Urine Collection Research Articles

Use of urine collection as an alternative of custom-made Plastic bag for limited access dressing (LAD)

To evaluate the use of urine collection bag as an alternate of custom-made Plastic bag for Limited Access Dressing (LAD). Moist wound dressings maintains the moist and warm environment suitable for growth of granulation tissues, control wound infection, increased epithelization and reduces pain. One of the recent advances in wound care management is limited access dressing (LAD). It combines the principle of moist wound healing and a negative pressure wound therapy and accures the benefit of both principles.

Effect of feeding diets containing levels of ginger (<i>Zingiber officinale</i>) on digestibility and nitrogen balance of red Sokoto bucks

The apparent digestibility and nitrogen balance of nutrients in isocaloric and isonitrogenous diets containing 0, 250, 500 and 750 g ginger inclusion levels was studied in a 14-day trial involving twenty (20) red Sokoto bucks (RSB) weighing on the average 17.86 kg. The treatments were replicated five times in a completely randomized design. The animals were individually fed at 4% of their body weight for both the concentrate (1.5% as supplement) and Digitaria smutsii hay (2.5% as basal diet). The trial consisted of 7-day adjustment period followed by a 7-day total collection of faeces and urine. Nutrient digestibility, faecal and urine outputs were recorded. Results indicated a similar dry matter intake across the treatments. Crude protein and crude fiber intakes were significantly (P<0.05) affected by ginger inclusion levels with higher values recorded in the group fed 250 g. Dry matter digestibility significantly (P<0.05) increased with increase in ginger levels. Nitrogen retention was significantly (P<0.05) higher in bucks fed with 750 g ginger. It was therefore concluded that, varying inclusion levels of ginger improved nutrient digestibility and nitrogen retention of RSB. RSB can be fed up to 750 g/100 kg diet ginger.

FRI219 Pheochromocytoma Presenting As A Case Of Worsening Diabetes Mellitus

Abstract Disclosure: J. Eapen: None. E. Sedlis Singer: None. T.X. Lu: None. J.N. Shapiro: None. Introduction: Pheochromocytoma is often diagnosed incidentally during unrelated abdominal imaging, in patients with a family history of known disease, or in patients presenting with the classic triad of symptoms: episodic headache, sweating, and tachycardia. We describe an atypical case of pheochromocytoma presenting as acute decompensation of DM. Case presentation: A 79 year old female with DM previously well-controlled on glimepiride for 4 years presented with an acute worsening of symptoms notable for abdominal fullness, weakness and weight loss. Laboratory results revealed an increase in HbA1c from 6% to 14% (nl <5.7%) since 3 months prior. Metformin and basal insulin were added to her regimen with a subsequent improvement in HbA1c. An abdominal CT scan was done given the acuity of progression in her DM, which revealed a 5.8cm adrenal mass. The patient denied easy bruising, striae, mood changes, dizziness, or hypertension. Biochemical evaluation demonstrated normal potassium level 3.7 (3.5-5.3 mmol/dL) and aldosterone 8ng/mL (<28), non-suppressed cortisol 7.8mcg/dL after dexamethasone 1mg given the night prior, but Cushing’s Disease was ruled out by normal salivary cortisol 0.08 mcg/dL (nl 0.04-0.56 mcg/dL) and urine free cortisol 22.8 mcg/ 24h (nl 4-50 mcg/24h), and further testing revealed elevated metanephrines and catecholamines during 24 hour urine collection, Epinephrine 129 mcg/24h (nl 2-24 mcg/24h), Metanephrine 7121 mcg/24h (nl 90-315 mcg/24h) and Normetanephrine 2078 mcg/ 24h (nl 122-676 mcg/24h).Repeat CT scan again showed an indeterminate 5.4 x 3.8 x 5.5 cm right adrenal mass, a 6.9mm lipid-rich left adrenal adenoma, and left adrenal gland hyperplasia. Consequently, the patient underwent laparoscopic right adrenalectomy with pathology revealing a diagnosis of pheochromocytoma. Post-op plasma fractionated metanephrines normalized and have remained normal. Immediately post-op, all diabetes medications (including insulin, glimepiride, and metformin) were stopped and she has had resolution of diabetes with HbA1c 6 on no medications when 1-year post-op. Discussion: Excess catecholamines are known to cause disruption of glucose and insulin homeostasis from desensitization of the beta-adrenergic receptor and increased insulin resistance1. Despite this, less than a handful of pheochromocytoma cases have been reported to be presenting as an acute glycemic derangement as in our patient.

