Endocrinology Clinic Research Articles

Impact of Prescribing Patterns Before and After Short-Term, Pharmacist-Led Type 2 Diabetes Service in an Endocrinology Clinic

Impact of Prescribing Patterns Before and After Short-Term, Pharmacist-Led Type 2 Diabetes Service in an Endocrinology Clinic

WITHDRAWN: New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study.

Erhan Aysan, Yeliz Ersoy, Zuhal Gucin, Merve Cengiz, Huseyin Akbulut, Sema Arici, Mahmut Muslumanoglu. New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study, Clinical Endocrinology, 15th July 2014. https://doi.org/10.1111/cen.12554 WITHDRAWAL: The above article, first published online on Wiley Online Library (wileyonlinelibrary.com) on 15th July 2014, has been withdrawn by agreement between the Editors in Chief, Prof Aled Rees and Prof Maralyn Druce and John Wiley and Sons Ltd. The withdrawal has been made because the authors did not respond to requests to finalise the article for publication.

Prevalence and incidence of heart failure in patients with type 2 diabetes mellitus. Results of the prospective DIABET-IC study

Abstract Introduction Heart failure (HF) is one of the major health problems in our environment today. Type 2 diabetes mellitus (DM2) is an important cardiovascular risk factor and can increase the burden of HF through various mechanisms. The incidence of HF in DM2 has not been well studied. Purpose The aim of our study was to evaluate the prevalence and incidence of HF in patients with DM2 followed in hospital cardiology and endocrinology departments. Methods The DIABET-IC study is a longitudinal cohort, prospective, multicenter follow-up study that included 1,249 consecutive patients with DM2 in 2018-2019 in 30 Spanish centers in cardiology and endocrinology outpatient clinics. HF was diagnosed according to the clinical records and following the criteria of the European Society of Cardiology. The prevalence of HF at the inclusion visit was analyzed, as well as the incidence of HF (new diagnoses) during a 3-year follow-up. Results Mean age was 67.3±+9.9 years, with 31.7% of the patients being women. Cardiology clinics included 61.9% of patients and endocrinology clinics the remaining 38.1%. There was a previous history of coronary artery disease in 38.6%, hypertensive heart disease in 21% and atrial fibrillation in 31.9%. Cardiovascular and antidiabetic drugs prescribed at the baseline and 3-year visits are shown in figure 1. Figure 2 summarizes the results of the study. The prevalence of HF at the baseline visit was 39.2%, 490 cases (with reduced LVEF 17.3%, mildly reduced 8.1% and preserved 13.8%). After a follow-up of 1,935/100 persons-year of cases without baseline HF, 58 incident cases of HF were diagnosed, 7.6% (32 in the first year, 13 in the second and 13 in the third year of follow-up). The incidence rate was 3.01/100 person-years (95%CI: 2.30-3.92). Of these 58 cases, 23.7% were with reduced LVEF, 28.9% with slightly reduced LVEF and 47.4% preserved. The incidence was higher in patients followed by endocrinology (3.90 vs 2.90/100 persons-year; p=0.042). At the end of the 3-year follow-up, including baseline prevalence, 46.8% of all patients had HF. Conclusions The prevalence and incidence of HF in patients with DM2 are very high. The incidence of HF is around 3% per year, which is almost 8 times higher than the rate found in large studies in the general population. Approximately half of the new cases were HF with preserved LVEF, and the other half with LVEF < 50%. The use of new antidiabetic drugs, such as iSGLT2, which have been shown to reduce the incidence of HF, should be encouraged.

An exploratory study of perceptions and utilization of genetic information in the intended parent experience of oocyte donor selection.

Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors' available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor. An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors' available genetic information and process in choosing an oocyte donor. Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers. Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience.

Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial.

Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912.

The Manifestations and Complications of X-linked Hypophosphatemia in Saudi Arabia: A Retrospective Study

Background: X-linked hypophosphatemia (XLH) is a genetic disease of phosphate metabolism in which inactivating mutations of the phosphate regulating endopeptidase homolog, X-linked (PHEX) gene lead to local and systemic effects. In our pediatric clinics, XLH was observed to be associated with multiple complications despite conventional treatment. There is a need for novel treatment modalities to prevent disease progression and aid in the resolution of symptoms. Methods: This retrospective cross-sectional study aimed to understand the manifestations and complications of XLH in patients followed up at the endocrinology clinics in King Faisal Specialist Hospital and Research Center in Saudi Arabia. The study was conducted by reviewing the medical files of all XLH patients at the King Faisal Specialist Hospital and Research Center. Results: All the patients (N=24) who were included in this study had PHEX gene mutations. The mean age was 18.7 13.6 years and 68% were females. The mean height standard deviation score (HSDS) was ‑2.96 (-5.25 to -0.97) and 12 patients reached their final height (mean final HSDS, -3.28 [-1.39 to ‑5.39]). Skeletal deformities (mainly genu varum) were observed in 68% of the patients and 29% had craniosynostosis; 54% had undergone corrective osteotomy. Hyperparathyroidism was observed in 54% of the patients and 45% of the patients had nephrocalcinosis (grades 2/3). Conclusions: In our study, a majority of the XLH patients suffered from complications arising from the use of conventional therapy, thus indicating the need for novel treatment modalities for these patients. Additionally, no correlation between genotype and phenotype was found.

