- |||||||||| hydrocortisone / Generic mfg.
Adrenal Insufficiency in Advanced Cirrhosis: A (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2815;
Pt was started on IV hydrocortisone 50 mg TID...Whether adrenal insufficiency is truly one of the complications of advanced cirrhosis contributing to persistent hypotension, or a mere laboratory finding is difficult to answer. It is also yet to be determined whether patients with advanced cirrhosis might benefit from screening and treatment of adrenal insufficiency in circumstances of persistent hypotension, and studies are needed to decide on optimal diagnostic tests to recognize the disease and develop treatment algorithms.
- |||||||||| Rare Case of Ectopic Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2809;
Her AM cortisol level remained unsuppressed at 79.2 and 59.4 mcg/dL (n< 1.8 mcg/dL) after 1 mg and 8 mg overnight dexamethasone suppression tests respectively...After stabilizing her clinical condition and correcting electrolyte abnormalities, she was started on chemotherapy with paclitaxel and carboplatin by the oncologist...Despite initial clinical improvement, her disease progressed with widespread liver, lymph node, and osseous metastases within 3 months necessitating escalating doses of ketoconazole, spironolactone, and potassium supplementation. Although ectopic CS caused by parotid pleomorphic adenocarcinoma is rare, prompt recognition and treatment is necessary because ectopic ACTH production is associated with poor prognosis in these patients.
- |||||||||| hydroxychloroquine / Generic mfg., hydrocortisone / Generic mfg.
A Case of Bilateral Adrenal Insufficiency Associated With Borderline Lupus and Antiphospholipid Syndrome. (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2808;
Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are uncommon conditions associated with BAH.We describe here a 79-year-old woman with a history of hypertension and a 23-year history of borderline SLE treated with hydroxychloroquine (HCQ) who presented at the ED with epigastric pain, diarrhea, and nausea...The patient was then admitted to the hospital, and hydrocortisone (HCT) therapy was initiated...Although in this case, no cardiovascular collapse was observed, when unrecognized or undertreated, adrenal insufficiency complicating BAH can evolve into an adrenal crisis. Infections and medications that increase cortisol metabolism can also contribute to this complication.
- |||||||||| voriconazole / Generic mfg.
Voriconazole Usage, An Atypical Cause of Primary Adrenal Insufficiency (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2807;
He was started on hydrocortisone with improvement in vitals, labs and mentation...Ketoconazole and fluconazole are more often linked with AI, through inhibition of steroidogenic enzymes 11b-hydroxylase, 17a-hydroxylase and 18-hydroxylase...Our patient had been off and on voriconazole for 2 years with plan for chronic use, and had therapeutic range voriconazole levels after treatment for 3 weeks prior to the rapid response. This case demonstrates the risk of precipitating AI with second-generation azoles.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
A Case of Recurrent Cardiac Tamponade as Initial Presentation of Primary Adrenal Insufficiency (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2803;
This patient may have autoimmune polyglandular syndrome type 2 (APS-2), which is a cluster of two or more endocrine glandular disorders primarily diagnosed in adulthood and predominant in females. The risk of adrenal crisis is more than twofold in Addison disease due to APS-2.
- |||||||||| hydrocortisone / Generic mfg.
Adrenal crisis in a patient diagnosed with primary adrenal insufficiency following COVID-vaccination (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2801;
The patient was promptly treated with intravenous hydrocortisone and saline fluids...The importance of stress-dose steroids during illness or vaccination in patients with adrenal insufficiency is underscored. This case highlights that the Healthcare providers should be aware of this rare but severe complication and consider appropriate monitoring and stress-dose steroid coverage in susceptible populations.
- |||||||||| Pseudopheochromocytoma Due to Severe Obstructive Sleep Apnea (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2800;
This case highlights that the Healthcare providers should be aware of this rare but severe complication and consider appropriate monitoring and stress-dose steroid coverage in susceptible populations. She is currently using carvedilol 50 mg bid, chlorthalidone 25 mg, olmesartan 40 mg, amlodipine 10 mg, spironolactone 50 mg, clonidine 0.2 mg tid, hydralazine 50 mg every 6 hours, acetylsalicylic acid 100 mg, atorvastatin 80 mg, and metformin XR 1000 mg...Hormone evaluation showed basal cortisol 7
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
A Rare Presentation of Primary Adrenal Insufficiency with Hypertension & Hypokalemia (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2799;
It manifests by a wide spectrum of symptoms and signs, some can be masked by the presence of other comorbid conditions leading to atypical presentations. Our case highlights the importance of maintaining a high level of suspicion of adrenal insufficiency in patients with atypical presentation, including those with hypertension & hypokalemia.