THU422 Laboratory Evaluation For Etiologies Of Secondary Osteoporosis

Abstract Disclosure: N. Shah: None. H. Galitzer: None. D. Sellmeyer: None. Data on the prevalence of laboratory abnormalities in individuals with osteoporosis is limited. The purpose of this study was to quantify the frequency of test results indicative of secondary osteoporosis in patients referred for skeletal fragility. A retrospective chart review was conducted on 653 consecutive patients referred for low bone density or fracture at Stanford Medical Center from October 2018 to December 2021. Patients were asked to complete a standardized set of laboratory tests including comprehensive metabolic panel, 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), thyroid testing, complete blood count, phosphorus, celiac screening, and 24 hour urine calcium. Demographics, bone density, and laboratory results were extracted from the medical record; statistical analysis was performed using STATA. Subjects were 65 +/- 14 (mean+SD) years old. The majority were White (59%) or Asian (24%). Most (81%) were postmenopausal women, 10% were men >50 years old, 9% were men under 50 and premenopausal women. Of men over 50/postmenopausal women, 32% had osteopenia and 67% had osteoporosis. Among premenopausal women/men under age 50, 67% had Z-scores of −2 or less. Over 99% of serologic testing was completed; however urine calcium testing was completed in 46% of subjects. Overall, 66% of subjects had at least one lab abnormality. The most common abnormalities were of PTH and 25OHD with 20% of each test showing abnormal results. Anemia was present in 16% of subjects, alkaline phosphatase and TSH each were abnormal in approximately 11% of subjects; serum phosphorus and calcium each were abnormal in 5% and celiac testing was positive in 1.2% of subjects. Of 299 subjects who completed urine collections, 27% had hypocalciuria (<100 mg), 24% had hypercalciuria (>250 mg). There was no difference in the prevalence of laboratory abnormalities among individuals with Z-scores <=−2, p=0.14. CKD stage 3 or lower was present in 15% of subjects; this was not counted in the overall rates of lab abnormalities as it was anticipated this was known. The prevalence of any lab abnormality was higher (77% vs 64%) among subjects with eGFR<60, p=0.01. PTH was significantly higher in individuals with 25 OH vitamin D levels <30, p=0.006. This study reveals a high prevalence of laboratory abnormalities while screening for secondary osteoporosis. While urine collection can be cumbersome, the high prevalence (52%) of abnormal results demonstrates the importance of this test. The rate of celiac disease is low, however, these patients were asymptomatic other than low bone density and otherwise would be undiagnosed. Low Z-score did not predict lab abnormalities. Current guidelines do not provide consensus on laboratory testing for secondary etiologies of osteoporosis due to the paucity of data. This study highlights the importance of screening patients with metabolic bone disease to identify secondary contributors. Presentation: Thursday, June 15, 2023

FRI349 Atypical Timing: Transient Diabetes Insipidus After Pituitary Apoplexy

Abstract Disclosure: I.A. Rivera Nazario: None. A.M. Santiago Carrion: None. M.T. Torres: None. A. Figueroa Cruz: None. Y. Ortiz: None. A. Aponte Velez: None. A. Vazquez: None. E.J. Sola Sanchez: None. M.M. Mangual Garcia: None. Pituitary apoplexy results from acute hemorrhage or infarction of the pituitary gland. Also, an adenoma that can develop transient or permanent pituitary hormone deficiency. Posterior pituitary function is nearly always preserved due to alternate blood supply. Most cases presenting among the fifth or sixth decade. Few cases of transient Diabetes Insipidus (DI) have been described in literature, approximately 4% of patients, making this an uncommon complication of this condition. Hereby, we describe a young male with sudden onset headache due to pituitary apoplexy with transient DI. A 33-year-old man without past medical history, presented to the emergency room with the chief complain of sudden severe headache. Physical examination without altered consciousness, visual impairment or meningeal irritation. Initial head CT was negative, except for findings of muscle spasms. Patient was discharged home with muscle relaxant and NSAIDs. Ten days later, patient continued with worsening headache, not responding to medical therapy. On reevaluation, brain MRI identified a pituitary macroadenoma, measuring 2.2 cm, with mass effect, suprasellar extension impinging the pituitary stalk, prechiasmatic optic nerves and cavernous sinus extension. Blood tests showed Na 139 mEq/L, K 4.1 mmol/L and adequate renal function. Pituitary function test consistent for hypopituitarism with free T4 0.39 ng/dL, TSH 0.084 mIU/mL, cortisol 0.19 mcg/dL, ACTH 9.39 ng/mL, GH <0.1 ng/mL, IGF-1 22.8 ng/mL and prolactin 1.52 ng/mL; except normal FSH, LH and testosterone levels. After four months of apoplectic episode, he developed polyuria and polydipsia. Brain MRI with residual sellar mass of 1.2 cm with resolution of mass effect. Visual field charting was normal. Blood tests showed Na 139 mEq/L, K 4.1 mmol/L and adequate renal function. Started on hydrocortisone and levothyroxine replacement. Diagnosis of DI was suspected, but he refused water deprivation test or DDAVP therapy. During follow-up, patient was found with serum osmolality 288 mOsm/kg, urine osmolality 202 mOsm/kg and 4.6 L 24-hour urine collection. Three months later serum osmolality was 294 mOsm/kg, urine osmolality of 383 mOsm/kg with resolution of polyuria and polydipsia. This case presents a delayed onset of transient DI treated in a conservative way. In documented cases average onset was a period of 2 weeks with resolution in 2 months. Etiology most likely due to compression or destruction of the pituitary gland or stalk impeding transit of ADH from hypothalamus to the neurohypophysis. Transient impairment of the ADH secretion is rare in pituitary apoplexy deserving evaluation in this clinical scenario. When seen, it has been related to glucocorticoid use. This is an example of an atypical pituitary disorder requiring prompt recognition to prevent further complications. Presentation: Friday, June 16, 2023