The Relationship Between Discomfort Intolerance And the Fear Of Self-Injection And Testing In Patients With Diabetes Using Insulin: A Cross-Sectional Study.

Diabetes is a global problem. Diabetes nurses, in particular, take great responsibility in reducing and controlling the fears of individuals using insulin and increasing their capacity to tolerate discomfort. This study was conducted to examine the effects of the capacity to tolerate discomfort on the fear of self-injection and the status of testing blood glucose levels in patients with type 1 and type 2 diabetes using insulin. This cross-sectional study was conducted between December 2022 and February 2023 with 320 adult patients with type 1 and type 2 diabetes using insulin who were followed up in the Endocrinology and Internal Medicine Clinics of a university hospital in Turkey. The data analysis process included analyses of the frequency, independent-samples t-tests, one-way ANOVA, the Kruskal-Wallis H test, and Pearson's correlation analysis. Data were analysed using the IBM SPSS v27.0 software, considering alpha as 0.05. The mean total Discomfort Intolerance Scale score of the patients was 22.78 ± 6.74, and the mean Fear of Self-Injecting and self-testing was 21.1 ± 6.7. A negative significant correlation was found between the discomfort intolerance levels of the patients and their levels of fear of self-injection and self-testing (p < 0.05). Individuals with a higher capacity to tolerate discomfort have lower levels of fear of self-testing and self-injection. Therefore, the fear of self-testing and self-injection in patients using insulin injections may affect diabetes self-management. Individuals with low tolerance for discomfort should be identified, interventions to increase tolerance in individuals at risk should be planned, and diabetes self-management should be better supported. The reporting of the results of the study adhered to the STROBE guidelines.

6869 Endocrinologist Perceptions of the Value of Digital Health Tools to Assist in the Management of Insulin Dosing

Abstract Disclosure: M.B. Davidson: Employee; Self; Eli Lilly &amp; Company. B. Liao: Employee; Self; Eli Lilly &amp; Company. C. Heckman: Employee; Self; Eli Lilly &amp; Company. Background and aims: Insulin management is complex for both people with diabetes (PwD) and the healthcare providers (HCP) who treat them. Digital tools, such as connected insulin pen (CIP) platforms may reduce burden and improve suboptimal insulin dosing, especially through automatic capture of insulin dose events and integration with glucose values. However, the acceptance and utilization of CIP platforms in clinical practice remains lower than expected, given this clinical care gap. This study attempted to ascertain beliefs of HCP leading to this finding. Methods: For this cross-sectional study, 190 members of The Endocrine Society who self-identified as “clinical endocrinologists who treat diabetes” completed a 10-question survey on their perception of digital health tools and their value in clinical practice. Results: In their patients using multiple daily injections (MDI), defined as three or more injections of insulin per day, documentation of insulin dosing data was identified as “important” or “very important’ to 81% of respondents. However, only 48% of respondents are “confident” or “very confident” in the reliability of manually captured insulin and glucose data. While 92% of respondents indicated that a digital platform that displays insulin and glucose data would be “beneficial” or “very beneficial” for making dosing recommendations, 60% have found that a CIP platforms had been “beneficial” or “very beneficial” in helping PwD improving their glycemic control. Conclusion: A group of almost 200 clinician members of the Endocrine Society, who actively treat PwD, indicated that in their PwD using MDI regimens, access to combined insulin and glucose data is important, and digital capture of this data would be beneficial. However, this data is often unavailable or unreliable. The survey revealed a gap between their belief that availability of glucose data and insulin dosing data can help them make dosing recommendations and their belief that these will translate into impacting glycemic control of patients. Further research would be helpful to determine how diabetes technology may better support these HCP and the PwD they treat in practice. Presentation: 6/1/2024

