- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg.
Adrenal adenoma with biochemical findings suggestive of Cushing's disease (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1939;
Absolute washout of 85 % and a relative washout of 63%, having 12 Hounsfield units (HU) on the non-contrast phase, findings suggestive of a benign adenoma.Further work up including 1 mg Dexamethasone suppression test (DST) showed unsuppressed plasma ACTH 17 pg/ml and total cortisol 9.4 mcg/dL...The follow-up cortisol level was 11.3 mcg/dL when the patient was off hydrocortisone...(1-2) Therefore, it is important to analyze clinical findings and biochemical testing and if lab tests are discordant, recheck using a different analytical platform in a different lab or an alternate ACTH assay to confirm ACTH levels. (1-2
- |||||||||| hydrocortisone / Generic mfg.
Psychiatric Illness Masking Autoimmune Polyglandular Syndrome in a Middle-Aged Woman. (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1934;
Poly endocrinopathies often present with vague symptoms that need to be worked up to prevent the life-threatening effects of APS2 including adrenal crisis. We present an uncommon case of middle-aged woman with Tri-glandular syndrome with delayed diagnosis due to underlying psychiatric disease.(1)Meyer et al.Horm Metab 2013; 45:92-95
- |||||||||| dexamethasone / Generic mfg.
A Rare Case of Coexisting Acromegaly and Adrenal Cushing's Syndrome (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1931;
Though the relationship between acromegaly and cancer has been historically controversial, more recent studies have shown an increased risk of both benign and malignant tumors with acromegaly. Untreated Cushing's Disease has been associated with mildly elevated IGF1 which then decreases after remission; it is unclear if the same pathological process is involved in other etiologies of hypercortisolemia like adrenal Cushing's syndrome, but re-evaluation of IGF1 after treatment of Cushing's should be considered.
- |||||||||| dexamethasone / Generic mfg.
Splenic Infarct: A Rare Presentation of Cushing Syndrome (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1930;
An overnight 1-mg dexamethasone suppression test revealed post-dexamethasone cortisol of 4.58 mcg/dL...The pathogenesis is not fully understood but is believed to be related to shortening of activated partial thromboplastin time (aPTT), increased clot lysis time, and glucocorticoid-induced increase in procoagulant factors such as fibrinogen, von Willebrand factor, and factor VIII. Our case will closely demonstrate the link between hypercortisolism and hypercoagulability.
- |||||||||| hydrocortisone / Generic mfg.
A Rare Case of Cushing Syndrome in Pregnancy: Diagnosis and Therapeutic Challenges (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1929;
Was started on hydrocortisone (HC) following surgery...Clinical Lesson:This case depicts the challenges in managing CS in pregnancy and its repercussions regarding maternal, fetal, and delivery outcomes. Additionally, it highlights the importance of implementing a multidisciplinary approach, including obstetricians, endocrinologists, endocrine surgeons, and pediatricians, to ensure the optimization of therapeutic strategies.
- |||||||||| dexamethasone / Generic mfg.
A Case of Pseudoadrenal Tumor Mimicking Left Adrenal Pheochromocytoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1928;
The plasma corticotropin and cortisol concentrations were normal and suppressed normally after a 1-mg overnight dexamethasone suppression test...Lessons learned from our case include the importance of clinicians need to be aware of the limitations of diagnostic imaging studies in diagnosing non-functioning adrenal incidentalomas, which require a pathologic analysis for the final diagnosis. Moreover, clinicians need to provide patients with sufficient informed consent when deciding on treatment strategies.
- |||||||||| A Curious Case of Psychosis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1927;
Two of her medications, gabapentin and mirtazapine were thought to be the contributors and were stopped upon admission, however with little improvement...She was ultimately started on hydrocortisone replacement therapy, with subsequent improvement and stabilization of her mental status, mood, and behavior; and was discharged with outpatient Endocrinology follow-up.This case highlights the importance of the broad differentials to consider for mental and behavioral changes...The exact mechanism of neuropsychiatric symptoms (which may precede metabolic abnormalities) is unknown but is hypothesized to involve elevated levels of endorphins and electrophysiological disturbances as glucocorticoid receptors are widely distributed in the brain, specifically in the hippocampus. Megestrol is an established cause of secondary adrenal insufficiency, and monitoring is essential with long-term use.