SAT551 Significantly Elevated Thyroglobulin Levels with Negative Whole-Body Scan and PET/CT After Treatment of Thyroid Cancer: A Case Report

Abstract Disclosure: A. Bassatne: None. J.T. Chaiban: None. Background: Thyroglobulin (Tg) levels are used to monitor recurrence or persistence of disease after treatment of differentiated thyroid cancer. Some cases may have persistently elevated Tg and negative whole-body scans (WBS). We present a case of substantially elevated Tg levels despite negative WBS and PET/CT after thyroidectomy and radioactive iodine (RAI) treatment in a patient with papillary thyroid carcinoma (PTC). Clinical Case: A 66 years old lady was referred to the endocrinology clinic almost 5 years ago after incidental findings of calcified thyroid nodules on CT. Thyroid US confirmed 2cm aggregate calcified nodules. FNA revealed PTC for which she underwent thyroidectomy. Pathology showed a unifocal 3.5 cm left lobe conventional PTC without angioinvasion nor extrathyroidal extension, 3/13 positive lymph nodes (LN) on the lateral dissection of the left neck as well as multiple small LN on the central dissection. 6 days postop, her Tg was still significantly high at 40.5ng/mL (Ref 1.2-35 ng/mL) and then increased to 397ng/mL after thyrogen preparation for RAI ablation, antithyroglobulin antibodies were negative. WBS post RAI was negative except for the physiologic neck uptake. Almost a year later, a diagnostic WBS after thyrogen stimulation was still negative but the stimulated Tg increased again to 235 ng/mL with negative thyroglobulin antibodies. Tg result were confirmed by LC-MS method. Heterophile Antibodies were negative. Patient confirmed that every single time she followed at least 2 weeks of low iodine diet in preparation for the WBS. Unfortunately, we were not able to get a 24 hour urine collection for iodine. A PET/CT was reassuring. CT neck/chest did not show any suspicious metastases. TSH was maintained at an adequately suppressed level all through and Tg levels were ranging around 6-8 ng/mL. After another year, a stimulated Tg was 302.4 ng/mL with a TSH of 198 mcU/mL (Ref 0.35-5.0 mcU/mL). At that time, a repeat WBS was negative and a repeat PET/CT demonstrated an interval development of a small thyroid focus thought to be consistent with recurrence of malignancy. However, a CT of neck/chest did not reveal any abnormal thyroid findings or metastases. Patient received 100 mCi of RAI after thyroid hormone withdrawal. Subsequent WBS was negative. Currently her Tg levels are stable at around 8-9ng/mL for the past 6 months with a suppressed TSH. Patient had another PET/CT through her breast surgeon to follow on a previous breast lesion and no thyroid abnormality was noted. Conclusion: Elevated Tg levels despite negative imaging may be seen in patients with PTC as illustrated in this case. We are reporting it due to the extent of elevation of Tg levels seen on more than one occasion in the absence of structural recurrence. Evaluation and treatment of such patients remain controversial. Presentation Date: Saturday, June 17, 2023

FRI687 Clinical Relevance Of 24-hour Urine Calcium Measurement In Patients With Primary Hyperparathyroidism (PHPT)

Abstract Disclosure: A. Bhan: None. R. Simon: None. G. Jacobsen: None. A. Yaseen: None. P. Navaratnarajah: None. A. Sweidan: None. S.D. Rao: None. Introduction: PHPT is the third most common endocrine disease and the most common cause of hypercalcemia in outpatient setting, presents with mild to moderate hypercalcemia with unsuppressed or elevated serum PTH levels, and most patients are asymptomatic. A 24-hour urine Ca measurement to exclude both hypo- and hypercalciuria is used to recommend parathyroidectomy. The purpose of our study is to evaluate the clinical relevance of urine Ca measurement in evaluating patients with PHPT. Methods: A retrospective electronic medical record review was performed on all adult patients with PHPT in whom a 24-hour urine Ca was measured between 2015-2019. Patients with secondary HPT, those without a 24-hour urine Ca measurement, and patients with serum Cr >1.5 mg/dl were excluded. Results: 393 patients met inclusion criteria for subsequent analyses. For the entire cohort, mean serum Ca was 10.9 ± 0.6 mg/dl, Cr 0.9 ± 0.2 mg/dl and PTH 111± 65 pg/ml with no significant difference between groups by gender, race, or stone history. Mean urine Ca for the entire cohort was 254 ± 170 mg/day. 46% and 35% had urine Ca >250 or >300 mg/d respectively. Multiple linear regression results indicated that higher serum Ca (p=0.004), lower serum Cr (p<0.001), white race (p<0.001), and higher urine sodium (p<0.001) were all significantly predictive of higher UCa. However, the mean urine Ca did not differ between patients with and without nephrolithiasis (276 ± 182 Vs. 280 ± 247 mg/d; p=0.174). Discussion: The most recent guidelines for the management of asymptomatic PHPT recommend measurement of 24-hour urine Ca in all PHPT patients. However, the validity, sensitivity and specificity of such an approach has never been formally evaluated, considering wide variability of urine Ca excretion in the population and lack of difference in urine Ca between patients with and without nephrolithiasis. Previous guidelines discussed this issue and determined that measurement of a 24-hour urine collection is cumbersome and adds very little to patient management. Our study questions the clinical relevance of re-including 24-hour urine Ca in the latest guidelines. Conclusions: Our study suggests that measurement of 24-hour urine Ca in the routine evaluation of patients with PHPT is unhelpful. Presentation: Friday, June 16, 2023