6370 New-Onset Autoimmune Diabetes Following COVID-19 Infection and its Implications for Identical Twin Siblings

Abstract Disclosure: G. Wintermyer: None. S. Gillis-Funderburk: None. COVID-19 patients face many post-recovery complications,including autoimmune disorders. Late autoimmune diabetes ofadults (LADA) is one such disorder. Studies suggest that SARS-CoV may trigger proinflammatory cytokines that damage beta cellsand impair insulin secretion. Here, we explore a case of new-onsetLADA in a patient after recovery from COVID-19. Further, asidentical twins of LADA patients have a higher risk of developingit, we discuss how we approached the patient’s identical twin.A 29-year-old female with history of obesity (BMI 32.3) presentedto our endocrinology clinic. She complained of difficulty losingweight and fatigue and reported having COVID-19 three monthsearlier. She also mentioned having polyuria. She underwent labtests, including CBC, CMP, TSH, A1C, and a lipid panel. The testresults were within normal limits, except for her A1C of 11.3%.She was started on metformin and weekly Semaglutide injections.Given her recent COVID-19 history, she was assessed for LADA.Anti-GAD-65 and ZNT8 antibodies were 120 U/mL and 150U/mL, respectively. Serum C-peptide and IA-antibodies werewithin normal ranges. The patient informed us of her twin sister’sconcurrent COVID-19 infection. Due to the risk of LADA in hertwin sister, we recommended an evaluation by our clinic. Duringthe sister’s first visit, her BMI was 37.5, and she asked for weightloss medication. Comprehensive testing, including LADAantibodies, was conducted, with results within normal ranges andA1C level of 4.9%. The sister was also started on Semaglutide forweight management.The patient had quarterly follow-up appointments at the clinic.After a year, her A1C and continuous glucose monitoring machine(CGM) readings showed improvement. Her BMI decreased to 24.She never required insulin therapy, as her diabetes was well-managed and her average monthly glucose level on GCM readings were 125, 123 and 119 mg/dL in three different periods. Antibodieswere retested. This time IA-2 antibody was also elevated.Similarly, her twin sister continued to follow-up at our clinic. Thesister achieved significant weight loss without complications. HerLADA antibodies remained negative, and her A1C remainednormal. Clinicians should be vigilant for post-COVID LADA. In this case,Semaglutide aided weight loss, which benefits diabetesmanagement. Ongoing studies explore the potential of GLP-1medications in early-stage LADA. Historically, LADA patientswere started on insulin. However, CGM has enabled close glucosemonitoring, offering management of LADA with non-insulinmedications. It is also important to remember that autoimmunedisease risk is elevated in identical twins. In this case, although thetwin sister did not develop antibodies, the risk remains. Regularevaluation of high-risk patients is crucial for early detection ofantibodies, facilitating timely treatment to prevent adverseoutcomes. Presentation: 6/3/2024

8125 Long-term Effects of Gender Affirming Hormone Therapy (GAHT) on Lipid Profile

Abstract Disclosure: G. Le: None. S. Pinkson: None. J. Trejo: None. D. Tripathy: None. Long-term Effects of Gender Affirming Hormone Therapy (GAHT) on Lipid Profile There is differential effect of long-term Estrogen and Testosterone therapy on lipid profile. While oral estradiol therapy in post-menopausal women has been associated with increased serum triglyceride and HDL, testosterone therapy in hypogonadal men decreases total cholesterol, LDL and HDL cholesterol. However, the long-term effects of Estrogen and Testosterone on lipid profile in transgender patients are not clear. We conducted a retrospective study to analyze the long-term effects of GAHT in transgender men and women followed in Endocrinology Clinic at Veterans Affairs Hospital. 36 transgender men (age 38 ± 2 years, on IM Testosterone cypionate) and 54 transgender women (age 46 ± 2 years, 36 on E2 tablet, 12 on patch, 6 on IM) were followed for 46 ± 5 months and 61 ± 5 months, respectively. Total cholesterol, triglyceride, HDL, LDL cholesterol, systolic and diastolic blood pressures, and BMI were compared before and after initiation of therapy. As expected, following GAHT, total testosterone was higher (546 ± 48 vs. 35 ± 9 ng/dL, P&amp;lt;0.001) in transgender men; in transgender women, serum E2 was higher (110 ± 9 vs. 26 ± 2 pg/dL, P&amp;lt;0.001) and total testosterone was suppressed (444 ± 29 ng/dL vs. 66 ± 13 ng/dL). In transgender men, after a follow-up period of approximately 4 years, there were no significant changes in lipid profile (total cholesterol 178 ± 8 vs. 175 ± 8 mg/dL, triglyceride 121 ± 4 vs 134 ± 12 mg/dL, HDL 47 ± 2 vs. 44 ± 2 mg/dL, LDL 107 ± 7 vs. 106 ± 8 mg/dL, all p=NS). Similarly in transgender women, no difference in lipid profile (total cholesterol 170 ± 5 vs. 175 ± 4 mg/dL, triglyceride 118 ± 7 vs 140 ± 9 mg/dL, HDL 49 ± 2 vs. 53 ± 3 mg/dL, LDL 99 ± 4 vs. 97 ± 4 mg/dL, all p=NS) was observed after 5 years of GAHT. There were no differences in lipid profile regardless of E2 tablet, patch or IM therapy. In transgender men, there was an increase in diastolic blood pressure (72 ± 3 vs. 76 ± 2 mmHg, P&amp;lt;0.05) while in transgender women there was decrease in systolic blood pressure (124 ± 2 vs. 118 ± 2 mmHg, p&amp;lt;0.005), and slight increase in BMI (28 ± 0.9 vs. 30 ± 1 kg.m2, P&amp;lt;0.005). In conclusion, long-term testosterone therapy in transgender men and estrogen therapy in transgender women was not associated with worsening lipid profile. Estrogen therapy was associated with lower BP in transgender women and testosterone therapy led to higher BP in transgender men. Presentation: 6/2/2024

