bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP301 Corticotroph Macroadenomas with Extensions to Third Ventricle: Four Case Reports
Authors: Suzuki Yasuhiro , Igarashi Katsushi , Fujimoto Masanori , Suzuki Sawako , Koide Hisashi , Horiguchi Kentaro , Yokote Koutaro 
Published: November 2022

Abstract

Background
Pathophysiology of corticotroph macroadenomas has not been elucidated. In this study, we present four cases of adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas with extensions to the third ventricle (TV) and investigate their clinical and pathological characteristics.

Case 1
A male in his seventies went to a hospital because of a fall. Upon performing computed tomography, a tumor was incidentally noted. Pituitary MRI revealed a macroadenoma with extension to TV. He presented with Cushingoid features (CF). His basal ACTH level was 112 pg/mL, and urinary free cortisol (UFC) was 129.1 μg/day. Cortisol was not suppressed in the 0.5 mg dexamethasone suppression test (0.5 mg DST). ACTH level increased in the corticotropin-releasing hormone (CRH) stimulation test and the desmopressin (DDAVP) stimulation test. He was diagnosed with Cushing's disease (CD), and endoscopic transsphenoidal surgery (ETSS) was performed. Pathological findings showed densely granulated corticotroph adenoma (DGCA). Somatostatin receptor type 5 (SSTR5) was negative, and ubiquitin-specific protease 8 (USP8) was not mutated.

Case 2
A female in her fifties had a visual field defect and pigmentation of the face. MRI revealed a macroadenoma with extension to TV. She presented with CF. Her basal ACTH level was 57.9 pg/mL, and UFC was 259.7 μg/day. Cortisol was not suppressed in the 0.5 mg DST. ACTH level increased in the CRH test and the DDAVP test. She was diagnosed with CD. Pathological findings showed DGCA. SSTR5 was moderate positive, and USP8 was suspected to be mutated.

Case 3
A female in her fifties had a throbbing headache. MRI showed a macroadenoma with extension to TV. She did not present with CF. Her basal ACTH level was 71.8 pg/mL, and UFC was 134.3 μg/day. Cortisol was not suppressed in the 0.5 mg DST. ACTH showed response to the CRH test and the DDAVP test. She was diagnosed with subclinical Cushing's disease (SCD) and sparsely granulated corticotroph adenoma (SGCA). SSTR5 was slightly positive, and USP8 was not mutated.

Case 4
A male in his fifties had general malaise and polyuria. MRI showed a macroadenoma with extension to TV. He did not present with CF. His basal ACTH level was 179 pg/mL, and UFC was 187.4 μg/day. Cortisol was not suppressed in the 0.5 mg DST. ACTH did not show response to the CRH test and the DDAVP test. He was diagnosed with SCD, and the tumor had oncocytic changes. SSTR5 was negative, and USP8 was not mutated.

Conclusion
The findings from these case reports suggest that phenotypes of CD and SCD are associated with the differences between SGCA and DGCA. Moreover, it is also suggested that USP8 mutations correlate with SSTR5 expression in macroadenomas that extend to the TV.
Presentation: No date and time listed
ODP306 Diplopia as Presenting Manifestation of Acromegaly
Authors: Rjoob Hani , VanUum Stan , Alexander Fraser J , Ohorodnyk Pavalo , Bursztyn Lulu , Mcinnis Rachel Lang 
Published: November 2022

Abstract

Introduction
Acromegaly is a chronic disorder characterized by excess growth hormone production, withclinical manifestations ranging from subtle signs to significant systemic complications. We describe a patient who presented with diplopia as initial symptom of acromegaly. Clinical case: A 72-year-old female patient was referred for diplopia. Upon questioning, she reported headache, muscle aches and heavy sweating. On physical assessment, she had coarse facial features, thickened tongue and hand enlargement. Orbital CT images revealed a mild to moderate symmetric enlargement of the extraocular muscle which spared myotendinous junction. MRI sella showed a 12 mm pituitary adenoma. The diagnosis of acromegaly was confirmed with high IGF-1 and oral glucose tolerance test. The patient underwent endoscopic debulking of the pituitary tumor and pathology showed a densely granulated GH producing adenoma. Upon follow up, she reported improvement of the diplopia which was completely corrected with prism glasses. Remission of acromegaly was confirmed biochemically and repeated MRI sella showed no residual tumor.

