bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBSAT308 A Tale Of Two Endocrinopathies: Hyperthyroidism And Hypophysitis In A Case of Metastatic Melanoma
Authors: Loughner Chelsea L , Mahmood Ejaz 
Published: November 2022

Abstract
Introduction: Several endocrinopathies have been associated with immunomodulator therapy, including hyperthyroidism, hypophysitis, and adrenal insufficiency. However, there have not yet been reports of more than one endocrinopathy in a single patient undergoing treatment with these agents. Clinical case: A 35 year old male was referred to Endocrinology after labs revealed hyperthyroidism. He had recently been diagnosed with melanoma that had metastasized to the liver and had been receiving dual immunotherapy with Nivolumab and Ipilimumab for 2 months. Routine labs from Oncology revealed TSH 0. 005 mIU/L (n 0.358-3.740 mIU/L), free T4 2.23 ng/dL (n 0.89-1.76 ng/dL), and total T3 232.3 ng/dL (n 60. 0-181. 0 ng/dL). Dual immunotherapy was discontinued given these findings. When he presented to Endocrinology, he endorsed nausea, vomiting, and chills. He was started on propranolol and a thyroid uptake scan was ordered. Two weeks later, the patient was unable to complete imaging due to fatigue, nausea, vomiting, and extremity pain. Labs at that time revealed PM cortisol 0.69 mcg/dL (n 3.44-16.76 mcg/dL), plasma ACTH &lt;5 pg/mL (n 6-50 pg/mL), testosterone 74.5 ng/dL (n 123.1-813.9 ng/dL), prolactin 20.2 ng/mL (n 2.1-17.7 ng/mL), LH 9.80 mIU/mL (n 1.5-9.3 mIU/mL), and FSH 5.3 IU/L (n 1.4-18.1 IU/L). Interestingly, the patient's TSH and free T4 continued to reveal hyperthyroidism. A pituitary MRI demonstrated a 9 mm hypoechoic area at the posterior aspect of the pituitary. Given the lab and imaging findings, a diagnosis of hypophysitis was made. The patient was started on glucocorticoid therapy with good response. Over the next several months, a slow prednisone taper was initiated. Thyroid function returned to baseline normal values. He continued to be followed by Oncology for surveillance but has not been restarted on immunotherapy. Clinical lesson: Although there have been several reports of hyperthyroidism or hypophysitis in response to immunotherapy, this is the first reported case of a patient with dual endocrinopathies associated with immune modulator inhibition.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
ODP083 Burosumab Treatment for Fibrous dysplasia/McCune-Albright Syndrome with Severe Spine Deformity
Authors: Sato Tetsuhiko , Azuma Yoshinori , Tauchi Ryoji , Matsushita Masaki , Ozone Chikafumi 
Published: November 2022

Abstract

Introduction
Fibrous dysplasia/McCune-Albright Syndrome (FD/MAS) is a rare multi-endocrine disorder with bone abnormalities called polyostonic fibrous dysplasia, presumably related to fibrous growth factor 23 (FGF23). We present a case of a patient with FD/MAS who successfully underwent spinal fusion surgery after efficacious anti-FGF23 treatment using its monoclonal antibody (burosumab).

Clinical Case
A late teenage boy, clinically diagnosed with FD/MAS, was referred to our hospital for possible treatment of burosumab, because he desperately needed promising medical intervention for bisphosphonate-resistant severe polyostonic fibrous dysplasia with enormously high turnover bone disease. On presentation, he had severe scoliosis (&gt;80 degree-thoracic spine curve) with mild hypophosphatemia (2.5 mg/dL), low 25-hydroxyvitamin D (7.3 ng/mL), normal corrected calcium (9.6mg/dL) and high intact PTH (95.7 pg/mL). His FGF23 level was 90.4pg/mL, which was inappropriately high. He had a history of previous bilateral hip fractures with partially removed Café au macules on the back. Baseline laboratory findings revealed no remarkable signs of endocrinopathies, whereas serum bone markers were remarkably high (tartrate-resistant acid phosphatase 5b, &gt;1500 mU/dL; procollagen type 1 N-propeptide, &gt;1200 ng/mL, alkaline phosphatase, 2638 U/L). He was started on monthly 50mg of burosumab therapy subcutaneously. Interestingly enough, his alkaline phosphatase levels gradually decreased down to 1619 U/L at month 6 post-anti-FGF23 treatment. Subsequent spine fusion surgery was successfully underwent with his thoracic curve corrected by instrumentation.