SAT230 A Case Of Pseudohypoparathyroidism Without Any Hereditary Features

Abstract Disclosure: I. Haque: None. L.A. Robles: None. Background: Pseudohypoparathyroidism (PHP) refers to a heterogeneous group of disorders characterized by resistance to parathyroid hormone. PHP type Ib is characterized clinically by isolated renal PTH resistance manifesting as hypocalcemia, hyperphosphatemia, and increased serum PTH. About 60-70% of patients also present with elevated TSH levels due to TSH resistance. We present a unique case of adult onset PHP. Clinical Case: A 30-year-old woman admitted to the hospital for recent onset recurrent hypocalcemia with symptoms of weakness, muscle spasm and cramps. Until recently she was in a normal state of health. Admission labs revealed ionized calcium 0.78 (1.15 - 1.30 MM/L) , serum Ca 6.2 (Albumin 4.3). PTH elevated to 364. Creatinine 0.54 mg/dl, GFR 131 ml/min. Vit D level 35, Bone ALP 49.3 (premenopausal female :4.5-16.9 UG/L), Mag 1.9 , Ph 6.6. A 24-hour urine collection for Ca showed a value of 14 mg/24hr (50 - 400 MG/24H). Additionally, she was found to have a TSH <0.01 and Free T4 1.1. These labs confirmed PTH-resistant hypocalcemia and hyperphosphatemia with concurrent hyperthyroidism. Thyroid Ultrasound demonstrated a possible parathyroid adenoma on the left measuring 0.8x0.4x0.7 cm, which we suspect was a result of hyperplasia from PTH hypersecretion secondary to PTH resistance. TSI and TRAB antibodies were later found to be positive confirming grave’s hyperthyroidism. She had a similar presentation about 3 months earlier with symptomatic hypocalcemia and was discharged on Calcitriol, Ca CO3, and Cholecalciferol. Prior to this including through childhood, patient denies symptoms or lab abnormalities. Patients’ physical exam shows a height of 5ft 4-inch, weight 78kg, BMI 29.7. She had no abnormal facial features or skeletal/digit abnormalities. Patient reached all physical and cognitive milestones at expected times through childhood. Her calcium supplementation was adjusted to calcium carbonate 2000 mg every 8 hours, calcitriol 1 mcg twice daily, cholecalciferol 1000 units daily. Her total calcium improved to 7.4, ionized calcium improved to 0.93, phosphorus remained elevated at 6.1. Patient was discharged at her will due to personal social commitment. She was also started on Methimazole 5mg daily on discharge. Follow up labs showed Ca remained stable and eventually normalized on the above Ca supplementation 6 months after discharge. Conclusion: Unlike PHP Ia, patients with PHP Ib usually lack the physical characteristics of Albright hereditary osteodystrophy (round facies, short stature, short metacarpal bones (especially III-V), obesity, subcutaneous calcifications, and developmental delay), and typically show no other endocrine abnormalities, although our patient presented with subclinical hyperthyroidism. Typically, PTH-resistance disorders present as symptomatic hypocalcemia in childhood, however our patient presented in adulthood. Presentation: Saturday, June 17, 2023

SAT145 Familial Renal Glycosuria - A Differential Diagnosis For Hypoglycemia

Abstract Disclosure: S. Syed: None. S. Naqvi: None. L. Menon: None. J. Holthoff: None. A.R. Kasireddy: None. S. Alshami: None. Background: Familial renal glycosuria can be an uncommon cause of hypoglycemia. We present the case of a woman who was referred to the endocrinology clinic for further evaluation of hypoglycemia and was found to have familial renal glycosuria due to a novel mutation in the solute carrier family 5 member 2 (SCL5A2) gene. Case presentation: A 24 year-old woman with past medical history of rheumatoid arthritis, hyperlipidemia and renal glycosuria presented for persistent hypoglycemia. She first started noticing these episodes four years ago and they have increased over the last year. These events occur in the early hours of the morning or overnight despite a high carbohydrate meal at bedtime. She had the following labs: fasting C-peptide 1.04 (0.9-4.3 ng/ml), insulin 4.1 (2.4-21.8 microU/ml), fasting glucose 84 (70-110 mg/dl) and HbA1c 4.8%. DEXCOM download showed hypoglycemic episodes 2-3 hours after meals. On urinalysis, glucose was >1000 mg/dl and a 24 hour urine collection for glucose was 16.8 g/24 hours. She was first diagnosed with asymptomatic glycosuria during her first pregnancy 7 years ago but the cause was never investigated. After seeing endocrinology, she was referred to nephrology who ordered further workup. Initial markers of a complete Fanconi syndrome were normal: urine pH 5.5, magnesium and phosphorus were normal. Genetic testing was done and the patient was found to have a missense mutation in the SCL5A2 gene which results in a single amino acid substitution of Arg to Cys at codon 60 in exon 2 and encodes the SGLT2 protein. On review of literature, this particular mutation has never been reported and the inheritance pattern is likely to be autosomal dominant since she had a heterozygous mutation. The hypoglycemia was noted to be reactive and occurred after meals. She was advised to avoid simple sugars which can precipitate reactive hypoglycemia within a couple of hours of eating foods with a high glycemic index. She also has a bicornuate uterus and history of recurrent urinary tract infections. Out of her 4 children, two have omphalocele and genetic analysis showed that they are recessive carriers for Smith-Lemi-Optiz syndrome. One of those children suffered from hypoglycemia following birth with prolonged NICU stay. No urinalysis or genetic analysis is available for that child. Her third child was born premature and had hydronephrosis. Conclusion: In literature, a total of 86 mutations of the SLC5A2 gene have been reported to be associated with familial renal glycosuria. There are case reports on some of these mutations also causing hypoglycemia. Our case highlights that renal glycosuria should be considered as a differential when evaluating patients with hypoglycemia since these may be correlated. The patient had a novel mutation causing glycosuria, hypoglycemia and could be associated with congenital malformations. More studies on this association are needed. Presentation: Saturday, June 17, 2023