7902 Improvement In Follow-Up Of Post-Hospital Discharge Patients After Targeted Approach

Abstract Disclosure: S. Ward: None. Q. Aziz: None. A.L. Champion: None. K.E. Izuora: None. Improvement in Follow-up of Post-hospital Discharge Patients after Targeted Approach Introduction: Outpatient follow up after discharge from the hospital is a well-established factor affecting health outcomes in patients with chronic medical conditions. A prior QI project at our institution utilizing a Plan-Do-Study-Act (PDSA) cycle showed that overall follow up rate was 24% in patient expected to follow up in our outpatient clinic. The aim of this QI project was to identify and implement a targeted approach to improve outpatient follow up at our clinic. Methods: This study was a second round of a PDSA cycle with the goal of improving outpatient follow up. Analysis of prior data identified 54 patients referred for outpatient follow up in our endocrinology clinic after hospital discharge (non-targeted approach). Of these 54 only 13 patients had established follow up care (24%). We looked closer at the 39 patients who did not follow up to identify areas we could act on to improve follow up; 38% of these patients did not follow due to one of the following: did not know they needed to follow up, lack of knowledge of how to contact office, unable to reach office by phone. To overcome these obstacles, we developed a targeted approach for all patients seen in the hospital who were expected to follow up in the outpatient setting. This approach included the following: clinic business card with contact information given to patient, follow up instructions included in discharge instructions including how and when to contact office, message sent from physician to outpatient clinic staff requesting staff contact patient and schedule follow up appointment. This targeted approach was implemented for all patients requiring outpatient follow up seen by the UNLV Endocrinology consult service from August 1, 2023 to September 30, 2023. Results: During the two months of recruitment we identified 34 patients who needed outpatient follow up. All 34 of these patients had the targeted approach implemented. Of the 34 patients 12 have successfully followed up and one patient has a future appointment scheduled. This is a follow up rate of 35%, an increase of 11% compared with the prior QI data that did not use a targeted approach. If all future appointments are kept the follow up rate will be 38%. Five patients who had scheduled appointments did not show up to their appointment and are not counted in the successful follow group . Conclusions: Our targeted approach showed an improvement in outpatient follow up from 24% to 35% compared to a non-targeted approach. Five patients that scheduled appointments did not keep those appointments. Future steps would include evaluating reasons for no-show and identifying approaches to improve our no-show rate. . Presentation: 6/2/2024

6987 Whole exome sequencing for permanent congenital hypothyroidism

Abstract Disclosure: J. Ahn: None. H. Jeong: None. Background: Guidelines on congenital hypothyroidism (CH) recommend that genetic testing should aim to improve diagnosis, treatment or prognosis. Little information is available regarding the genetic heterogeneity of CH in Koreans. We aimed to investigate the genetic etiology of permanent CH to increase the genetic diagnosis rate and find associated diseases by whole exome sequencing (WES). Methods: A total of 32 patients with permanent CH were enrolled from Endocrinology Clinic at Jeju National University Hospital and Soonchunhyang University Cheonan Hospital. WES was performed on 3billion extracted through the patient's buccal swab. Variant classification is based on the guidelines presented by the American College of Medical Genetics and Genomics (ACMG) and the Association for Molecular Pathology (AMP). Results: A total of 30 variants were identified in 20 patients. (62%). WES identified 22 variants in 6 genes (DUOX2, DUOXA2, TPO, PAX8, TG, TSHR). We detected 20 Pathogenic /Likely pathogenic of 5 genes in 15 patients (50%). The most frequently affected genes were DUOX2 (n = 10), TPO(n=4) DUOXA2 (n=3), TSHR(n=3)and PAX8 (n=2). 16 patients are monogenic and 4 patients have oligo-genic mutations. The test results of patients (n=6) with thyroid agenesis or ectopic thyroid gland were all negative. Conclusions: In patients with permanent congenital hypothyroidism, the mutation rate through the WES method is quite high. Genetic testing is useful for medication dose adjustment and genetic counseling through correlation of genotype and phenotype. Presentation: 6/1/2024