Discussion
This is, to our knowledge, the first case with FD/MAS, who was given monthly burosumab, followed by orthopedic spinal instrumentation to straighten the spine curve. Burosumab treatment for FD/MAS may enhance bone flexibility by blocking abnormal FGF23-related signaling, enabling safer approach to promising orthopedic surgeries.
Presentation: No date and time listed
ODP089 Familial correlation and heritability of muscle strength in Korean adults (KNHANES 2014-2019)
Authors: Hee Ahn Seong , Cho Yongin , Hong Seongbin , Kim So Hun , Park Eun Byeol , Seo Da Hea , Seo Seongha , Ju Seo Young 
Published: November 2022

Abstract

Objective
The onset and progression of sarcopenia are highly variable between individuals due to genetic and environmental factors. However, studies that have measured muscle strength directly in large numbers of matched parent-adult offspring pairs are limited. In this study, we investigated familial correlation and heritability of handgrip strength (HGS) in Korean adults.

Methods
This was a family-based cohort study from the Korea National Health and Nutrition Examination Survey (2014-2019) including 5,004 Koreans aged ≥19 years from 1,527 families. HGS was measured using a digital grip strength dynamometer. Familial correlations for HGS were calculated in different types of relative pairs. Variance component methods were used to obtain heritability estimates.

Results
Mean HGS of parents were 39.3 ± 7.5 kg in fathers and 24.4 ± 5. 0 kg in mothers and those of offspring were 41.8 ± 8. 0 kg in sons and 24. 0 ± 4.8 kg in daughters. Correlation coefficient estimates between parent-offspring pairs, sibling pairs, and spouse pairs for HGS were significant as 0. 07, 0.10, and 0.23 (p &lt;0. 001, p = 0. 041, and p &lt;0. 001), respectively. The total variance of the phenotype under study was explained by additive genetic (15.4%), common shared environmental (11. 0%), and unique environmental (73.6%) influences. The risk of low HGS conferred by parents’ low HGS were found to be significant for individuals whose parents had low HGS (OR 3.10, 95%CI 1.14-8.45).

Conclusion
Muscle strength showed a familial correlation in Korean adults. A significant heritable tendency of muscle strength from parents to their adult offspring and common shared environmental influence can explain this correlation.
Presentation: No date and time listed
ODP092 Guideline Adherence for Age-based Screening of Osteoporosis in Men at a Veterans Affairs Medical Center
Authors: Alsamarraie Henin , Clark Alexandra 
Published: November 2022

Abstract

Background
Osteoporosis is one of the leading causes of morbidity and mortality in older women and men. Men with osteoporosis have higher fracture-related morbidity and mortality rates compared to women, but screening rates in men remain much lower. Moreover, there is limited veteran-specific data despite the suggestion that veterans may be at higher risk for osteoporosis. (1) Objective: To assess current dual energy X-ray absorptiometry (DEXA) ordering practices within a veteran cohort. Design: A retrospective cohort study of male veterans aged71-75 years who were evaluated by a primary care provider (PCP) within the last 5 years (n = 13,174).

Results
DEXAs wereordered for ∼7% of the population (920/13,174), and 91.6% were completed (843/920). Over 60% of completed DEXAs were ordered due to the presence of risk factors (308/843, 36.5%), history of fractures (60/843, 7%), known osteopenia or osteoporosis (59/843, 7%), or osteopenia mentioned on another imaging modality (78/843, 9.3%), while only 33.5% (282/843) were ordered for screening purposes. Of those with DEXA results reported (838/843, 99.4%), 34.5% (289/838) were normal, 51% (427/838) were in the osteopenia range and 14.5% (122/838) were in the osteoporosis range. Regarding DEXAs obtained for screening purposes, 42% (118/282) were normal, 48% (136/282) were in the osteopenia range, and 10% (28/282) were in the osteoporosis range.

Conclusions
Despite the Endocrine Society and National Osteoporosis Foundation recommending screening men aged ≥70 years, less than 10% of male veterans eligible for osteoporosis screening based on age alone had a DEXA scan. Of those male veterans who received a DEXA for screening purposes, almost 60% were found to have an abnormal result. The lack of screening for osteoporosis in this population has the potential to worsen the disparity in bone health between men and women, and between veterans and non-veterans, making it difficult to determine the scope of a problem which has the potential to cause significant morbidity and mortality.