FRI364 A Case Of Carcinoid Syndrome Symptoms Masked By Niacin Use

Abstract Disclosure: S. Yang: None. R. Sharag Eldin: None. D. Teves Qualler: None. Case Presentation: A 72 male presented with worsening of facial flushing and diarrhea for 10 years. The patient described episodic feeling of hotness in the face associated with red- purplish discoloration of his facial skin lasting for 2 to 3 minutes. He has had 5 to 6 episodes per day. The patient reported the use of Niacin in the past and it was believed that it was the cause of his flushing episodes despite its persistence for years after stopping it. The patient also suffered from long standing diarrhea which started around the same time of the flushing. Diarrhea has been watery or loose and he has 5 to 6 bowel movements a day. His symptoms were concerning for Carcinoid syndrome and a 24-hour urine collection for HIAA showed elevated HIAA to 108.7 mg/24 hour (<6 mg/24 hour). A CT scan of the abdomen revealed a 1.8 cm wall thickness in the cecum and a 3.6 cm spiculated mesenteric mass with central calcification with multiple hypervascular masses in the liver concerning for a metastatic neuroendocrine tumor. Core biopsy of one of the liver masses showed a well differentiated neuroendocrine tumor. He was also found to have tricuspid valve regurgitation as well as a Glycohemoglobin of 9%. The patient was treated medically with octreotide rather than surgery due to the significant disease burden. Interestingly, he was initially started on Lanreotide but developed foreign body granulomas at the injection sites. Discussion: Carcinoid-syndrome is a category of well-differentiated neuroendocrine neoplasms. The overproduction of serotonin is most used to assess the presence of carcinoid syndrome via its breakdown product 5- HIAA in the urine. Symptoms from niacin supplementation are variable and may include flushing and constipation. Patient’s flushing presented for years after discontinuing niacin supplementation. However, clinicians continued to attribute it to its use despite typical resolution of symptoms within 3 hours of discontinuing use. Niacin exposure may have been a mimicker of his underlying neuro endocrine neoplasia (NEN) as diarrhea is also an overlapping feature as seen in our patient’s presentation. DM as seen in our patient is not well documented in relation to carcinoid syndrome. One study (n=10) of the patients with functionally active NENs, 70% had borderline to diabetic-level blood glucose. Of the patients with carcinoid syndrome, there was no significant difference in fasting plasma glucose concentration or fasting plasma insulin concentration when compared to age-matched normal volunteers. Conclusion: Clinicians should have low level of suspicion in diagnosing carcinoid syndrome in the presence of typical symptoms of flushing and diarrhea. Due to the past use of niacin, our patient’s diagnosis was delayed despite the persistence of flushing years after stopping it. Presentation: Friday, June 16, 2023

THU268 Hyperuricemia In Insulin Resistance Is Associated With Increased Synthesis And Not Decreased Renal Excretion Of Uric Acid In Humans