- |||||||||| Lysodren (mitotane) / HRA Pharma
Severe Hypertriglyceridemia and Acute Pancreatitis in a Patient with Adrenocortical Carcinoma (ACC) taking Mitotane (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1924;
We describe an ACC patient with a history of fatty liver disease and mixed hyperlipidemia who developed severe hypertriglyceridemia and acute pancreatitis leading to multiorgan failure about one month after starting mitotane. This case highlights hypertriglyceridemia as a serious complication of mitotane in a patient with preexisting dyslipidemia.*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation.
- |||||||||| hydrocortisone / Generic mfg.
Tuberculosis and Adrenal Glands: The Great Forgotten (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1921;
He also refers progressive hyperpigmentation for the past 3 years. Denies recent travel abroad.On physical examination hypotension (80/53 mmHg) and generalized hyperpigmentation predominantly in the oral mucosa stand out.Blood test: Glu: 41 mg/dL, Na+: 122 mmol/L, K+: 4.8 mmol/L, ACTH: 922 pg/mL, Cortisol: 4.63 ug/dL, Anti-Hydroxylase Ab and Anti-Adrenal glands Ab: negativeA computed tomography scan of the abdomen with intravenous contrast revealed bilaterally enlarged adrenal glands with small bilateral calcifications (12-18mm).TB QuantiFERON test: positiveShe was initially treated with saline serum and intravenous hydrocortisone causing her symptoms to improve significantly in a few days and was subsequently discharged on hydrocortisone and fludrocortisone and proper treatment for TB Adrenalitis and follow-up in outpatient clinicsConclusionsAlthough not frequent, infectious causes should always be kept in mind, such as the etiology of adrenal insufficiency in a patient with long-term compatible symptoms, even though it is a developed country, given world globalization, which makes infectious diseases highly transmissible between countries and continents.
- |||||||||| alendronate / Generic mfg.
A Case of Isolated Osteonecrosis of Torus Palatinus in a Patient on Alendronate (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1832;
The possibility of OTP development should be considered with appropriate oral complaints among OBP users with TP. Further retrospective analyses to ascertain how prevalent this uncommon condition is would provide much needed clinical information.
- |||||||||| hydrocortisone / Generic mfg.
Clinical Conundrum: Salt Wasting Congenital Adrenal Hyperplasia With Paradoxical High Cortisol (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1741;
An ACTH stimulation test is often used to diagnose adrenal insufficiency and initiate life-saving hydrocortisone therapy.Clinical Case: I present a case of a male infant who was found to have salt-wasting CAH crisis despite a paradoxically high serum cortisol... By reporting this case, I draw attention to the possibility that high levels of cortisol do not definitely rule out salt-wasting CAH.Reference Ranges:NA 132 - 145 mmol/L K 3.0 - 6.0 mmol/L Cortisol:1.7 - 14.0 ug/dL17 OHP:INTERPRETIVE INFORMATION for 17-Hydroxyprogesterone in premature and normal male infants: Premature (26 to 28 weeks) 124 to 841 ng/dL Premature (29 to 35 weeks) 26 to 568 ng/dL Full term Day 3 7 to 77 ng/dL 4 days to 2 months Less than 200 ng/dL
- |||||||||| cabergoline / Generic mfg., dexamethasone injection / Generic mfg.
Partial Third Nerve Palsy as a Presentation of Prolactinoma, a Case Report (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1692;
Rarely, prolactinomas have been associated with third nerve palsywith proposed mechanisms including compression of the nerve in the cavernous sinus or compression ofthe nerve's vascular supply. Through this case we hope to highlight this uncommon presentation ofprolactinoma and propose it be considered in the workup for third nerve palsy.
- |||||||||| methimazole / Generic mfg., metoprolol tartrate / Generic mfg., hydrocortisone / Generic mfg.
A Case of Contrast Induced Thyrotoxicosis in a Patient Newly Diagnosed with Hyperthyroidism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1651;
This usually happens in older patients with known underlying coronary artery disease in response to the rise in cardiac contractility and strain caused by thyrotoxicosis. Our case did not have any history or risk factors of coronary artery disease other than hyperthyroidism.
- |||||||||| hydrocortisone / Generic mfg.
Circulating and Urinary Metabolites Associated with Total Exposure of Cortisol and Cortisol Time Profile (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1590;
The aim of this study was to better understand these outcomes by identifying metabolites associated with total exposure of cortisol and cortisol time profile separately.This was a hypothesis-generating study using a randomized, two-armed, 12-week cross-over study comparing once-daily (OD) dual-release hydrocortisone tablet treatment with the same daily dose of thrice-daily (TID) conventional immediate-release hydrocortisone tablet treatment...The study results therefore support that the total exposure and the time profile of cortisol may have different metabolic effects. The outcome of the study may be a step towards identifying novel biomarkers of the action of cortisol.