References
1. Nahm ES et al. Osteoporosis Preventive Practice Between Veteran and Nonveteran Older Adults: Findings From Patient-Reported Data. Orthopedic Nursing. 2016 Nov/Dec;35(6): 401-410.
Presentation: No date and time listed
ODP096 Hypercalcemia Secondary to Vitamin D Supplementation with Normal 25-Hydroxyvitamin D Level in an Elderly Female - Case Report
Authors: Arora Gunjan , Patel Toral 
Published: November 2022

Abstract

Case presentation
A 92-year-old female with a history of heart failure, dementia (alert and oriented to time, place and person at baseline), osteoporosis and hypothyroidism presented to the emergency department with altered mental status and constipation. She was oriented to time and person only. Labs included: WBC count 6.2 (4 - 11k/mm cu), Creatinine 1.23 (0.6 - 1.2 mg/dL), Calcium 12.8 (8.6 - 10.3 mg/dL), Albumin 3.9 (3.5 - 5.7 g/dL) and Glucose 94 (70 - 99 mg/dL). CT head showed no acute abnormality. Medication reconciliation revealed that she was taking Cholecalciferol (Vitamin D3) 2000 units daily, which was held. Intravenous fluids were started and further workup was done: PTH &lt; 6 (12 - 88 pg/mL), serum 25 Hydroxyvitamin D 45.1 (30 - 100 ng/mL), serum 1, 25 Dihydroxyvitamin D 79 (19.9 - 79.3 pg/ml) and PTHrP 2.6 (0 - 3.4 pmol/L). Endocrinology was consulted for management of PTH independent hypercalcemia and recommended Zoledronic acid. Serum calcium levels normalized with bisphosphonate therapy and withholding of Vitamin D3 supplementation in addition to symptomatic improvement. Repeat 1-25-Dihydroxyvitamin D level decreased to 38.3 pg/mL while repeat PTH normalized at 20.8 pg/mL. Subsequently, serum calcium levels remained within normal limits, and she was discharged.

Discussion
Vitamin D, the "sunshine Vitamin", has claimed much fame and popularity for its varied benefits. With a growing user base, there is concern for potential adverse effects, primarily involving the population with an underlying propensity for hypercalcemia. According to the NIH, the safe upper limit of daily Vitamin D intake is 4000 IU; however, for adults &gt; 70 years of age, 800 IU is the recommended dose. Our patient was taking 2000 IU (almost 2.5 times the recommended dose) of Vitamin D3, the most potent form which raises Vitamin D levels twice as fast as Vitamin D2. In addition, her serum 1,25 Dihydroxyvitamin D levels normalized when supplementation was withheld pointing to a cause - effect relationship and thus, effectively ruling out an endogenous source. Moreover, other factors such as prolonged duration of supplement intake, advanced age, immobility, osteoporosis and hypothyroidism contributed to her hypercalcemia. Current review of literature suggests that serum concentrations of 25-Hydroxyvitamin D at which hypercalcemia arises remains undefined. With this case, we wish to emphasize that a holistic approach should be utilized to advise patients regarding Vitamin D supplementation considering pre-existing risk factors for hypercalcemia, concurrent medical conditions, diet and functional status. Although current guidelines detail the ideal dosage and duration of Vitamin D supplementation therapy for different sectors of population, streamlining and individualizing therapy to mitigate potential harm to patients is pivotal.
Presentation: No date and time listed
ODP097 Hyperparathyroidism as a major risk factor of fracture and its prevalence in patients with hip fracture
Authors: Tan Lok Yi Joyce , Asri Nur Atikah Mohd 
Published: November 2022

Abstract

Introduction
Hyperparathyroidism is a risk factor of osteoporosis. Excess parathyroid hormone (PTH) accelerates bone loss via bone reabsorption and increases the risk of fragility fracture. Fragility fractures are associated with serious consequences in older patients. [1] This study aimed to look at the prevalence of hyperparathyroidism and vitamin D deficiency in geriatric patients (age &gt;60) who presented with hip fractures in an Irish tertiary hospital.

Methods
Data was collected from Irish hip fracture Database (IHFD) and the Ortho-geriatric Electronic Patient Medical System (EPMS) between July 2019 and April 2020 (n=207). Demographic data and bone health profile (PTH, Vitamin D, and Calcium) were analysed using SPSS for statistical analysis.