Abstract Disclosure: R. Haykal: None. A. Kinzer: None. B. Abel: None. M. Lightbourne: None. M.S. Startzell: None. E. Cochran: None. R.J. Brown: None. Title: Hyperuricemia in insulin resistance is associated with increased synthesis and not decreased renal excretion of uric acid in humans. Background: In obesity and lipodystrophy (LD), insulin resistance (IR) is “selective”, with lack of insulin signaling causing hyperglycemia, but enhanced insulin signaling causing dyslipidemia. Rare human conditions exist in which there is extreme, non-selective IR impairing all insulin signaling pathways (e.g. mutations of the insulin receptor, INSR), resulting in hyperglycemia without dyslipidemia. We previously found that patients with non-selective IR do not have the hyperuricemia observed in selective IR. Potential mechanisms of hyperuricemia in selective IR include altered expression of renal uric acid transporters leading to impaired uric acid excretion, and increased activity of xanthine oxidoreductase (XOR), causing increased uric acid synthesis. We thus hypothesized that enhanced insulin signaling in selective IR would result in decreased fractional excretion of uric acid (FEUA) and/or increased biomarkers of XOR activity compared to non-selective IR. Method: We conducted 2 cross-sectional analyses of patients with severe IR that was either selective (due to LD) or non-selective (due to INSR mutation). Analysis 1 compared fasting insulin, fasting serum uric acid, and FEUA from 24-hr urine collection in 46 patients with LD and 13 with INSR. Analysis 2 compared products of purine nucleotide catabolism and salvage pathways by untargeted metabolomics in serum of 30 subjects each with LD and INSR. Results: In analysis 1, fasting insulin was lower in LD vs INSR (median 37.5 [25th-75th percentile 23.1-87.0] vs 88.7 [41.9-458.6] mcU/mL; P=0.0097). Serum uric acid was higher in LD vs INSR (5.3±1.6 vs 3.3±1.0 mg/dL; P=0.04). FEUA was comparable in the 2 groups (9.0±5 vs 8.5±3.5%; P=0.75). In analysis 2, uric acid was 1.6 fold higher (P<0.0001) in LD vs INSR. Xanthine, hypoxanthine, and xanthine to hypoxanthine ratio were comparable in both groups, but uric acid to xanthine ratio was 1.5 fold higher (P=0.01) and AMP was 0.8 fold lower in LD vs INSR (P=0.0029). Conclusion: Patients with selective IR due to LD had elevated serum uric acid, consistent with the hyperuricemia seen in selective IR due to obesity. By contrast, patients with non-selective IR due to INSR had lower serum uric acid despite higher fasting insulin. However, FEUA did not differ in these groups, thus hyperuricemia in non-selective IR might not be related to decreased renal excretion of uric acid. Elevated uric acid to xanthine ratio and lower AMP in selective IR suggest increased irreversible conversion of xanthine to uric acid by XOR, precluding salvage of purine nucleotides to AMP. Direct measurement of XOR activity in selective vs non-selective IR is needed to this potential mechanism by which insulin may lead to hyperuricemia. Presentation: Thursday, June 15, 2023

FRI353 Diabetes Insipidus - Pituitary Apoplexy Or Placental Vasopressinase?

Abstract Disclosure: N.M. Rodrigues: None. J. Palacios Merchan: None. M.B. Twahirwa: None. Background: Pituitary apoplexy is rare in pregnancy. Diabetes insipidus is rare at apoplexy onset, present in about 5% of patients presenting with apoplexy. Gestational DI can occur due to placental vasopressinase though this is more common in twin pregnancies and pre-eclampsia. Clinical Case: 28-year-old Hispanic woman was admitted at 34-weeks' gestation for 1 week of headache, visual symptoms, elevated blood pressure and polyuria. Her thirst was intact. She had a known history of 8 mm prolactinoma, which was diagnosed 2 years prior to admission. She was treated with Cabergoline 0.5 mg twice weekly, which was stopped once pregnancy was confirmed. A 24-hour urine collection was performed as part of her pre-eclampsia workup. Total volume was 11,250 mL, osmolality 97 mOsm/kg and sodium of 25 mmol/L. Serum sodium was 136 mmol/L. MRI of the brain showed pituitary apoplexy with large suprasellar area hemorrhage, compressing the pituitary gland and infundibulum, resulting in anterior displacement. The optic chiasm was also compressed and displaced superiorly. Her BP remained normal throughout admission and pre-eclampsia workup was negative. Lab work did not show significant hypopituitarism with TSH of 1.3 microIU/mL, Free T4 0.53 ng/dL, random Cortisol of 11.5 mcg/dL, IGF-1 167 ng/mL, Copeptin 3.8 pmol/L. Considering this was the third trimester of pregnancy as well as the chronicity of the bleed, thought to be 5-7 days, neurosurgery suggested conservative management. She continued to maintain normal serum sodium levels throughout admission. She was delivered at 35 weeks by Caesarean section. She received Hydrocortisone 100 mg IV before the surgery. She also received DDAVP 1 mcg IV before delivery since her sodium level increased to 145 mmol/L from a baseline of 133-136 mmol/L. The delivery was uneventful, and she had a healthy baby. After delivery, her urine output decreased to 180 cc/hour with significant improvement in thirst. Her serum sodium remained normal. This raises the question of whether DI was due to apoplexy or placental effect. Conclusion: Even though pregnancy causes hypertrophy of the lactotrophs, pituitary apoplexy is less common in microadenomas. Apoplexy in pregnancy is very rare, occurring only in 1 in 10,000 gestations. The clinical presentation in this case suggests a low threshold to order pituitary imaging in cases presenting with concerning sign symptoms of increase intracranial pressure. Guidelines are limited in the management of pituitary apoplexy in pregnancy. There are case reports and case series where patients with apoplexy were delivered with C- section at 34 weeks. In addition, the element of pregnancy induced DI makes this presentation unique. Presentation: Friday, June 16, 2023

UP15 - Validation of mass spectrometry-based biomarkers to detect clinically significant prostate cancer: A study based on non-invasive urine collection