7241 Catamenial Diabetic Ketoacidosis

Abstract Disclosure: L. Javed: None. A. Rehan: None. L. Hashim: None. J. Lim: None. Introduction: Diabetic ketoacidosis (DKA) is a common cause of hospitalization and readmission in patients with diabetes mellitus. Etiologies are generally due to medication non-adherence, trauma, infection, or other precipitating illness. In approximately 10% of DKA cases, no discernible precipitating cause can be determined. The word catamenial is derived from a Greek word meaning monthly. It is used to describe the monthly occurrence of menstruation. Catamenial hyperglycemia is a phenomenon in which blood glucose levels change with the different phases in the menstrual cycle. This can precipitate recurrent, unexplained episodes of DKA. Here, we present a similar case. Case description:A 19-year-old woman with type 1 diabetes, gastroparesis, hypertension, dysmenorrhea and cyclical vomiting disorder presented with unrelenting nausea and vomiting for one day. Other symptoms included abdominal &amp; chest pain that the patient attributed to premenstrual symptoms. She is afebrile, doesn’t have any other symptoms of infection and no recent sick contacts. She is compliant with her home insulin regimen of Insulin detemir 20 units BID and pre meal 8 units insulin aspart. Further interrogation reveals she has regular menstrual cycles and has been hospitalized three times in the last three months due to DKA coinciding with premenstrual symptoms, specifically severe abdominal pain and vomiting, typically starting five days before the onset of her menstrual cycle. She is hemodynamically stable and physical exam is significant for mid epigastric tenderness. Significant labs: WBC 16.52 (N&amp;lt;11 K/mm3), glucose 457 mg/dl, anion gap 23, K 4.1 (mmol/L), bicarbonate 18 (≥19 mmol/L), lactate 3.2 (N ≤ 1.9 mmol/L), beta hydroxybutyarate 4.0 (N ≤ 0.27 mmol/L), trop T 6 (N&amp;lt;10 ng/L), BHCG negative . Hba1c a month ago was 9.6%. Infectious work up was negative. EKG showed no signs of ischemia. She was treated per DKA protocol which results in resolution of symptoms and normalization of labs. Since no other precipitating factors for DKA are identified, and her symptoms corresponded with her menstrual periods, she is given a diagnosis of Catamenial DKA and scheduled for regular follow up in endocrinology clinic. Conclusion: This case highlights the importance of considering the association betweenmenstrual cycle phases and blood sugar levels as a possible trigger, underscoring the role of a thorough menstrual history in patients presenting with DKA. The impact of menstrual cycle fluctuations on glycemic control varies among patients however glucose profiles seem to be consistent across cycles for each individual woman. This highlights the need for personalized management strategies including patient education and adjustment of insulin during these periods. Addressing this adequately will improve overall glycemic control, reduce hospitalizations, and help improve the quality of life. Presentation: 6/1/2024

8533 Salt on the Kidneys A case of DDAVP induced arginine vasopressin resistance

Abstract Disclosure: M.M. Jordan: None. J.R. Islam: None. R. Hassan: None. A 63-year old female with a history of head trauma complicated by polyuria and excessive fatigue diagnosed with central DI and started on treatment with oral Desmopressin. She had no other known pertinent medical history. Patient was lost to follow-up with an eventual visit to the emergency department with complaints of bilateral leg cramps, nausea and persistent headaches. She was noted to have been initiated intranasal desmopressin in addition to oral DDAVP. On initial lab work, Sodium was 114 along with acute kidney injury. She was admitted to ICU and treated with hypertonic saline. DDAVP was withheld until sodium normalized and stabilization of renal functions. GFR still remained impaired on discharge at 40 mL/min/1.73m*2. She was then discharged on DDAVP with reestablished follow up in the endocrinology clinic with complaints of persistent polyuria. Once more, she was sent to the emergency room and was admitted for acute renal injury secondary to dehydration in the setting of polyuria and altered mentation. Upon review of her medications, the patient continued both oral and inhaled DDAVP. No other medications or supplements were reported. During this subsequent hospitalization, sodium remained between 131-135 with urine output 4.5L/ day despite increasing doses of oral DDAVP and oral sodium supplementation. At which point, suspicion for mixed DI was hypothesized (central DI and arginine vasopressin resistance). Other causes of polyuria were ruled out. Labs for persistent AKI revealed gross proteinuria. Renal biopsy was performed during hospitalization which showed acute to chronic vascular thrombotic microangiopathy and focal segmental glomerulosclerosis with collapsing features. Extensive workup for chronic infections, autoimmune conditions and hematological malignancies were negative. This showed concerns for possible DDAVP induced renal injury. Presentation: 6/2/2024

8356 Total Hypophysectomy in Cushing’s Disease: Results from a Terciary Center

Abstract Disclosure: M.V. Lopes: None. M.D. Severino: None. J. Rocha: None. C.R. Peixe: None. M.I. Alexandre: None. A. Gomes: None. M.J. Bugalho: None. Introduction: Transsphenoidal surgery (TSS) is the first line treatment for Cushing’s disease (CD), leading to remission in 70-80% of cases. Though selective adenomectomy is the preferred approach, total hypophysectomy may be needed. Objective: To describe 3 CD patients in which total hypophysectomy was performed. Clinical cases 1. A 58-year-old man with a history of type 2 diabetes (T2D) and obesity, was referred to the Endocrinology Clinic due to abdominal purple striae and facial plethora. Laboratory tests suggested ACTH dependent hypercortisolism, with normal serum ACTH, high 24h urinary cortisol and no cortisol suppression in the overnight 1mg dexamethasone suppression test (DST). The CRH test was suggestive of CD but no adenoma was found on pituitary MRI. Inferior petrosal sinus sampling (IPSS) was compatible with CD with right-sided lateralization. Right hypophysectomy was performed but no CD remission was achieved, so the patient underwent total hypophysectomy. Corticotroph hyperplasia was identified in histology. After 9 months of follow-up, he mantains CD remission. 2.A 37-year-old woman was diagnosed with ACTH dependent hypercortisolism after referral to the Endocrinology Clinic for alopecia, amenorrhea, hypertension and hirsutism. Laboratory tests showed severe hypokalemia, high plasma ACTH and 24h urinary cortisol and the MRI showed a right-sided macroadenoma. Nonetheless, considering the clinical severity, an IPSS was performed and definitely excluded an ectopic Cushing’s syndrome (CS) thus confirming the diagnosis of CD with right-sided lateralization. The patient underwent selective TSS, however, for lack of CD remission, total hypophysectomy was performed. Histology revealed an adenocorticotrophic adenoma. Yet, a year later, she maintains persistence of CD, although less severe, and is under treatment with metyrapone. 3.A 58-year-old woman with a history of T2D and class 3 obesity, was evaluated in our Endocrinology Clinic due to obesity. Her physical examination suggested CS, so this hypothesis was investigated. Laboratory tests suggested ACTH dependent hypercortisolism, with normal serum ACTH, elevated 24h urinary cortisol and no cortisol suppression in the overnight 1mg DST. The high dose DST was suggestive of CD but the pituitary MRI didn’t show an adenoma. IPSS was compatible with CD but it was not possible to determine lateralization. So, total hypophysectomy was performed. An adenocorticotrophic adenoma was identified in histology. Postoperative CD remission was achieved and persists 3 months later. Conclusions: These 3 cases highlight the challenge of treating CD and suggest that in certain cases total hypophysectomy may be the treatment of choice to cure or at least improve CD. Although it is associated with more complications than selective TSS, our patients had no complications, only developed panhypopituitarism and diabetes insipidus. Presentation: 6/1/2024