- |||||||||| hydrocortisone / Generic mfg.
Acute Adrenal Crisis Secondary To Undiagnosed Addison's Disease (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2798;
Our case highlights the importance of maintaining a high level of suspicion of adrenal insufficiency in patients with atypical presentation, including those with hypertension & hypokalemia. If patient
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD), Recorlev (levoketoconazole) / Xeris Biopharma, Lysodren (mitotane) / Perrigo Company
Severe IGF-2 Mediated Hypoglycemia in a Patient With Adrenocortical Carcinoma: A Case Report (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2789;
CT scan of his chest and abdomen at that time revealed a large left suprarenal mass and multiple lung and liver masses; a biopsy from the liver lesion confirmed the diagnosis of ACC and he was started on treatment with mitotane, levoketoconazole and hydrocortisone. Oncology attempted treatment with 3 cycles of cisplatin and etoposide, with no significant response; subsequently, treatment with Keytruda initially decreased tumor size, but ultimately his CT scan showed progression of disease and mitotane was stopped in August 2023.When brought to the hospital in September 2023 due to seizures and altered mental status, the patient
- |||||||||| Lysodren (mitotane) / Perrigo Company, Isturisa (osilodrostat) / Novartis, Recordati
Management and Complications of Metastatic Adrenocortical Carcinoma Presenting with Severe Cushing Syndrome (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2774;
Simultaneous use of multiple adrenal steroidogenesis inhibitors is often required for control of hypercortisolism, and chemotherapy is equally necessary to manage tumor burden. However, as in this case, disease-related complications can limit treatment management and result in rapid deterioration.
- |||||||||| Exploring a Case Study on Navigating Complexities in Endocrine Health and Reproductive Challenges (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2769;
Despite classic symptoms, the initial PCOS misdiagnosis highlights the need for vigilance and comprehensive diagnostics. Complex cases underscore the importance of individualized management and interdisciplinary collaboration.Positive outcomes in complex endocrine disorders and pregnancy are attainable through accurate diagnoses and tailored treatments.
- |||||||||| A Broken Heart Due to Excess Thyroid (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2742;
Subsequently, the patient received propylthiouracil, propranolol, and prednisone, resulting in symptomatic improvement...While thyrotoxicosis-related congestive heart failure (CHF) is relatively uncommon among patients hospitalized for acute CHF, addressing hyperthyroidism and CHF through definitive treatment yields a more favorable prognosis compared to cases of acute CHF stemming from other etiologies. The intricate interplay of these mechanisms highlights the importance of a comprehensive approach in managing thyrotoxic cardiomyopathy, emphasizing the need for targeted interventions to address both the underlying thyroid dysfunction and associated cardiac manifestations.
- |||||||||| Rituxan (rituximab) / Roche
Insulin Autoimmune Syndrome Presenting with Severe Insulin Resistance and Recurrent Diabetic Ketoacidosis (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2636;
This case demonstrates that IAS - although classically associated with hypoglycemic episodes - may also present with severe insulin resistance and recurrent DKA without hypoglycemia. Whether characterized by high IA binding capacity and affinity or coexisting with IRAb, a combination of immunosuppressants proved effective in treating both TBIRS and IAS in this instance.
- |||||||||| Januvia (sitagliptin) / Merck (MSD)
Type 2 Diabetes in a Patient with IMAGe Syndrome (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2580;
The patient described above was diagnosed with new-onset diabetes at age 21, presumably T2DM in the context of undetectable antibodies and high-normal C-peptide. Interestingly, she did not have any typical stigmata of peripheral insulin resistance.
- |||||||||| hydrocortisone / Generic mfg.
Ovotesticular Difference of Sex Development: Prognostic Evaluation, Sex Assignment, and Ethics (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2485;
Prophylactic hydrocortisone was started due to concerns regarding NR5A1/SF1 mutation...Our approach to managing ovotesticular DSD involved a framework emphasizing ethical considerations and parental involvement. We advocated for and practiced a shared decision-making model involving healthcare providers, parents, and ultimately the patient.
- |||||||||| hydrocortisone / Generic mfg.