UP15 - Validation of mass spectrometry-based biomarkers to detect clinically significant prostate cancer: A study based on non-invasive urine collection

A dataset of pig feces and urine components in the Scientific Observation and Experiment Station of Livestock Equipment Engineering in Southwest of the Ministry of Agriculture and Rural Affairs in 2018

The Scientific Observation and Experiment Station of Livestock Equipment Engineering in Southwest of the Ministry of Agriculture and Rural Affairs is located at the junction of the middle hills of Sichuan Basin and the parallel ridges and valleys in the east of Sichuan Basin, within the geographical coordinates of 105°17'-105°44' E longitude and 29°15'-29°41' N latitude. The Station has been monitoring pig feces and urine components for DLY pigs since October 2017. The monitoring experiment of this dataset began in the summer of 2018 and continued for four consecutive quarters. The experimental animals in each quarter cover nursery pigs (about 20 kg), fatting pigs (about 70 kg) and breeding sows in three growth stages. These pigs were raised in metabolic cages equipped with fecal and urine collection devices to monitor fecal and urine production as well as their composition. Fecal data include water content, organic matter, ammonia nitrogen, total nitrogen, total phosphorus and heavy metal contents (mainly Cu and Zn). Urine data include pH, COD, ammonia nitrogen, total nitrogen and total phosphorus. Sample collection, transportation and testing are strictly in accordance with specifications to eliminate the loss and error, ensuring high levels of repeatability and reproducibility in the tests. Based on the continuous data accumulation and mining, we produced the dynamic change database of pig feces and urine composition to reveal the changing rules and influencing factors of pig feces and urine composition. The dataset is expected to provide basic data with scientific value for the safe treatment and rational utilization of livestock manure and urine, as well as the formulation of related policies.

Neck stiffness and bone osteolytic lesion in a 3-years old child: a case report

BackgroundNeuroblastoma is the most frequent extracranial solid tumor occurring in childhood, representing approximately 28% of all cancers diagnosed in infants. Signs and symptoms of neuroblastoma vary with the site of development of the tumor and can mimic other diseases due to its extreme clinical variability. However, torticollis is not reported in the medical literature as a leading symptom of neuroblastoma.Case presentationHere we report the case of a 3 years-old girl with fever and neck stiffness. Blood tests revealed a mild anemia and a rise in inflammatory markers. CT-scan showed a solid, heterogeneous, predominantly hypodense surrenal mass with eccentric calcification and extensive inhomogeneity of the vertebral metamers. Blood tests revealed raised serum levels of Neuron-Specific Enolase. At the 24-hours urine collection urinary catecholamines were greatly increased. A course of chemotherapy for neuroblastoma was promptly started with immediate clinical improvement.ConclusionsThis case shows that the presence of torticollis could be a chief complaint of neuroblastoma. To our knowledge, neuroblastoma is not mentioned among life-threatening underlying conditions of torticollis in most recent literature reviews.

Initial Management and Potential Opportunities to Deprescribe Dialysis among Patients with AKI-D Patients after Hospital Discharge.

Dialysis-requiring AKI (AKI-D) now accounts for more than 15% of outpatient hemodialysis initiations; over 30% of these patients with AKI-D may have potential to recover. However, little is known about strategies currently used to treat outpatient AKI-D and screen for recovery. In this study of 1754 patients with AKI-D, we found that ( 1 ) the initial dialysis orders were similar to those of patients with contemporary incident ESKD, despite different treatment goals; ( 2 ) timed urine collections were completed in only a minority of patients; and ( 3 ) most patients with AKI-D who recovered discontinued dialysis without ever having been weaned from their initial dialysis prescription, suggesting there may be substantial opportunity to wean dialysis sooner.

Design and Verification of Urine Collection Hose Assembly Used for Environment Control and Life Support System

The urine collection hose assembly is u sed in the urine collection subsystem of the environmental control and life support system (ECLSS) of the space station to connect the products or components in the urine collection subsystem and transmit the working medium. This paper introduces the design scheme and verification test of urine collection hose assembly. The urine collection hose adopts the design scheme of stainless steel wire armored polytetrafluoroethylene hose. Through the verification test, the results show that the scheme can meet the performance requirements of the space station toilet collection subsystem hose assembly.

A-041 Measurement of Plasma 3-Hydroxyisovalerylcarnitine by LC-MS/MS to Predict Marginal Biotin Deficiency in Inflammatory Bowel Disease