6517 Cardiac Tamponade Secondary to Occult Primary Hypothyroidism

Abstract Disclosure: L. Javed: None. H. Al jumaili: None. A. Mahaldar: None. I. Goyal: None. N. Shakir: None. E. Punni: None. Introduction: The incidence of pericardial effusion in hypothyroidism seems to correlate with severity and duration of the condition and ranges from 3% to 37%. Cardiac tamponade resulting from hypothyroidism is exceptionally rare. We present a case of a patient presenting with this complication.Case Summary:A 38-year-old woman presented during a routine clinic visit with symptoms of fatigue and was found to have elevated liver functions enzymes with ALT 107 (N&amp;lt;48 U/L ) and AST 70 (N&amp;lt;47 U/L)Further evaluation through abdominal imaging revealed incidental finding of a partially imaged moderate pericardial effusion. A subsequent echocardiogram showed circumferential pericardial effusion with early tamponade physiology, necessitating immediate referral to the emergency room (ER) for further assessment and management.Upon admission to the ER, the patient reported progressive fatigue, increased sleep and menorrhagia over 8 months. There were no accompanying symptoms of weight gain or constipation. Family history was positive for thyroid disease in her grandmother. Initial vital signs on admission were Blood pressure: 119/86, Pulse: 55, Respiratory Rate: 13, Temp: 36.7 °C. Electrocardiogram showed sinus bradycardia. Laboratory findings were significant for: Hgb 8.7 (N&amp;gt;11.5), MCV 77.5 (N&amp;gt;80 fL), mildly elevated ALT 56, markedly elevated TSH 255 (N&amp;lt;5 IU/mL), low free T4 &amp;lt;0.1 (N ≥ 0.7 ng/dL), low free T3 &amp;lt;0.6 (N ≥2.0 pg/m), and elevated TPO 472 (N 35 IU/mL). Infectious and rheumatologic work-up were negative. Thyroid ultrasound showed heterogenous echogenicity consistent with thyroiditis.Patient underwent urgent pericardiocentesis draining 750 ml of clear yellowish pericardial fluid. Simultaneously, the patient was initiated on daily levothyroxine at a dose of 112 mcg.Stability in hemodynamics and repeat echocardiogram showcasing no pericardial effusion facilitated the patient’s discharge. Notable improvement with reduction in TSH from 260 to 20 was seen at the one-month follow-up in endocrinology clinic. Conclusion: Hypothyroidism should be considered in patients diagnosed with cardiac tamponade presenting with bradycardia, as in this case. It's been observed that hypothyroidism can affect LFTs which typically resolve with thyroid replacement. Treatment of cardiac tamponade depends on the patient's hemodynamic status. For early mildly affected cases of tamponade, a conservative approach involving close monitoring and limiting fluid intake may suffice, but drainage is often necessary. Since the pericardial effusion and tamponade stem from hypothyroidism, there's a high chance of effusion recurring after drainage. Hence, administering levothyroxine is essential, often leading to effusion resolution within 2-12 months without recurrence. Presentation: 6/3/2024