Delayed Diagnosis of Classical Congenital Adrenal Hyperplasia: Case Series and Literature Review (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2469;
While the goal of the NBS (preventing salt wasting crises) may have been satisfied, it is plausible that these patients may have been remained undiagnosed entirely due to reports of normal screening tests. These cases highlight the importance for providers to pursue the diagnosis of classical CAH in spite of normal screening - detecting CAH and initiating hydrocortisone therapy prior to adrenal crisis is imperative while the other noted impacts of growth and puberty deserve discussions of management options, education and counseling for future implications.
- |||||||||| hydrocortisone / Generic mfg.
ACTH deficiency due to TBX19 mutation mimics complete adrenal insufficiency in a newborn (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2468;
These cases highlight the importance for providers to pursue the diagnosis of classical CAH in spite of normal screening - detecting CAH and initiating hydrocortisone therapy prior to adrenal crisis is imperative while the other noted impacts of growth and puberty deserve discussions of management options, education and counseling for future implications. After 3 months of life under treatment with hydrocortisone (10mg/m
- |||||||||| A Case of Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2453;
Ketoconazole and spironolactone were added, with no appreciable improvement in his cortisol levels but normalization of blood pressure...The patient was discharged on postoperative day 3 with oral hydrocortisone.Two weeks later, he was euglycemic off insulin and his blood pressure had normalized off spironolactone...To our knowledge, this is the first report of PRES associated with CS due to an ACTH-secreting pituitary adenoma in an adult. We suspect that this patient
- |||||||||| Isolated IgG4-Related Infundibulo-Hypophysitis (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2443;
We present a histologically-confirmed case of isolated IgG4-RH presenting with clinical manifestations of anterior hypopituitarism. Diagnosis and management of IgG4-RH requires multidisciplinary collaboration (endocrinology, rheumatology, neurosurgery, neuropathology and neuroradiology).
- |||||||||| cabergoline / Generic mfg.
The Cortisol Conundrum: A Case of Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2440;
While CBG adds to the armamentarium for these ACTH-PRL secreting pituitary adenomas, its use interferes with work up in patients with pituitary adenoma who are still undergoing diagnostic tests for pituitary function evaluation. Our case highlights a unique diagnostic challenge in the work up of CD.
- |||||||||| A Case of Pituitary Apoplexy in Pregnancy (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2438;
For prolactinoma, pharmacological therapy can be initiated. Surgery is considered if the medical therapy fails.
- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg.
ResolutionofCentralHypothyroidismshortlyafterTranssphenoidal Surgery For Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2435;
Previous studies suggest the monitoring of thyroid function at 6 and 12 months after surgical cure of hypercortisolism. Our case suggests that the resolution of hypothyroidism occurs shortly after surgery for Cushing
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Adrenal Crisis, Unrevealing the Impact of Immigration on Central Adrenal Insufficiency (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2416;
However, it is more difficult to define how emotional and psychological challenges affect the stress response, mainly because each challenge is unique. Therefore, it is important to advocate for policies to provide medical alert bracelets to immigrants with known AI in addition to providing education about emergency injection kits in cases of impending crisis.
- |||||||||| Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrronium) / AstraZeneca
The Prevalence of Adult-Onset Growth Hormone Deficiency in Mild Traumatic Brain Injury (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2414;
This study, using fixed-dose GST and strict BMI-adjusted cut-points, establishes a substantial prevalence of GHD in mild TBI, including uncomplicated cases. Screening for GHD in patients with a history of mild TBI is recommended, recognizing limitations such as sample size and potential overestimation in a 180-minute test, balanced by conservative BMI-adjusted cut-points in our study.
- |||||||||| dexamethasone injection / Generic mfg.
Curcumin a Double Edged Sword: A Case of Curcumin Induced Pituitary Macroadenoma Apoplexy (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2409;
She was given IV dexamethasone for 24 hours then underwent transsphenoidal resection of the hemorrhagic tumor that resulted in rapid resolution of headaches and visual symptoms...Headaches, nausea, and vision abnormalities completely resolved.The case illustrates the need to identify any herbal remedies and supplements a patient is taking, particularly turmeric, as supplements may contribute to increased bleeding tendency of an already existing adenoma. The case also emphasizes the potential rapid recovery of pituitary function after surgical resection of an apoplectic pituitary tumor.>
- |||||||||| remdesivir / Generic mfg., prednisone / Generic mfg., hydrocortisone / Generic mfg.