- |||||||||| hydrocortisone / Generic mfg.
Adrenal Insufficiency Presenting with Isolated Severe Hyponatremia: A Case Series (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1586;
A) Despite various hyponatremia guidelines suggesting ruling out AI and hypothyroidism before empirical diagnosis of SIADH, there can still be delay in checking cortisol status. B) AI presentation can lack hemodynamic instability or other electrolyte abnormalities so a high clinical index of suspicion should be exercised in diagnosing this potentially fatal condition when encountering isolated severe hyponatremia.
- |||||||||| dexamethasone / Generic mfg.
Once Daily Dexamethasone for Treatment of Severe Salt-Wasting 3?-hydroxysteroid Dehydrogenase Deficiency (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1582;
Children with HSD3B2 CAH and their unaffected age-matched siblings had similar scores within the normal range on Beck Youth Inventories. In conclusion, we show that once nightly dexamethasone is a reasonable alternative to thrice daily hydrocortisone for treatment of severe salt-wasting HSD3B2 deficiency, allowing for improved medication adherence, normal growth, and acceptable endocrine control, but does not reduce risk for hypertension more closely related to fludrocortisone overtreatment or prevent the emergence of TARTs.
- |||||||||| hydrocortisone / Generic mfg.
Remote monitoring of biometric, proteomic, and patient-reported outcomes in adrenal insufficiency (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1578;
In conclusion, we show that once nightly dexamethasone is a reasonable alternative to thrice daily hydrocortisone for treatment of severe salt-wasting HSD3B2 deficiency, allowing for improved medication adherence, normal growth, and acceptable endocrine control, but does not reduce risk for hypertension more closely related to fludrocortisone overtreatment or prevent the emergence of TARTs. Remote monitoring of biometrics and blood proteome in AI is feasible and informative and may identify biomarkers to optimize hydrocortisone replacement therapy.
- |||||||||| epinephrine / Generic mfg.
Is Stress Vulnerability in CAH Related to Epinephrine Deficiency and CYP21A2 genotype? (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1571;
However, it may put these patients at increased risk of fatigue or burn out syndrome. The psychological effects of the virilization due to CAH per se may partly overshadow the effects of the epinephrine deficiency in women with CAH.Larger studies are needed to be able to study what role the capacity to produce epinephrine, has for the psychological stress vulnerability in CAH.
- |||||||||| dexamethasone / Generic mfg., prednisone / Generic mfg., hydrocortisone / Generic mfg.
Adrenal Insufficiency In Olmsted County, MN, USA: A Population-Based Study (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1566;
Surprisingly, even after controlling for morbidity and prior hospitalizations, patients with AI were more likely to be hospitalized. In comparison to referent subjects, mortality was higher in patients with AI, even after adjustment for morbidity index.
- |||||||||| dexamethasone / Generic mfg., progesterone / Generic mfg.
Generation and Characterization of a Humanized CYP21A2 Mouse Model for Congenital Adrenal Hyperplasia (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1560;
Progesterone levels in homozygous mice are significantly higher (p<0.01) than in wildtype mice...Homozygous mice require dexamethasone treatment during pregnancy and until weaning but are viable without treatment afterwards...In conclusion, we demonstrate that the humanized mutant CYP21A2 mice may represent an excellent animal CAH model to test novel treatment strategies for CAH patients. We believe that this model(s) will facilitate the transition from basic research into clinical application.
- |||||||||| dexamethasone / Generic mfg.
Ligand Induced GR Heterodimerization with MR in Living Cells (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1555;
GR and MR fusion proteins with the luciferase fragments were expressed in HEK293 cells and the enzyme activities were determined in time course before and after the addition of ligands (dexamethasone and aldosterone)...Based on the results only C-terminal NanoBit fusion receptors showed positive heterodimerization-induced enzyme activity, we proposed ligand binding domain 3D structure heterodimer models and found amino acid residues in helix 9, helix 10, and near C-terminus are involved in the heterodimer interaction interface. Thus, this method will be a powerful tool for analyzing molecular mechanisms of GR - MR heterodimer formation in living cells.
- |||||||||| dexamethasone / Generic mfg., tamoxifen / Generic mfg.
