bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP068 A Case Report of Nivolumab Associated Hypercalcemia
Authors: Sherpa Chheki , Shrestha Bishow , Singh Vinita 
Published: November 2022

Abstract

Introduction
Nivolumab is a human immunoglobulin G4 (IgG4) antibody which binds to programmed cell death receptor-1 (PD-1) and blocks the binding of PD-1 to either the PD-ligand 1 (PD-L1) or PD-L2 expressed on the surface of cancer cells. It has been approved for the treatment of melanoma, non-small cell lung cancer, renal cell carcinoma etc. Various endocrine immune-related adverse events including thyroiditis, hyper- and hypothyroidism, hypophysitis and type 1 diabetes has been described. We report a case of Nivolumab associated hypercalcemia.

Case presentation
67-year-old female with history of CKD stage 3 with secondary hyperparathyroidism, melanoma of right ankle was admitted after one month of receiving the first dose of Nivolumab for her melanoma. She had altered mentation with elevated corrected calcium of 15.94(8.4-10.2) mg/dl. Prior calcium levels were in low to normal range, eGFR was 13, creatinine elevated at 3.4 (0.57-1.11) mg/dl, PTH 84 (10-65) pg/ml, 25 OH vitamin D 54 (30-74) ng/ml, Phosphorus normal, Magnesium normal, 1,25-OH vitamin D was elevated at 103(18-72) pg/ml, PTHrp normal, normal SPEP, normal TSH, no history of fractures, normal DXA, no history of kidney stones, not on any calcium supplements, not on thiazide or lithium. Chest x ray and NM full body PET CT did not show any evidence of granulomatous disease except for recurrence and metastasis of melanoma in right thigh, calf, and ankle. No family history of kidney stones or hypercalcemia. Patient was treated with IV fluids and Calcitonin. Her calcium quickly improved to 9.9 within 48 hours. Within 3 weeks of discharge, she was readmitted for elevated calcium of 14.4 mg/dl, creatinine 2.29 mg/dl, eGFR 21, PTH 96 pg/ml, Mg 1.8 (1.6-2.6) mg/dl. She was treated with IV fluids and calcitonin and calcium normalized within 48 hours. Parathyroid scan did not show any parathyroid adenoma. She was started on prednisone for possible Nivolumab associated immune adverse reaction. She was also briefly treated with cinacalcet which was discontinued. Prednisone was tapered and then stopped over the course of 6 weeks. Calcium remains normal. PTH remains slightly elevated which is thought to be due to secondary hyperparathyroidism from CKD. Normal cortisol level.

Discussion
This is likely a case of Nivolumab associated hypercalcemia given the onset soon after immunotherapy initiation and improvement with glucocorticoid therapy. Immunotherapy was not resumed after the first dose due to recurrent severe hypercalcemia. The patient is currently under surveillance for melanoma. Calcium level remains normal. Although it is rare, a few cases of Nivolumab associated hypercalcemia have been reported previously. Exact mechanism is not known but it has been speculated that macrophage activation by Nivolumab can cause increased level of 25(OH) D-hydroxylase with increased conversion of 25-OH vitamin D to 1,25-OH vitamin D resulting in calcitriol mediated hypercalcemia.
Presentation: No date and time listed
ODP117 Pseudohypoparathyroidism Type IB: A Rare Cause of Hypocalcemia
Authors: Encarnacion Dionardo Medina , Sharma Brihant , Malik Maham , Sood Aayushi , Syed Omar , Khattar Khyati 
Published: November 2022

Abstract

Introduction
Pseudohypoparathyroidism (PHP) describes disorders of hypoparathyroidism that are the result of resistance of target tissues to the actions of parathyroid hormone (PTH). Studies have estimated the prevalence of PHP to be 0.34 in 100,000 in Japan and 1.1 in 100,000 in Denmark. The first biochemical abnormalities to become apparent are elevated serum levels of PTH and elevated serum levels of phosphorus, followed by hypocalcaemia. We present a patient diagnosed with PHP Type 1B (PHP1B), which was presented to us many years after her initial diagnosis, with other major comorbidities now present.