Conclusion
Acromegaly is the most likely cause of extraocular muscle enlargement with subsequent diplopia in this patient. Ocular manifestations in patients with acromegaly include visual field defect, excessive lacrimation, proptosis and double vision. This case adds to previous literature that diplopia could be the presenting manifestation of acromegaly. This is the first case reporting of improvement of diplopia following remission of acromegaly. Comprehensive ophthalmic assessment of patients presenting with eye symptoms and features suggestive of acromegaly is of value as it helps with early diagnosis as well as improving the outcome of this condition.
Presentation: No date and time listed
ODP308 Does This Patient Have Sheehan's Syndrome Due to Thrombosis?
Authors: Dawahir Wafa , Gilden Janice 
Published: November 2022

Abstract

Background
Sheehan syndrome (SS) is the necrosis of the anterior pituitary cells due to ischemia. The most common etiology is the result of postpartum hemorrhage, causing hypovolemia and decreased blood supply to an already enlarged pituitary gland, which occurs during pregnancy. Other less common causes are thrombosis, vasospasm, or compression on hypophysial arteries.

Clinical Case
A 35-year-old lady G1P1 was referred to Endocrinology Clinic for evaluation of secondary amenorrhea and infertility, and a desire for a second child. Prior to birth of her daughter, she had irregular menses every 30-90 days. She did not have excessive bleeding with delivery. However, she developed postpartum deep vein thrombosis, and was treated with enoxaparin for 1 year after delivery. Although she had no symptoms of hypopituitarism, she has not had a menstrual period since delivery of her child and does not exercise vigorously. She did not have symptoms or signs of PCOS. Upon evaluation, Factor V Leiden showed a heterozygous mutation, Estradiol14.98L[19.5-144.2 pg/mL], LH 2.3[ 1.9 - 26.2 mIU/mL], FSH 7.4[2.3 - 12.6 mIU/mL], FT4 1.3 [0.76 - 1.46 ng/dL],TSH 1.10[ 0.358 - 3.74uIU/mL], IGFI 182[ 53 - 331ng/mL], ACTH 12[ 0–47 pg/mL], am Cortisol 15.2[5.3 - 22.5 ug/dL],Testosterone18 [ 2–45 ng/dL],DHEA Sulfate58[35-430mcg/dL] Prolactin 5.7[&lt;25 ng/ml],with normal fallopian tubes on HSG. Pituitary MRI was done due to low estradiol with inappropriately normal FSH and LH and was normal. The patient was diagnosed with Hypogonadotropic deficiency leading to secondary amenorrhea, of unclear etiology, in the setting of possible hereditary caused thrombosis. The concern for hormonal therapy for a second pregnancy was whether this is safe and effective, given her history of DVT and factor V Leiden mutation.

Discussion and Conclusion
Previous studies have found that 82% of cases with SS were due to postpartum hemorrhage, but also suggests that there are other etiologies for SS. In addition, failure of lactation occurs in 67% of patients and secondary amenorrhea in 73% of patients, as in our case. However, the extent of pituitary involvement can vary, with abnormal GH and prolactin in 90-100% of cases, while abnormal TSH, Cortisol and GnRH in 50-100%. Although anti-phospholipid syndrome has been described as a possible etiology for hypopituitarism, related to formation of thrombi, our case suggests that other coagulopathies should be considered as a cause of partial pituitary dysfunction leading to hypogonadotropic hypogonadism, due to thrombus formation.
Presentation: No date and time listed
ODP316 Hyponatremia as a Prognostic Factor for Mortality in COVID-19 at The National Hospital "Dos de Mayo", Lima Peru.
Authors: Miranda Gonzalo , Uriarte Manuel Angel Jiménez , Velasquez Anggi July Tadeo 
Published: November 2022

Abstract

Introduction
Hyponatremia is the most common electrolyte disorder in hospitalized patients. It's more common in patients who were hospitalized with a diagnosed of pneumonia, which worsen the prognosis of the general condition. The infection in patients with SARS-CoV-2, can present hyponatremia, which would affect in a negativity way the recovery of them with mild, moderate or severe respiratory symptoms.

Objective
Establish if hyponatremia is a prognostic factor of mortality in patients with covid-19 diagnosis.Material and methods: The sample consisted of 185 medical records of patients with a COVID-19 diagnosis, which has been seen between June 2020 and February 2021 an observational, cohort and retrospective study. We recorded epidemiological, demographic, clinical, biochemical and radiological variables of SARS-CoV-2 infection and hyponatremia at the time of diagnosis during hospitalization. Descriptive analysis was used for main variables, Chi square tests, OR calculation and confidence interval were used to assess the statistical association of the variables. Finally, a logistic regression analysis was performed to evaluate confusing variables.

