.5 mm deviating the infundibulum to the left causing compression of the caudal aspect of the optic chiasm. Initial endocrinology work-up revealed noon time cortisol of 10.7 mcg/dL (range 7-23), 7 pm ACTH of 34.6 pg/mL (range 7.2-63.3), TSH of 1.71 mIU/mL (range 0.35- 4.94), free T4 of 0.93 ng/dL (range 0.5-1.39), FSH of 4.45 mIU/mL (range 1.27-19.26), LH 5.51 mIU/mL (range 1.24-8.62), IGF-1 level of 199 ng/mL (range 68-225), prolactin &lt;0.60 ng/mL (range 2.64-13.13), and testosterone level of 186 ng/dL (range 175-800). A presumed diagnosis of non- functioning pituitary macroadenoma with compression of chiasm was made and he underwent transsphenoidal hypophysectomy after evaluation by a multi-disciplinary team including neurosurgery, ENT and endocrinology. Post-operative course was uneventful, he was started on empiric steroids which were tapered slowly. Final pathology of surgical specimen demonstrated epidermoid cyst, focal necrosis, lymphocytes and macrophages infiltration consistent with reactive granulation tissue. On subsequent laboratory evaluation, he was found to have hypogonadotropic hypogonadism with an undetectable testosterone. FT4 was also low at 0.61 ng/dL (range 0.5-1.39). He is closely following with endocrinology for management of hypogonadotropic hypogonadism and hypothyroidism.

Conclusion
Intracranial epidermoid cysts are uncommon benign congenital lesions arising from trapped surface of ectodermal elements. Very rarely, they are found in the sellar region. Sellar epidermoid cysts tend to present late and often after significant growth and mass effects. Complete resection is challenging and recurrence is a feared complication. Our patient presented with acute symptoms from expansion of a large epidermoid sellar cyst mimicking a pituitary macroadenoma. It also resulted in hypopituitarism. Although, a rare entity, early recognition and prompt management of such lesions is key.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
RF25 | PMON179 Role of Apparent Strong Ion Difference in the Differential Diagnosis of Thiazide Associated Hyponatremia
Authors: Monnerat Sophie , Potasso Laura , Refardt Julie , Winzeler Bettina , Christ-Crain Mirjam 
Published: November 2022

Abstract

Background
Differential diagnosis of hyponatremia is challenging, particularly for thiazide associated hyponatremia (TAH), as patients might have either volume depletion in need for fluid substitution or syndrome of inappropriate antidiuresis (SIAD)-like presentation requiring fluid restriction. Urine indices are of little utility, because they are influenced by thiazide therapy. Apparent strong ion difference (aSID) describes the relation between sodium, potassium and chloride in serum and is used in evaluation of acid-base disorders according to Stewart model. aSID could help in the differential diagnosis of TAH because a value &gt;40 identifies patients with contraction alkalosis due to relative hypochloremia, and hypochloremic alkalosis is a well-known possible adverse effect of thiazide diuretics.

Material and Methods
This was a post-hoc analysis of prospectively collected data of hospitalized patients with hypotonic hyponatremia &lt;125 mmol/l. TAH patients were divided according to treatment response in patients needing intravenous fluid substitution or fluid restriction. Treatment response was defined as a sodium increase of at least 4 mmol/l/die or &gt;130 mmol/l based on chart review. aSID at baseline was calculated with the formula serum sodium plus potassium minus chloride and a value &gt;40 was used to identify volume-depleted TAH patients. Descriptive analysis was carried out to find differences between volume-depleted and SIAD-like TAH patients, and patients with SIAD without thiazide use. Logistic regression and ROC curves were computed to investigate the role of aSID&gt;40 for differential diagnosis of hyponatremia in TAH patients, in addition to known factors for identifying SIAD patients as body mass index (BMI) and fractioned uric acid excretion (FUA) with the previous described cut-off of 12%.

Results
Out of 303 hyponatremia patients, 131 (43.2%) had a TAH and 75 (24.8%) SIAD without thiazide use. Among TAH patients, 81 (61.8%) were successfully treated with fluid substitution and 31 (23.7%) with fluid restriction. 19 patients (14.5%) were excluded as they received no treatment, or needed to switch treatment during hospitalization. No differences in baseline characteristics were seen between patients with SIAD and SIAD-like TAH patients, except for BMI, lower in SIAD patients (mean(SD) 23.5(5.1) vs 27.0(5.7) kg/m2, p=0.003). A higher BMI and a FUA&lt;12% had a sensitivity of 84% with a specificity of 60% in identifying volume-depleted TAH patients. Adding aSID&gt;40 improved the specificity to 74% maintaining a sensitivity to 82%.