Case description
This patient is an 81 year old female presenting to the clinic to discuss her previously diagnosed PHP1B. Her past medical history revealed she began having symptoms of intermittent muscle cramping at the age of 22, followed by carpopedal spasms and periorbital paresthesia a year later. She has also had a physical examination significant for a positive Trousseau sign, but no phenotypical signs of Albright hereditary Osteodystrophy (AHO). Lab evidence from 1977 was recovered showing urinary cyclic AMP level &lt;20 nmol/mg after administration of PTH, consistent with PHP1B. The family history in her parents and children has revealed no similar genetic history so far. Other comorbidities she has developed since her diagnosis are hypokalemia, hypothyroidism, osteoporosis with a femur fracture, obesity, chronic kidney disease and nephrolithiasis. She has been continuing treatment throughout her life with calcium, calcitriol and vitamin D supplementation for hypocalcemia. She has been mostly eucalcemic since then, and complains of occasional carpopedal spasms and perioral numbness.

Discussion
PHP1B is isolated resistance to PTH in the kidney and normal PTH response in bone without features of AHO. PHP1A and 1C have PTH resistance in bone, and both express AHO. These various forms of PHP are due to defects in the GNAS gene that lead to decreased expression of the alpha-subunit of G protein (Gsa). In the absence of molecular analysis, the clinical and biochemical overlap between PHP and related disorders can lead to challenges in diagnostic classification. There are 2 types of PHP1B cases- autosomal dominant (AD) and sporadic. However, the majority of Patients with PHP1B do not have mutations within the GNAS but they have methylation and imprinting defects that result in absence of maternal Gsa. To emphasize, epimutation study rather than sequencing of the coding region in GNAS should be performed for genetic investigation, which has now become standard practice. Although there is no difference in clinical presentation between AD PHP1B and sporadic PHP1B, their differentiation early during the disease onset can help providers give patients more reliable genetic and reproductive counseling and provide optimal medical management of complications such as hypocalcemia.
Presentation: No date and time listed
ODP126 THE PREVALENCE OF LATENT IRON DEFICIENCY AND SARCOPENIA IN FREESTYLE WRESTLERS OF THE NATIONAL TEAM OF THE REPUBLIC OF SAKHA (YAKUTIA), RUSSIA
Authors: Grigoriev Nikolay , Kalinchenko Svetlana , Vorslov Leonid , Savvina Nadezhda , Petrova Milana N 
Published: November 2022

Abstract

The assessment of the quantity and quality of muscle mass is extremely important for assessing the current state of the athlete's somatic health. Decreased muscle mass and strength - sarcopenia - is a common cause of reduced athletic performance. The most common cause of sarcopenia, along with decreased levels of N-3 fatty acids and vitamin D, is iron deficiency, which has become a pandemic in the 21st century.

Purpose
To assess the prevalence of latent iron deficiency (LID) in the leading freestyle wrestlers in Yakutia, as well as the strength and endurance of the muscular system, using a questionnaire, available laboratory and instrumental studies.

Materials and Methods
The study included 13 freestyle wrestlers aged 18 to 34 years, members of the national team of the Republic of Sakha (Yakutia) and pupils of the Yakut wrestling school, now competing for other countries. All of them underwent anthropometric studies, measurements of isometric strength using a DK-50 hand dynamometer, questionnaires according to the questionnaire "SMART-diagnosis of iron deficiency", laboratory research: a complete clinical blood test and determination of the ferritin level.

Conclusions
In all 13 studied athletes, the result of "SMART-diagnosis of iron deficiency" score was more than 10 points, which is a clinical manifestation of iron deficiency, confirmed by laboratory examination (impaired erythrocyte quality (MCV, MCH, MCHC) and low ferritin levels). A decrease in the iron reserve in athletes leads to a decrease in physical performance, the gas gradients of oxygen and carbon dioxide in the blood change, and these, in turn, leads to "overtraining" and overstrain, and limits the athlete's ability to achieve high sports results and recovery. LID negatively affects the quality of muscle tissue. This is expressed by a decrease in muscle strength and endurance with carpal dynamometry. Changes of the traditional nutrition among the peoples of the North, strenuous exercise among freestyle wrestlers, as well as periodic dietary restrictions for weight loss before competitions and the lack of adequate correction and control of the iron status lead to the development of iron deficiency and a decrease of physical strength
Presentation: No date and time listed
ODP127 Trabecular Bone Score and Advanced Glycation End Products In Adults with Type 1 Diabetes
Authors: Coll Julie-Catherine , Garceau Élodie , Leslie William D , Michou Laëtitia , John Weisnagel S , Mac-Way Fabrice , Morin Suzanne N , Rabasa-Lhoret Rémi , Gagnon Claudia 
Published: November 2022

Abstract

Background
Individuals with type 1 diabetes (T1D) have a two- to threefold increase in fracture risk at any site, and up to a sevenfold increase in hip fracture risk compared to those without diabetes. Reduced bone quality appears to contribute to the increased fracture risk observed in this population. Advanced glycation end products (AGEs) tissue accumulation, which reflects long-term glycemic control, may influence bone quality in T1D.