Results
160 patients have hyponatremia (34.9% mild, 26.7% moderate and 40% severe) and none of them had a previous diagnosis of SIHAD (Syndrome of inappropriate antidiuretic hormone secretion) consigned in their clinical histories. The increase of mortality was consigned (viewed) in patients with severe hyponatremia compared with moderate and mild hyponatremia diagnosed at hospital admission (20.8% mild hyponatremia, 21.6% moderate and 46.4% severe, p=0. 03)

Conclusion
Severe hyponatremia at hospital admission was associated with elevated mortality in SARSCoV-2 patients.
Presentation: No date and time listed
ODP317 Hypophysitis or No? A Rare Case of Bipolaris Fungal Sinusitis Causing Severe Pituitary Inflammation.
Authors: Aleman Lorianna , Burks James , Malik Sonika 
Published: November 2022

Abstract
Clinical case: A 28 year old male with uncontrolled diabetes mellitus presented to the hospital with severe, worsening holo-cephalic headache associated with fevers, light sensitivity which was unresponsive to pain medications. Initial CT of the brain showed severe paranasal sinus disease. Lumbar puncture was significant for elevated protein and cell count with neutrophilic predominance and negative CSF culture. Patient was empirically treated for meningitis. Due to no improvement in his symptoms, MRI brain with contrast was done that showed complete opacification of the left sphenoid sinus with partial opacification of the ethmoid sinus. Of note, heterogeneous enlargement and enhancement of pituitary gland including portion of distal infundibulum was seen with mild compression of optic chiasm. High dose dexamethasone was initiated. Pituitary workup revealed preservation of all axes including AM cortisol 36.5 mcg/dL (6.6mcg/dl- 33 mcg/dl), prolactin 2.9 ng/ml (2.1ng/ml-17.7ng/ml), TSH 1.4 uIU/mL (0.34-5.6 uIU/mL), FT4 0.99 uIU/mL (0.80-1.80 uIU/mL) with normal serum chemistry and hemodynamics. Repeat MRI brain showed sphenoid pyomucocele with infection extending to the sella, cavernous sinuses and anterior/middle cranial fossas. ENT surgery was emergently performed with surgical debridement of the sphenoid and ethmoid sinuses revealing green cement like debris causing posterior septal perforation from the pressure. Interestingly, ethmoid sinus fluid culture grew Bipolaris fungal species. Patient's condition gradually improved and he was discharged on oral itraconazole with steroid taper. The patient did not develop signs or symptoms of hypophysitis during his hospital course.
Presentation: No date and time listed
ODP323 Increased Serum High-Sensitivity C-Reactive Protein Levels in Adult Growth Hormone Deficient Patients with Non-Functioning Pituitary Tumors
Authors: Seki Yasufumi , Takano Noriyoshi , Yamashita Kaoru , Bokuda Kanako , Sasaki Nobukazu , Ishikawa Toru , Kimura Miwa , Watanabe Satoshi , Watanabe Daisuke , Morimoto Satoshi , Ichihara Atsuhiro 
Published: November 2022

Abstract

Background
Growth hormone (GH) deficiency, a common endocrine deficit in non-functioning pituitary tumors, causes visceral obesity and fatty liver and increases cardiovascular event risks. High-sensitivity C-reactive protein (hs-CRP) has been used as a useful marker to estimate cardiovascular event risks. Because GH supplementation therapy was reported to decrease serum hs-CRP levels in GH deficient patients, inflammatory processes might be activated in GH deficient state, however, the underlying mechanism has been still unknown.

Patients and Methods
We retrospectively reviewed charts of 134 patients with non-functioning pituitary adenoma and Rathke's cysts who underwent preoperative GH-releasing peptide-2 (GHRP-2) tests and investigated the association between serum hs-CRP levels and background characteristics. Patients who had a history of pituitary surgery, severe renal insufficiency or active inflammatory diseases or received GH supplementation therapy were excluded. GH secretion was determined by GHRP-2 tests.