Results
The median age of patients was 81 years (SD 8.7), and 68.3% of patients were female. Median 10-year probability of major osteoporotic and hip fracture risk is 22.5% and 12.2%, respectively. 29.9% was diagnosed with hyperparathyroidism with prevalence of primary and secondary hyperparathyroidism of 6.7% and 23.1%, respectively. The majority of these (87.3%) were normocalcaemic hyperparathyroidism. 50.7% were vitamin D deficient, with 11.5% being severely deficient (Vitamin D &lt;20nmol/L).

Conclusion
The prevalence of hyperparathyroidism is higher in the hip fracture group than in the general population. [2] Vitamin D deficiency is also prevalent in this group. FRAX score indicated significant proportion of patients with high major osteoporosis and hip fracture risks. Routine bone health profile checks in this high-risk group allow early identification and management of hyperparathyroidism and vitamin D depletion, which can potentially reduce the risk of future fracture. Reference: 1. Bukata SV, DiGiovanni BF, Friedman SM, Hoyen H, Kates A, Kates SL, Mears SC, Mendelson DA, Serna Jr FH, Sieber FE, Tyler WK. A guide to improving the care of patients with fragility fractures. Geriatric Orthopaedic Surgery & Rehabilitation. 2011 Jan;2(1): 5-37.2. Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Jin J, Monteiro R, Mino J, Swagel W, Mitchell JC. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013 Dec 1;154(6): 1232-8
Presentation: No date and time listed
ODP107 Oral Ulcerations, A Rare Side Effect of Intravenous Zoledronic Acid
Authors: Del Mar Morales Hernandez Maria , Ghayee Hans Kumar , Kadiyala Sushma , Xhikola Majlinda 
Published: November 2022

Abstract

Introduction
Zoledronic acid is an intravenous bisphosphonate known for its anti-resorptive effects and osteoporotic fracture risk reduction. A common adverse reaction with this medication is mild to moderate flu-like symptoms, which are transient and attributed to an acute phase reaction post treatment. A less common side effect, of oral ulcers is associated with oral bisphosphonates, attributed to incorrect oral intake but the real mechanism is still not well understood. We present a patient that developed oral ulcers after use of both oral and intravenous bisphosphonates, leading to suspicion of other underlying mechanisms other than incorrect oral intake of bisphosphonates.

Case Report
We present a 73 year old male with history of mild primary hyperparathyroidism and osteoporosis. Patient opted for medical management of his mild primary hyperparathyroidism in addition to having non-localizing studies. Treatment for osteoporosis was recommended due to femoral neck T score -2.4, FRAX score of 3.3% risk for hip fractures and history of low impact right foot fracture. The primary care team started treatment with alendronate 70 mg once a week, but patient developed oral blisters within a week of starting the treatment. Stopping alendronate led to resolution of the oral symptoms without any additional supportive treatment. Patient was later started on intravenous zoledronic acid, attributing the previous history of oral ulcers to a local effect of the oral bisphosphonates. Two days after the zoledronic acid infusion patient developed fatigue, fever, and oral ulcers. The oral ulcers were described as painful, located at the base and lateral aspects of the tongue. The ulcers later progressed to the buccal mucosa. No gingival ulcers were reported. Development of the oral blisters led to significant discomfort in eating and talking. Patient was treated with liquid nystatin 10,000 units/mL and lidocaine 2% viscous liquid. Patient had resolution of the painful ulcers approximately 2 weeks after the initial appearance. No recurrence of the oral ulcers has been reported, 4 months post treatment with zoledronic acid.

Discussion
Intuitively oral bisphosphonate induced mucosal injury is thought to be related to direct contact of the tablet with the oral mucosa or inappropriate ingestion of the medication and is not thought to be a systemic reaction. Our patient developed oral ulcers from both oral and intravenous bisphosphonates suggesting a possible systemic mechanism involved. Understanding potential side effects such as mucosal injury from intravenous bisphosphonates will be helpful for patient education and timely care.
Presentation: No date and time listed
ODP108 Palovarotene for the Treatment of Fibrodysplasia Ossificans Progressiva: Methodology of the Phase III Open-Label PIVOINE Rollover Trial
Authors: Artyomenko Alex , Houchard Aude 
Published: November 2022

Abstract

Objectives
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder characterized byheterotopic ossification (HO) and progressive restriction of mobility. To date, no approved disease-modifying treatments for FOP exist, but interim phaseIII MOVE trial (NCT03312634) results suggest marked efficacy for palovarotene (PVO). 1 The PIVOINE rollover trial (NCT05027802) has been designed to allow treatment continuity and further evaluation of PVO safety and efficacy; the methodology is given here.