Objective
We aimed to determine if skin AGEs, as a surrogate marker for bone AGEs, are associated with vertebral trabecular bone score (TBS),anindex of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images and evaluating bone quality.

Methods
We present preliminary data from subjects with T1D who participated in a cross-sectional study aiming at comparing the prevalence of vertebral fractures between adult subjects with T1D from two tertiary care centers and age-, sex- and BMI-matched controls without diabetes. TBS and bone mineral density (BMD) were assessed using DXA. Skin AGEs were measured by skin autofluorescence. Simple and multiple linear regression analyses were used to explore the factors associated with TBS.

Results
One hundred and six subjects with T1D (52.8% women; mean age 42.7±14.7 years; mean BMI 26.9±5.6 kg/m 2; mean diabetes duration 27.6±12.3 years; 48.1% with a microvascular complication; mean HbA 1C in the preceding 3 years 7.5±0.9%; mean skin AGEs 2.15±0.54 units; mean TBS 1.428±0.113) were included. Higher skin AGEs were associated with a lower TBS in simple regression analysis (p=0. 012). In multiple linear regression, older age, male sex, higher BMI, current smoking, higher serum calcium, lower lumbar spine and femoral neck BMD, but not skin AGEs, were significantly associated with a lower TBS (model adjusted R 2 =0.65).

Conclusion
In this population with relatively well-controlled T1D, skin AGEs were not independently associated with TBS.
Presentation: No date and time listed
ODP266 Deficiency of Calcitriol and Sex Hormones, Which Leads to a Severe Course of Psoriasis
Authors: Samburskaya Olga , Svetlana Kalinchenko , Batkaeva Nadejda 
Published: November 2022

Abstract

Materials and methods
The study group consisted of 17 patients with psoriasis from 19 to 76 years. All patients underwent studies to determine the body's vitamin D supply by its metabolite calcidiol 25(OH)D by enzyme immunoassay and to determine the level of steroid hormones by the steroid profile of saliva by mass spectrometry: progesterone, testosterone, estradiol.

Results
Vitamin D insufficiency was detected in 9 patients (n=9, 52.9%), the average level was 24.3±0.96 ng/ml. Vitamin D deficiency was observed in 3 patients (n=3, 17.7%), the average level was 16.6±1.634 ng/ml. Adequate vitamin D levels was detected in 5 patients (n=5, 29.4%), the average level was 34.56±1.955 ng/ml. In all patients (n=17, 100%), psoriasis was in a progressive stage, PASI more than 20 points – severe psoriasis. When evaluating the steroid profile of saliva in 7 patients (n=7, 41.2%) the level of progesterone was below the reference values (reference values 80-180 pg/ml), average level 56.86±6.53 pg/ml. In 11 patients (n=11, 64.7%), including 7 patients with progesterone deficiency plus 4 patients whose progesterone levels are within the reference values, have the level of testosterone was below the reference values (reference values from 114.8 pg/ml) the average level 51.93±9.5 pg/ml.

Discussion
Considering steroidogenesis [1], even though only 4 (n=4, 23.5%) patients had estradiol levels below reference values (reference values 4.17-9.28 pg/ml), we conclude that estradiol deficiency was observed in at least 11 patients (n=11, 64.7%). Also, knowing the effect of vitamin D on steroidogenesis (increases the expression of the 3b-HSD gene, thereby increasing progesterone synthesis [2]), thus we already know that if a patient is vitamin D insufficient or deficient, even when within the reference values, progesterone levels will not be sufficient for this individual, and therefore there will be testosterone and estradiol deficiency. It follows that another 8 patients with vitamin D insufficiency or deficiency will have progesterone deficiency, that is, out of 17 patients, 15 (n=15, 88.2%) have progesterone deficiency and, therefore, testosterone and estradiol deficiency. In enzyme immunoassay vitamin D determination, a cross-reaction occurs with another metabolite - 24.25(OH)D, whose concentration is up to 20% of the total calcidiol concentration. Therefore, it is necessary to subtract up to 20% from the data obtained in order to determine the true level of 25(OH)D [3], which means that all patients have vitamin D deficiency. Estrogens enhance the synthesis and effects of 1,25(OH)D, through an increase in the expression of the CYP27B1 (1α-hydroxylase) gene and VDR [4].