Results
Among 134 patients (94 NFPA and 40 Rathke's cysts), 46 (34%) presented severe GH deficiency, as diagnosed using GHRP-2 tests. Serum hs-CRP levels were significantly higher in the patients with severe GH deficiency than in those without severe GH deficiency (723 [299-1285] vs 278 [124-561] ng/mL, P &lt; 0. 001). Serum hs-CRP levels were significantly higher in men (P = 0. 003) and in patients with diabetes mellitus (P = 0. 040) and were significantly correlated with age (r s = 0.19, P = 0. 039), body mass index (r s = 0.37, P &lt; 0. 001), serum levels ofgamma-glutamyl transpeptidase(r s = 0.28, P = 0. 001), creatinine (r s = 0.30, P &lt; 0. 001), low-density lipoprotein cholesterol (r s = 0.21, P = 0. 013), triglyceride (r s = 0.38, P &lt; 0. 001) and free thyroxine (r s = -0.30, P= 0. 001), blood hemoglobin A1c levels (r s = 0.20, P = 0. 018), peak GH response to GHRP-2 (r s = -0.47, P &lt; 0. 001) and IGF-1 SD score (r s = -0.18, P = 0. 040). In the multiple regression analysis, peak GH response to GHRP-2 was a significant variable for determining serum hs-CRP levels (β = -0.340, P = 0. 003) after adjustment with age, sex, BMI, smoking, alcohol consumption, hypertension, diabetes mellitus, serum levels ofgamma-glutamyl transpeptidase, creatinine,triglyceride and free thyroxine and adrenal function.

Conclusion
We observed a significant association between GH deficiency and increased serum hs-CRP levels independent to BMI and liver dysfunction. GH deficient state might cause inflammation independent to development of visceral obesity and fatty liver.
Presentation: No date and time listed
ODP324 Internal Carotid aneurysm inside a pituitary macroadenoma: case study and literature review
Authors: Rabiei-Flori Elham , Farhad Hasan 
Published: November 2022

Abstract
BACKGROUND: Coexisting pituitary adenoma (PA) and intracranial aneurysms (IA) is relatively frequent. However, the finding of an aneurysm inside a PA is extremely rare. We report a patient with pituitary macroadenoma with an embedded internal carotid artery (ICA) aneurysm, who presented with anterior hypopituitarism. CLINICAL CASE: 73 y. o. black female presented after a fall secondary to orthostastic hypotension. In the ER her BP was 78/50 mmHg, HR 76/min sinus rhythm. She reported fatigue, presyncope, and 20 lbs weight loss in the preceding 3 months. CT head without contrast showed a sellar mass. Pituitary MRI confirmed a 20×24×29 mm sellar mass consistent with a macroadenoma extending laterally to both cavernous sinuses with bilateral encasement of ICAs, superiorly elevating optic chiasm, and mild extension to the left Meckel's cave. The study also incidentally showed a &gt; 5 mm ICA aneurysm embedded within the macroadenoma. Diagnostic cerebral angiogram demonstrates a medially directed left superior hypophyseal ICA aneurysm measuring 5.4×4. 0 mm with a 3.5 mm neck. The patient denied headaches, peripheral vision loss, or polyuria. On examination her weight was 154 lbs, height 5'6", normal visual field testing, and no neurologic deficits. Endocrine testing was consistent with anterior hypopituitarism: ACTH 17 pg/mL (10-48), Cortisol 4.7 mcg/dL (6-18.4), TSH 1.4 mIU/L (0.4- 4. 0), FT4 0.7 (0.7-1.9 ng/dL), IGF1 7 ng/mL (55-162), Prolactin 38.3 ng/mL (4.8- 23.3), and FSH 6.6 IU/mL (20-138). Clinical improvement followed hydrocortisone and levothyroxine replacement. Patient was discharged home with a plan for outpatient endocrine follow up and subsequent endovascular intervention. Unfortunately, she presented a few weeks later with pulmonary embolism, for which she was treated with Eliquis. Given high risk of bleeding, the plan for endovascular embolization was postponed. Patient was educated about sick day rules and is set for routine endocrine visit and periodic MRI surveillance of the macroadenoma. DISCUSSION: intracranial aneurysms appear to occur more frequently in association with PAs than among the general patient population. In 2 cohort of patients with PA, 5.4-7.3% had coexisting IAs, the majority of which are outside the pituitary region. However, the presence of an aneurysm embedded within a PA, as in our case, is very rare, and most are discovered by accident. In such cases, although spontaneous aneurysm rupture or pituitary apoplexy is extremely rare, misdiagnosis of the embedded aneurysm can potentially result in catastrophic outcomes if it is not appropriately recognized and addressed prior to pituitary surgery. Cerebral angiography with embolization or coiling of the aneurysm prior to hypophysectomy can decrease the risk of perioperative rupture or bleeding. In our case, given the risk of bleeding while on anticoagulation therapy, the plan for endovascular intervention was postponed.
Presentation: No date and time listed
ODP330 Long-term Effects of Prenatal Undernutrition on Hypothalamic KNDy Gene Expression in Female Rats
Authors: Minabe Shiori , Iwata Kinuyo , Watanabe Youki , Ozawa Hitoshi 
Published: November 2022