Regulation of Stem/Progenitor Cells of the HPA Axis During Stress Adaptation (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1552;
To assess the contribution of stem cells during stress adaptation in the adrenal cortex in vivo, we performed immobilization stress and lineage tracing studies using the tamoxifen inducible Gli1:CreERT2/R26R:eYFP mouse line...To follow the effect of GC excesses on the negative feedback loop observed during a normal stress response on the pituitary gland, we stimulated adherent primary anterior pituitary colonies with dexamethasone and corticosterone...This downregulation caused by GCs could be mediated through different gene targets of the glucocorticoid receptor as well as via paracrine signalling from pituitary stem cells. Altogether, our results will provide us with more profound knowledge of mechanisms underlying interactions between stressors and stem/progenitor cells of the HPA axis along with novel therapeutic targets for stress-associated disorders.
- |||||||||| A Case of Acute Liver Failure Within 48 Hours of Initiation of High Dose Thionamides for Thyroid Storm (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1305;
Viral and autoimmune hepatitis panel, acetaminophen and alcohol levels were negative...Risk factors appear to include very high dose methimazole and PTU exposure as well as potentially the patient's intermittent use of methimazole in the past. Further study is needed to clarify potential risk factors of thionamide-induced hepatotoxicity as data is limited.
- |||||||||| mycophenolate mofetil / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Orbital Lymphoma masquerading as Thyroid Eye Disease (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1296;
She was continued on weekly IVMP and oral mycophenolate mofetil (MMF) was added on as per the latest EUGOGO guidelines published in 2021...This case highlights the importance of considering alternative differential diagnosis in certain patients with atypical features or those who are non-responders to the first line immunosuppressive therapies for thyroid eye disease. Details of this case and relevant literature will be reviewed in this report.
- |||||||||| Central Hypothyroidism following Neonatal Graves Presentation (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1287;
This case highlights the severity of neonatal Graves' disease and the possibility of the subsequent development and persistence of central hypothyroidism following neonatal Graves' diagnosis despite the resolution of hyperthyroidism and normalization of TSI antibody. Due to the risk of the development of hypothyroidism, it may be worthwhile to continue to trend TSH and FT4 to ensure that the infant has not developed hypothyroidism.
- |||||||||| dexamethasone / Generic mfg.
The Pathophysiologic Spectrum of Primary Aldosteronism Determined via Saline Suppression Testing in Overweight Hypertensive and Pre-Hypertensive People (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1241;
Despite existing categorical thresholds for SSST, dynamic phenotyping studies in overweight/obese stage I hypertensive and pre-hypertensive individuals demonstrate a continuum of non-suppressible and renin-independent aldosterone production following SSST that parallels higher levels of ACTH-dependent aldosterone production. These findings underscore the fallibility of currently recommended diagnostic limits for SSST and suggest that primary aldosteronism pathophysiology transcends these relatively arbitrary thresholds.
- |||||||||| dexamethasone / Generic mfg.
Aldosterone secretory capacity immediately after surgery predicts biochemical outcome 1 year after surgery in primary aldosteronism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1230;
5 ?g/dL after a 1 mg overnight dexamethasone suppression test (n = 9) were excluded...A/C at 30 minutes after ACTH loading had 83% sensitivity and 62% specificity when 6.03 was set as the cutoff; 24-hour urine aldosterone had 84% sensitivity and 61% specificity when 2.6 was set as the cutoff. [Conclusion] AST and OST immediately after surgery are useful for predicting biochemical outcomes 1 year after surgery in patients with PA.
- |||||||||| dexamethasone / Generic mfg.
Role of Glucocorticoid on Bone Metabolism through AKAP13 (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1057;
To examine the effect of glucocorticoids on preosteoblasts, immortalized bone marrow mesenchymal stem cells (imBMSCs) were sown in 6-well plates at a concentration of 2x105/well and treated with various concentrations (0-1000 nM) of dexamethasone (Dex) 24 hr later, and The expression of GILZ, osteoblast and adipocyte-associated markers were evaluated using qRT-PCR...It has a nuclear receptor binding domain and is known to be involved in osteogenesis. On the other hand, AKAP13 expression was decreased by osteoblast differentiation in an in vitro system, suggesting that AKAP13 may influence the regulation of GC action between the proliferative and differentiation phases of BMSCs.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
Diffuse Large B-Cell Lymphoma Pituitary Metastasis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_964;
She was initiated on methotrexate and leucovorin chemotherapy. This is an unprecedented case of metastatic DLBCL to the leptomeninges, hypothalamus, and pituitary infundibulum confirmed by CSF cytologic analysis that presented in the context of associated panhypopituitarism that manifested initially as SIADH followed by sudden DI.Abbreviations: R-CHOP: Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone
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