Conclusion
The sufficient intake of vitamin D and a sufficient level of calcidiol, the intensity of the synthesis of the hormonal form of vitamin D and the realization of its effects depend on several factors, which include a sufficient level of sex hormones.
Presentation: No date and time listed
ODP542 Challenging Management of Fasting Hypoglycemia in a Patient With Pancreatic Neuroendocrine Tumor and Lupus Nephritis
Authors: Alba Rebecca , Go Hanah , Joven Mark 
Published: November 2022

Abstract

Background
Derangements of calcium metabolism are common in patients with cancer.1 Unlike hypercalcemia which is well-recognized, little is known about hypocalcemia of malignancy.2 In fact, there were only 2 studies published to date that investigated its incidence among cancer patients. 2,3 Clinical Case: A 40-year-old male consulted an ENT specialist for a 2×2 cm left parotid mass of 3 years duration. There was no fever, cough, night sweats or significant weight loss. Histological analysis of the mass revealed parotid gland adenocarcinoma. Tumor metastases to lung and spine were seen on PET CT scan. Consequently, he received 18 cycles of chemotherapy and 10 sessions of radiotherapy without surgery because of the advanced stage. He initially exhibited good response with the treatment. A year after, he developed shortness of breath, numbness of hands with seizure episode. Chest x-ray showed pleural effusion and osteoblastic changes while cranial CT scan revealed brain metastasis. Bone scintigraphy was evident for multiple osseous metastases. He underwent stereotactic brain surgery, and thoracentesis with pleural fluid analysis consistent with malignancy. Biochemical tests were remarkable for hypocalcemia (0.99, n&gt;1.12 mmol/L, normomagnesemia (0.89, n&gt;0.74 mmol/L), low vitamin D (11.6, n&gt;30 ng/mL), elevated phosphate (1.73; n: &lt;1.49 mg/dL), and elevated intact PTH which eventually dropped (157.7 to 9, n&gt;15 pg/mL). Ultrasound of the neck revealed diffuse thyroid calcifications. Despite oral calcium supplementation (14.4 grams elemental calcium), calcium infusion (1.35 mg/kg/hour elemental calcium) and vitamin D supplementation (6000 IU cholecalciferol and 0.5 mg calcitriol daily), he remained hypocalcemic. His condition eventually worsened, and he succumbed to death in due course despite aggressive measures provided.

Conclusion
To our knowledge, this is the first case illustrating the therapeutic challenge in addressing an intractable hypocalcemia in the setting of an advanced parotid carcinoma in our country.Reference: (1)Carl Blomqvist. A Hospital Survey of Hypocalcemia in Patients with Malignant Disease. Acta Med Scand. 1986;220. (2) Schattner et al. Hypocalcaemia of Malignancy. The Netherlands Journal of Medicine. July 2016, Vol. 74, No. 6. (3) Goncalves. Hypocalcemia in cancer patients: An exploratory Study. Porto Biomed. J. (2019) 4: 4
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP589 Acute Hypercalcemic Crisis in an Elderly with Granulomatous Disease
Authors: Capellan Maria Leonora , Tiu JR Leo 
Published: November 2022

Abstract
We present here a case of an 81 year old female who developed changes in neurologic status due to elevated serum calcium levels in the setting of an elevated Vitamin D and low-normal parathyroid hormone level. Upon evaluation of PTH-independent causes of hypercalcemia, she was noted to have Tuberculosis. Anti-Koch's and steroids were initiated on top of vigorous hydration and diuresis which lead to improvement in the patient's serum calcium levels and clinical status. Tuberculosis rarely leads to clinically significant hypercalcemia. However, elderly patients remain predisposed due to advanced age, multiple comorbidities and polypharmacy. Hypercalcemia is a life threatening condition, but with prompt diagnosis and management it portends excellent outcomes.
Presentation: No date and time listed
OR01-6 Bone Health Outcomes Post-Lung Transplantation in Cystic Fibrosis Patients
Authors: Li Xilong , Maalouf Naim , Tran Triet Vincent 
Published: November 2022

Abstract

Background
Osteoporosis is a common comorbidity in patients with cystic fibrosis (CF); malabsorption, chronic glucocorticoid use, and chronic inflammation all contribute to increased bone resorption and decreased bone formation. Although lung transplantation (LTx) improves quality of life and short- and long-term outcomes of CF patients, there is little research examining long-term bone health outcomes following LTx in these patients.