Abstract
Accumulating evidence suggested that the nutritional environment during development periods induces metabolic programming, leading to metabolic disorders and detrimental influences on human reproductive health. The purpose of this study was to determine whether intrauterine malnutrition has a long-term adverse effect on a reproductive center, kisspeptin-neurokinin B-dynorphin A (KNDy) neurons in the hypothalamic arcuate nucleus (ARC) of the female offspring. In female offspring from 50% undernutrition (UN) dams, first virginal estrus tended to be advanced, and hypothalamic neurokinin B gene (Tac3) expression was increased in adolescents. Conversely, the UN caused the significant suppression of ARC kisspeptin (Kiss1) and Tac3 gene expression after 29 weeks of age. These results suggested that intrauterine undernutrition stress caused developmental programming in KNDy neurons, which changed in their gene expression depending on life stages. Furthermore, our data showed obesogenic effects of prenatal undernutrition in the female rats; UN offspring showed low birth weight, rapid catch-up growth at four weeks of age, visceral fat accumulation, and an increase in calorie intake and plasma triglyceride levels at adulthood. The current study demonstrated that intrauterine undernutrition affected hypothalamic developmental programming in female rats, which induced long-term effects on hypothalamic KNDy gene expression and could influence metabolism and reproductive function later in life.
Presentation: No date and time listed
ODP339 Nonfunctioning Giant Adenomas
Authors: Oliveira Miriam C , Nesello Alberto C , Pereira-Lima Ana Paula S , Rech Carolina GSL , Pereira-Lima Julia Fernanda S , Corso Eduardo Raul B 
Published: November 2022

Abstract

Introduction
Giant pituitary tumors (GA), those with 4 cm or more on the largest axis, exhibit extension beyond the sella turcica and invade structures adjacent to it.

Objectives
To evaluate demographic, clinical, and imaging variables in a cohort of nonfunctioning GA(NGA) patients.

Methods
We conducted a retrospective and observational study of patients with NGA followed in our tertiary center between 2005 and 2021. We evaluated variables related to diagnosis, treatment, and follow-up.

Results
We found 48 patients diagnosed with NGA. Most patients were men (n=35, 73%), and meanage at diagnosis 55.5 ± 11.8 years (35-83). Symptoms such as headache and visual alteration were present within 13 years of diagnosis. The BMI was higher than 30 in 10 cases, two with morbid obesity. Among the comorbidities, 10 patients had diabetes mellitus and one glucose intolerance; hypertension was present in 20 cases and depression in 7. Polymedication was verified in 20 patients. Pituitary MRI revealed the largest tumor axis between 4-4.9 cm in 33 patients, 5-5.9 cm in 9, and equal or greater than 6 cm in 6. In 14 cases, there was intraventricular extension, invasion of the sphenoid sinus in 11, cavernous sinus in 21, frontal lobe in 1, temporal region in 6, clivus in 3, retroclivus in 3, and rhinopharynx in one. Hyperprolactinemia was detected in 17 cases (maximum value: 70.8 ng/mL). Only three patients presented all hormonal axes intact. Respectively, 9, 15, 11, and 8 patients presented 1, 2, 3, or 4 deficient axes. Hypocortisolism was present in 18 cases, GH deficiency in 16, hypothyroidism in 32, hypogonadism in 35, and hypoprolactinemia in 3. Four patients had diabetes insipidus. Ten cases of the 44 who underwent surgery underwent two interventions and 4 cases, 3. Nine patients underwent radiotherapy. After the first surgery, 26 patients had follow-up greater than 12 months (13 to 214 months). The last image showed a giant lesion in 7 cases, macroadenoma with a larger axis less than 4 cm in 15 cases, a lesion restricted to the sella in 3 cases, and 1 case without lesion.

Conclusion
In our cohort, the results show the handling difficulty of NGA, determined by the complex removal of the lesion, high degree of invasion to adjacent structures, and tumor regrowth. Sequential therapeutic decisions in this group of patients require a qualified multidisciplinary team to maximize the patients’ life expectancy and quality of life while working on sharing experiences and investing in the tumor molecular characterization and new molecules that add to the poor therapeutic arsenal available.
Presentation: No date and time listed