7812 Community Practice Setting Experience in Evaluation of Incidental Thyroid Nodules

Abstract Disclosure: N. Abate: None. H. Rhodes: None. M. Horlavadi: None. B. Adams-Huet: None. M. Chandalia: Advisory Board Member; Self; Boehringer Ingelheim. Speaker; Self; Boehringer Ingelheim, Eli Lilly &amp; Company, Novo Nordisk. Background: There is a significant increase in detection of incidental thyroid nodules due to increase in routine screening ultrasounds at church, workplace, and health fairs, increase in routine ultrasound in primary care clinics and incidental finding of thyroid nodule during carotid artery ultrasound. These patients are then referred for thyroid nodule fine needle aspiration biopsy. Aim of this study was to evaluate real world data in frequency of thyroid cancer in patients referred for incidental thyroid nodule to a nonacademic Endocrinology clinic utilizing centralized collection of cytology and molecular analysis. Method: Medical records were reviewed for consecutive FNA of incidental thyroid nodule in an Endocrinology clinic in greater Houston from 2021 to 2023. FNA was performed in patients selected based on ACR TI-RADS classification. Patients with Bethesda score of 3 or more had molecular testing with Thyroseq performed. Patients with intermediate or high probability of cancer on Thyroseq as well as Patients with Bethesda 4 and 5 on cytopathology were referred for surgery. Surgical pathology was obtained in patients who underwent surgery. Data was tabulated and analyzed using SAS. Results: A total of 304 subjects, 267 Female and 37 males, age 57 ± 13, nodule size 2.69 ± 1.4 (mean ± SD), had thyroid nodule FNA between 2021 and 2023. Of these FNA, 23 (7.5%) sample collections were insufficient, 233 (77.3%) were benign (Bethesda 2), 46 (15%) were Atypia of undetermined significance or Suspicious for malignancy. Of those subjects with Bethesda 3 or higher, 36 patients had molecular testing by Thyroseq Method. Fifteen patients had intermediate and high risk finding on Thyroseq. Thirty-four subjects had surgery and 8 patients had malignancy on surgical pathology. One patient was identified as Medullary Thyroid cancer on Thyroseq, confirmed by surgery. Frequency of malignancy in incidentally detected thyroid nodule in the whole group was 2.6%, those with Bethesda 3 and more was 17.4% and those with Thyroseq intermediate or high risk was 27%. Conclusion: Availability of centralized cytopathology and reflex molecular testing to Community practice settings helps reducing unnecessary thyroid surgeries in patients with incidental thyroid nodules. Presentation: 6/1/2024

8125 Long-term Effects of Gender Affirming Hormone Therapy (GAHT) on Lipid Profile

Abstract Disclosure: G. Le: None. S. Pinkson: None. J. Trejo: None. D. Tripathy: None. There is differential effect of long-term Estrogen and Testosterone therapy on lipid profile. While oral estradiol therapy in post-menopausal women has been associated with increased serum triglyceride and HDL, testosterone therapy in hypogonadal men decreases total cholesterol, LDL and HDL cholesterol. However, the long-term effects of Estrogen and Testosterone on lipid profile in transgender patients are not clear. We conducted a retrospective study to analyze the long-term effects of GAHT in transgender men and women followed in Endocrinology Clinic at Veterans Affairs Hospital. 36 transgender men (age 38 ± 2 years, on IM Testosterone cypionate) and 54 transgender women (age 46 ± 2 years, 36 on E2 tablet, 12 on patch, 6 on IM) were followed for 46 ± 5 months and 61 ± 5 months, respectively. Total cholesterol, triglyceride, HDL, LDL cholesterol, systolic and diastolic blood pressures, and BMI were compared before and after initiation of therapy. As expected, following GAHT, total testosterone was higher (546 ± 48 vs. 35 ± 9 ng/dL, P&amp;lt;0.001) in transgender men; in transgender women, serum E2 was higher (110 ± 9 vs. 26 ± 2 pg/dL, P&amp;lt;0.001) and total testosterone was suppressed (444 ± 29 ng/dL vs. 66 ± 13 ng/dL). In transgender men, after a follow-up period of approximately 4 years, there were no significant changes in lipid profile (total cholesterol 178 ± 8 vs. 175 ± 8 mg/dL, triglyceride 121 ± 4 vs 134 ± 12 mg/dL, HDL 47 ± 2 vs. 44 ± 2 mg/dL, LDL 107 ± 7 vs. 106 ± 8 mg/dL, all p=NS). Similarly in transgender women, no difference in lipid profile (total cholesterol 170 ± 5 vs. 175 ± 4 mg/dL, triglyceride 118 ± 7 vs 140 ± 9 mg/dL, HDL 49 ± 2 vs. 53 ± 3 mg/dL, LDL 99 ± 4 vs. 97 ± 4 mg/dL, all p=NS) was observed after 5 years of GAHT. There were no differences in lipid profile regardless of E2 tablet, patch or IM therapy. In transgender men, there was an increase in diastolic blood pressure (72 ± 3 vs. 76 ± 2 mmHg, P&amp;lt;0.05) while in transgender women there was decrease in systolic blood pressure (124 ± 2 vs. 118 ± 2 mmHg, p&amp;lt;0.005), and slight increase in BMI (28 ± 0.9 vs. 30 ± 1 kg.m2, P&amp;lt;0.005). In conclusion, long-term testosterone therapy in transgender men and estrogen therapy in transgender women was not associated with worsening lipid profile. Estrogen therapy was associated with lower BP in transgender women and testosterone therapy led to higher BP in transgender men. Presentation: 6/2/2024

12261 Association Of Geographic And Demographic Factors With Receipt Of Endocrinology Care Among Adults With T2D And ASCVD Before And After Telemedicine Uptake