Unraveling the Enigma: A COVID-19 Triggered Revelation of Adult Idiopathic ACTH Deficiency (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2403;
He then received a course of remdesivir...An outpatient endocrinology evaluation recommended transitioning from prednisone to physiologic twice-daily dosing of hydrocortisone...Identifying AIAD can be challenging, leading to high rates of misdiagnosis and clinical omission. Physicians should consider AIAD when dealing with unexplained altered mental status, as the administration of a simple treatment with steroids can be life-changing.
- |||||||||| A Case of Psychosis in Ectopic Cushing's Syndrome: Unmasking the Diagnostic and Therapeutic Complexities (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2401;
Workup revealed hypercortisolism with concern for ectopic ACTH-production: elevated 24h urine cortisol (1924 mcg/L in 3.4L volume of urine, n 50% reduction) and inferior petrosal sinus:periphery sampling (IPS:P) ratio of 2 is diagnostic for a pituitary source of ACTH)...The patient was started on ketoconazole 200 mg twice daily (BID)...Alternative treatments were evaluated: mitotane was excluded due to slow onset of action, and mifepristone, though rapid-acting, was dismissed as cortisol levels cannot be used as a biomarker with this medication and titration based on symptomatic response was unreliable in the setting of psychosis. Osilodrostat (off-label for ectopic Cushing
- |||||||||| ketoconazole / Generic mfg., hydrocortisone / Generic mfg.
Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2384;
An accurate and timely diagnosis, while challenging, is key. Patients usually present with rapidly progressing symptoms that could cause life-threatening complications such as thrombosis and sepsis.
- |||||||||| methimazole / Generic mfg., hydrocortisone / Generic mfg., zoledronic acid / Generic mfg.
Does Allgrove Syndrome Have Endocrine Manifestations Beyond Adrenal Insufficiency? (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2367;
Patients usually present with rapidly progressing symptoms that could cause life-threatening complications such as thrombosis and sepsis. Workup was consistent with Graves
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg.
Hydrocortisone vs Prednisone During Recovery Following Surgical Cure for Endogenous Hypercortisolism: A Longitudinal Observational Study (251 - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_2058;
No differences in age (median age 51 vs 53 years, P=0.62), sex (84 vs 85% women, P=0.83), etiology of hypercortisolism (ACTH-dependent: 44% vs 48%, P=0.26), clinical severity of hypercortisolism (median score 13 vs 12, P=0.97), or biochemical severity of hypercortisolism (median score of 6 in both, P=0.31) were noted between groups. When assessed at 4-, 8-, and 12-weeks post-surgery, the prevalence and trajectory of symptoms (fatigue, myalgias/arthralgias, sleep, headaches, nausea, weakness) were similar in patients treated with hydrocortisone and prednisone (P>0.05 for all).
- |||||||||| RZ358 / Rezolute
RZ358 Therapy. A Novel Approach to Hyperinsulinemia in Metastatic Neuroendocrine Tumor Patients (156ABC - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1998;
RZ358 represents a novel and unique treatment option for refractory HH in patients with metastatic NETs and can improve clinical outcomes when standard interventions fail. This case underscores the potential of RZ358, a monoclonal antibody, to treat HH beyond its approved use for congenital cases, suggesting its applicability to cases of hyperinsulinemia secondary to NETs in adults.
- |||||||||| dexamethasone / Generic mfg.
The interplay of FOXO1 and NR3C1 in the development and function of pituitary somatotropes (151AB - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1938;
Our studies reveal that treating pregnant mice with the synthetic glucocorticoid, dexamethasone leads to premature somatotrope maturation...Further supporting this finding, the deletion of Nr3c1 results in a decreased number of GH-positive cells at e16.5. Altogether these findings demonstrate that NR3C1 and FOXO1 are key factors regulating somatotrope maturation.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Acute Onset Myxedema Coma After Pituitary Surgery (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1831;
Altogether these findings demonstrate that NR3C1 and FOXO1 are key factors regulating somatotrope maturation. The following day, the patient became unresponsive, bradycardic, and had hypothermia to 30
- |||||||||| Role of Plasmapharesis- A Tale of Two Thyroid Storms (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1821;
This case series shows two cases of thyroid storm treated with plasmapheresis and had two stark contrasts. Further studies should be done to elucidate the usefulness of plasmapheresis for thyroid storm when refractory to standard of treatment.
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