Methods
Patients will receive 5 mg PVO daily, or the parent study completion dose, for a maximum of 3 years; during flare-ups, patients will receive 20 mg daily for 4 weeks, then 10 mg daily for 8 weeks. Enrollment criteria: completion of a parent study (end of study/treatment visit of NCT03312634 or NCT02279095/NCT02979769), ≥14 years of age, full skeletal maturity if aged &lt;18 or deemed to be final adult height. PIVOINE aims to enroll 61 patients; recruitment has not begun. The primary outcome will be the incidence and description of all treatment-emergent adverse events, collected continuously over the study period. Secondary outcomes (collected every 6 months; reported as raw values and change from the inclusion visit for outcomes specified by *) include: range of motion* (using Cumulative Analogue Joint Involvement Scale total score), the use of aids, assistive devices and adaptations*, physical function* (using adult form of the FOP-Physical Function Questionnaire; total score and upper extremities and mobility sub-scores), the frequency of healthcare utilization, and physical and mental health* (using Patient Reported Outcomes Measurement Information System Global Health Scale). Lung function will be assessed via observed and percentage predicted (PP) forced vital capacity (FVC)*, forced expiratory volume in 1 second (FEV 1)*, diffusion capacity of the lung for carbon monoxide*, and the absolute and PP FEV 1 /FVC ratio*. The number of investigator-reported flare-ups*, including duration and outcomes, will be reported along with the percentage of patients with new bone growth.

Summary
Results from PIVOINE, estimated to end in November 2024, will allow further evaluation of PVO in FOP.

References
1. Pignolo R et al. ASBMR 2020;35(Suppl 1): 16–17 Funding: Sponsored by Ipsen.
Presentation: No date and time listed
ODP111 PERSISTENT TERTIARY HYPERPARATHYROIDISM AFTER TOTAL PARATHYROIDECTOMY AND KIDNEY TRANSPLANTATION: THE CASE OF THE SUPERNUMERARY GLANDS
Authors: Grigorie Daniel , Sucaliuc Alina , Tacu Dorina 
Published: November 2022

Abstract

Secondary hyperparathyroidism in patients with kidney failure and hemodialysis usually resolves after total parathyroidectomy or kidney transplantation.

Case report
We report a case of a 53 year-old women polycystic kidney disease diagnosed at the age of 32, with end-stage renal disease and hemodialysis between 45-51 yrs. At the age of 50 she developed hypercalcemia (10.4-10.8 mg/dl) with very high PTH levels of 1100 pg/ml, and was referred forparathyroidectomy. Intraoperatively the four parathyroid glands were identified in canonical sites and a total parathyroidectomy was performed; postoperative total serum Calcium 8.9-9.6 mg/dl, PTH 510-680 pg/ml, suggesting the presence of a functional remnant parathyroid tissue. One year later she underwent kidney transplantation, immediate preoperative serum Calcium 10.4 mg/dl. 2 yrs later, she was referred to our clinic for hypercalcemia (11.8-12.5 mg/dl; increasing 5 mo post-transplant), high serum PTH 229-316 pg/ml) and low bone mass (lumbar spine T-score = -4.4 DS, femoral neck T-score = - 2.6 DS). She was asymptomatic and the biochemistries were: total serum calcium 12.8 mg/dl (11.8 mg/dl after hydration), serum PTH 228 pg/ml, hypophosphatemia 1.9 mg/dl, Alkaline Phosphatase 102 U/l, creatinine 1.13 mg/dl (0.85 mg/dl after hydration). 99m Tc-sestamibi SPECT-CT imaging revealed an ectopic hyperfunctional parathyroid gland above pulmonary artery bifurcation. Waiting for surgical decision, the patient was treated with denosumab 60 mg, lowering serum Calcium at 11 mg/dl at 1 mo, 11.5 mg/dl at 3 mo, PTH 511 pg/ml.

Conclusion
This case illustrates the needfor more accurate preoperative localization of abnormal parathyroid glands in patients with tertiary hyperparathyroidism besides the standard 4-gland exploration.
Presentation: No date and time listed