Methods
We collected demographic and clinical data on patients who underwent LTx at a single institution between 2006-2019 and had bone mineral density (BMD) measured pre- and post-transplantation. We compared baseline characteristics, long-term BMD trends, and fracture incidence between the two patient populations. We also examined factors associated with post-LTx fractures in CF patients.

Results
Charts of 59 LTx recipients were reviewed including 30 with CF and 29 without CF. Compared with non-CF patients, patients with CF were significantly younger (32.8±10.0 vs. 56.7±10.7 years), had lower body mass index (19.7±3.0 vs. 26.7±4.4 kg/m2), and significantly lower baseline BMD Z-scores at the lumbar spine (-2.0±1.1 vs. -0.3±1.6), femoral neck (-1.6±0.8 vs. -0.7±1.0), and total hip (-1.6±0.8 vs. -0.7±1.0) (all p&lt;0.001). BMD at all three sites declined significantly in both groups in the first year post-LTx. In subsequent years, and compared with non-CF patients, CF patients exhibited better BMD recovery relative to pre-transplantation, but continued to have lower BMD post-LTx. Post-transplant fractures were relatively common, occurring in 30% and 34% of CF and non-CF patients, respectively. Within the CF group, those who developed fractures after LTx were more likely to have lower baseline BMD T-scores at the femoral neck (p=0.017) and total hip (p=0.050), and lower pre-transplantation percent predicted forced expiratory volume in 1 second (FEV1%) (p=0.042).

Conclusions
Compared with their non-CF counterparts, CF patients undergoing lung transplantation start with significantly lower BMD pre-LTx but exhibit better BMD recovery post-LTx. Despite their younger age at transplantation, CF patients experience a similarly high rate of post-LTx fractures. In CF patients, lower BMD and worse FEV1% pre-LTx are associated with development of post-LTx fractures. These findings highlight the unique contribution of the CF disease process to bone health, as well as a clear need for better prevention and treatment of osteoporosis in CF patients before and after LTx.
Presentation: Saturday, June 11, 2022 12:45 p.m. - 1:00 p.m.
PSAT194 Prolonged Hypercalcemia after Calcium Sulfate Beads Use
Authors: Pajuelo Cynthia Rivas , Tariq Sarah 
Published: November 2022

Abstract
Calcium sulfate beads (CSB) preparations are used for antibiotic release to prevent or treat periprosthetic infections. Transient hypercalcemia in the setting of CSB use have been reported, with most cases being mild. Here we present a case of prolonged hypercalcemia after the use of CSB
A 92-year old man with history of CKD stage is admitted to the hospital after sustaining a fall. He underwent a right femur periprosthetic fracture repair. Intraoperatively, he received 30 cc of antibiotic impregnated calcium sulfate beads into the wound. Preoperative labs showed calcium of 9.8 mg/dl, albumin 3.6g/dL, with creatinine of 1.6 mg/dl. 48-hours post-operative, patient developed acute encephalopathy, with laboratory analysis showing a calcium corrected for albumin raising up to 13.2 mg/dL, and creatinine of 1.8 mg/dl in the following days. PTH levels, PTH-rp, 25-OH Vitamin D were normal. He had no history of calcium disorders, kidney stones or pathological fractures. He was started on gentle IV fluids with normal saline, and calcitonin weight based (4 iu/kg) every 12 hours for a total of 6 doses with no improvement of calcium levels. Since he continued with persistent hypercalcemia, we decided to give 1 dose of Zoledronic Acid IV. Patient mental status improved; and calcium levels normalized along with creatinine 11 days after Zoledronic acid.
Hypercalcemia secondary to CSB is rare. The use of CSB implantation has increased by orthopedics in the last years. CSB releases 100% of its antibiotic load to improve antibiotic delivery for prevention and treatment of peri-prosthetic infections. There are only two studies evaluating the outcomes of CSB that reported hypercalcemia. In a prospective observational study involving 755 patients receiving CSB implantation, only 5.7% developed mild hypercalcemia, and 2 of them were symptomatic, requiring IV fluids and 1 dose of Bisphosphonates. Hypercalcemia can appear 1 day post-operatively and improve after 5 days. Infrequently, hypercalcemia can be moderate to severe causing symptoms as in our patient. It is important to keep in mind transient hypercalcemia with the use of CSB, especially in high-risk patients. Discussion should include alternate options to prevent peri-prosthetic infections and closer monitoring of calcium and creatinine within the first 24-48 hours of implantation. To our knowledge, this is the second case report of prolonged moderate to severe hypercalcemia.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.