Abstract Disclosure: M. Zupa: None. J. Bauer: None. S. Rothenberger: None. Y. Zheng: None. A. Johnson: None. E. Kinnee: None. A. Rosland: None. Care from endocrinologists has been linked to improved care quality and uptake of novel treatments which may improve outcomes for adults with T2D and ASCVD, who are at high risk for adverse health outcomes. However, transportation, geographic, and other barriers may impact access to specialty care for under-resourced populations. We sought to evaluate the impact of patient-level geographic and sociodemographic factors on receipt of endocrinology care before and after widespread telemedicine uptake. We conducted a retrospective cohort study of adults with T2D and ASCVD in a large health system from 1/2018-6/2022. ZIP Code centroids were used to map patients to their home geographic area, and multivariable logistic regression models evaluated associations between sociodemographic and geographic predictors with receipt of endocrinology care. Analyses were stratified into pre- (1/1/2018-3/15/20) and post- (3/16/2020-6/30/2022) telemedicine periods. Mixed effects models tested for differences in associations between the pre- and post-telemedicine periods. The cohort included 9,546 patients, with mean age 68.5 (SD 10.0), 39% female, 89% white, 83% urban residents; 1,725 patients received endocrinology care. In the pre-telemedicine period, geographic factors associated with receipt of endocrinology care included distance to the nearest endocrinology clinic (aOR 0.74 (95% CI 0.64-0.84) per 10 miles) and neighborhood walkability (aOR 1.38 (1.00-1.91) per 10 point increase on 0-20 scale); sociodemographic factors included age (aOR 0.70 (0.66-0.75 per 10 years), male gender (aOR 0.81 (0.72-0.92), race (aOR 1.21 for Black vs white, aOR 2.55 for Asian vs white, p=0.003), social deprivation index (0.95 (0.91-0.99) per 10 point increase on 0-100 scale, with higher values indicating more local area deprivation), and comorbidity burden (aOR 1.27 (1.02-1.59) for Elixhauser score 14+ vs &amp;lt;0, p&amp;lt;0.001). In the post-telemedicine period, distance to endocrinology clinic (aOR 0.82 (0.73-0.93) per 10 miles), age (aOR 0.67 (0.63-0.71) per 10 years), male gender (aOR 0.83 (0.74-0.94)), and comorbid conditions (aOR 1.13 (0.90-1.43) for Elixhauser score 14+ vs &amp;lt;0, p&amp;lt;0.001) were associated with receipt of endocrinology care. In mixed models comparing pre- vs. post-telemedicine periods, travel distance to endocrinology clinic, race, and social deprivation index had weaker associations with receipt of endocrinology care in the post-telemedicine period compared to pre-telemedicine, while older age was more negatively associated with care receipt post-telemedicine. These findings indicate that both geographic and sociodemographic factors impact receipt of endocrinology care among high-risk adults with T2D and ASCVD. Widespread availability of telemedicine may be associated with more equitable access to endocrinology care for some under-resourced populations. Presentation: 6/3/2024

8561 Association Of Alopecia And Hirsutism With Severity Of Depression In A Sample Of Hispanic Women With Polycystic Ovary Syndrome

Abstract Disclosure: C.M. Casas Loyola: None. Y.G. Rivera-Rodriguez: None. B. Marin Rodriguez: None. J.A. Roque Torres: None. L.A. Gonzalez Rodriguez: Research Investigator; Self; Lilly USA, LLC. J. Romaguera: None. Purpose: Polycystic ovary syndrome (PCOS), a highly prevalent endocrine disorder in females has been associated with several chronic diseases. Females with PCOS have been found with a higher prevalence of mental disorders. Depression and its severity have been associated with the development and progression of cardiovascular disease. We aimed to assess depression severity and its association with PCOS related comorbidities such as alopecia and hirsutism. Methods: A cross sectional study of females aged 21-45 years was conducted in the endocrinology clinics at the RCM-Clinics. PCOS was diagnosed using the Rotterdam criteria, hirsutism was defined by modified Ferriman-Gallwey score (mFG ≥ 9), alopecia was defined using the Ludwig scale and Depression using the Patient Health Questionnaire (PHQ9). Severity of depression and presence of alopecia and hirsutism were compared among groups. Results: A total of 112 patients were included in this study (85 patients PCOS+ and 27 patients PCOS-). Mean age was 32 ± 6 years. Severity of depression in PCOS- patients was: 44% none to minimal, 30% mild and 27% moderate to severe. Severity of depression in PCOS+ patients was: 28% none to minimal, 35% mild and 36% moderate to severe. Participants with alopecia and PCOS+ had a greater percentage of moderate to severe depression (58%) compared to the control group without alopecia (30%) (p value&amp;lt;0.05). No differences were observed between hirsutism and severity of depression among groups. Conclusion: Our study showed an association between alopecia and severity of depression in patients with PCOS+. The presence of hirsutism was not associated to severity of depression. Currently, there are more available treatments for hirsutism than for alopecia. For this reason, patients with hirsutism have more opportunities to manage their condition than patients with alopecia, which often require more invasive procedures. The presence of alopecia can be considered a risk factor for developing major depressive disorder in patients with PCOS. Treatment of PCOS-related abnormalities should be emphasized soon after diagnosis. Evaluation of mental health is imperative in our PCOS patients. Presentation: 6/3/2024