Conclusion
In hospitalized patients with TAH, calculation of aSID may help differentiating patients with volume depletion in need of fluid substitution from SIAD-like manifestation requiring fluid restriction.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:37 p.m. - 12:42 p.m.
ODP379 Brain MRIs may be value in children with isolated growth hormone deficiency whose peak GH level below 5 ng/mL in two growth hormone provocation test
Authors: Park So Yun , Kang Seok-Jin 
Published: November 2022

Abstract
Brain MRIs are considered essential in the evaluation of children diagnosed with growth hormonedeficiency (GHD), but there is uncertainty about the appropriate cut-off for diagnosis of GHD and little data about the yield of significant abnormal findings in patients with peak growth hormone (GH) of 7–10 ng/mL. We aimed to assess the frequency of pathogenic MRIs and associated risk factors in relation to peak GH concentrations. In this retrospective multicenter study, charts of patients diagnosed with GHD who subsequently had a brain MRI were reviewed. MRIs findings were categorized as normal, incidental, of uncertain significance, or pathogenic pituitary hypoplasia, small stalk and/or ectopic posterior pituitary and tumors. Of the 379 patients with GHD, 60.4% had normal MRIs. 22.4% had incidental findings, 3.2% had pathogenic findings including ectopic pituitary gland, pituitary hypoplasia, and pituitary stalk interruption syndrome. Patient with peak GH level &lt;5 ng/mL had a significantly higher prevalence of pathogenic findings.
Presentation: No date and time listed
ODP388 Hypernatremia in a Male Adolescent Leading to Diagnosis of Septo-optic Dysplasia
Authors: Currais Carolina , Gomez Patricia 
Published: November 2022

Abstract

Introduction
Septo-optic dysplasia (SOD) is a rare, heterogeneous condition defined by any combination of optic nerve hypoplasia, midline radiologic abnormalities and pituitary hypoplasia. The majority of cases are sporadic, but a number of familial cases have been described. Mutations in genes such as HESX1, SOX2 and SOX3 have been identified. Typically, SOD is diagnosed in newborns and infants with a reported incidence of 1: 10,000 live births. The diagnosis can be made when two or more features of the classic triad are present. If familial, genetic testing can be obtained to confirm the diagnosis.

Clinical Case
A 17 year and 7-month-old male patient with a history of cerebral palsy, paraplegia and obesity was admitted for management of a right arm osteomyelitis. We were initially consulted for incidentally discovered pre-diabetes (HbA1c: 6.4%), likely secondary to unhealthy eating patterns (negative pancreatic antibodies). He was made NPO prior to surgery and subsequently developed hypernatremia (161 mmol/L), which was initially thought to be iatrogenic due to large volume of normal saline received. Despite discontinuation of normal saline and replacement of free water, hypernatremia persisted (159-172 mmol/L). He had an elevated serum osmolality (321 mOsm/kg) with a low urine osmolality (240 mOsm/kg) and low specific gravity (&lt;1. 005). He was also polyuric (urine output 4.7 mL/kg/hr). With mentioned findings and a Copetin level of 2mol/L, a diagnosis of compensated central DI was established. He initially required a vasopressin drip in addition to slow replacement of free water in order to normalize his sodium level. After his sodium was stabilized, he was started on treatment with oral desmopressin. An MRI obtained was remarkable for small optic nerves and a small optic chiasm. Ophthalmology evaluation confirmed small, hypoplastic optic nerves. Constellation of findings were indicative of septo-optic dysplasia, presenting with central diabetes insipidus. Other than an IGF-1 on the low side (155 ng/L, z-score: -2.7), there was no evidence of additional pituitary hormone deficiencies.

Conclusion
The presence of cerebral palsy and central diabetes insipidus generated suspicion of midbrain defects, which may be associated with SOD. SOD is typically diagnosed in the newborn period, but this case points to the possibility of a more delayed presentation and diagnosis. SOD is a rare, highly heterogeneous condition. Both the age of presentation and which pituitary hormone deficiencies are present are variable. With early diagnosis, hormonal deficiencies can be monitored and replaced as required. A high index of suspicion is essential if features of the classic triad are present, regardless of age of presentation.
Presentation: No date and time listed