Abstract Background Biotin’s role in the immune response have emergently revealed that biotin is related to inflammation and that its deficiency leads to an increase in the level of proinflammatory cytokines. A biotin-deficient diet was recently shown to induce a colitis-like phenotype in mice, alleviated by biotin substitution. Mice with dextran sulphate sodium (DSS)-induced colitis showed biotin deficiency and significantly reduced biotin absorption. Oral biotin substitution reversed DSS colitis and induced remission. Diagnosis of biotin deficiency is rather challenging since based solely on measurement of circulating biotin levels has been shown to be insufficiently sensitive for clinical purposes. Increased urinary excretion of biotin metabolites, is suggested as a sensitive indicator of biotin deficiency. However, 24 h urine collection is time consuming, expensive, and the test relies on correct collection of samples by the patient, thus if this is not done properly the results may be inaccurate. 3HIVc increases in the case of biotin deficiency as a response to the decreased activity of biotin dependent enzyme methyl crotonyl-coenzyme. Analysis of circulating 3HIVc levels by LC-MS/MS has been found to be one of the most sensitive markers of biotin depletion. Methods Study cohort conducted with 100 inflammatory bowel disease (IBD) patients (20–60 years, 40 females) whom diagnosed according to standard clinical, radiological and pathological criteria and 100 healthy controls (20–60 years, 40 females). Of the patients 58/100 had Crohn’s Disease (CD), 42/100 had ulcerative colitis (UC) and 29/100 were in inflammatory state (serum high sensitivity C reactive protein (hsCRP) concentrations >5 mg/L). Standard serum and citrate-plasma samples were withdrawn between 8:00–10:00 h in the clinic after overnight fasting and stored at −20 °C until the analysis. Complete blood count (CBC), high sensitivity C reactive protein (hsCRP), fecal calprotectin (fCal) were determined with standard methods in serum matrix. 3-Hydroxyisovalerylcarntine (3HIVc) levels were determined by a commerical LC-MS/MS Kit in citrate plasma (KM3200, Immundiagnostik AG, Germany). Results Patients with IBD were found to have significantly higher 3HIVc levels than controls (6.1 ± 2.4 ng/mL vs 5.1 ± 2.1 ng/mL respectively, P = 0.004). 3HIVc concentrations were compared according to different disease characteristics within the patient group: circulating 3HIVc levels were found to be similar in patients with CD and UC (5.2 ± 2.1 ng/mL vs 4.9 ± 2.1, P = 0.451). Patients were also found to have similar circulating 3HIVc concentrations irrespective of whether or not inflammatory activity was present (5.1 ± 2.0 ng/mL in inflammatory vs 5.7 ± 2.4 ng/mL in noninflammatory conditions, P = 0.131). Conclusion The clinical findings of this study are in line with the existing preclinical evidence indicating that biotin deficiency is more common in patients with IBD in comparison to healthy controls in a clinical setting. However, surprisingly, the biotin status of patients with IBD was not found to differ according to inflammatory status. Therefore, there is still a room for more comprehensive look into the relationship between IBD related inflammation and biotin deficiency. Moreover, LC-MS/MS analysis of plasma 3HIVc has the potential to help clinicians to define biotin repletion and help to clearify the latter relation.

B-316 Retrospective Data Analysis Reveals Unusual Metabolism Pattern of Ethanol in Pediatrics as Compared to Adult and Geriatric Populations

Abstract Background Ethanol is utilized in many pharmaceutical formulations and in the treatment of methanol poisoning. It is also consumed recreationally and is the most abused drug globally. About 95% of consumed ethanol is metabolized by alcohol dehydrogenase into acetaldehyde, followed by conversion of the acetaldehyde into acetic acid by acetaldehyde dehydrogenase. Less than one percent is metabolized via nonoxidative pathways, which may include: glucuronidation, sulfation, and the formation of fatty acid esters of ethanol. In neonates the glucuronidation pathway has been reported to be underdeveloped and matures with age. In this work, the patterns and concentrations of phase II nonoxidative metabolites of ethanol, ethyl glucuronide (EtG) and ethyl sulfate (EtS), were assessed in random urine collections of pediatric, adult, and geriatric patients. Methods Test results (n = 63498) from urine samples tested for EtG and EtS by quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS) at our facility were utilized for this study. For both analytes, the lower limit of positivity was 100 ng/mL. The age range under consideration was 0–100 years. Data was partitioned into age groups: 0–17 years, 18–80 years and 81–100 years. The EtG and EtS concentrations across the partitions were compared. Results Across all ages, 60%–65% of patients had both EtG and EtS present in urine. Between 5%–10% had EtG present without EtS, and 25%–35% of patients had neither of the ethanol metabolites present. In all age groups there was a low positivity rate of EtS without the presence of EtG (0%–1%). All age partitions showed a similar pattern with the highest percentages of patients showing the presence of both metabolites, and the lowest percentage of patients showing the presence of EtS only. Markedly, there were no pediatric patient samples that had the sulfated metabolite present in the absence of the glucuronidated metabolite; this was statistically significantly different than this proportion in adults (Fisher’s Exact test, P = 0.025). This finding suggests greater glucuronidation activity in the pediatric population. Conclusion From the data presented in this work, EtG is more prevalent relative to EtS in urine samples of patients assessed for ethanol exposure. This work also shows that glucuronidation may be the predominant pathway for ethanol metabolism in pediatric populations. Although the level and frequency of ethanol exposure, as well as the time between exposure and sampling were unknown for the patients studied, the data offers insights into the relative distribution of EtG and EtS in random urine samples for pediatric and adult populations.

Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines

Background Pediatric nephrotic syndrome (NS) requires routine proteinuria monitoring, which is costly and affects patients’ quality of life. The gold-standard 24-h urine protein (UP) measurement is challenging in children, and first-morning urine collection requires specific conditions, making it difficult in outpatient settings. Studies have reported comparability of second or random morning urine sample to the first-morning specimen. This study aimed to compare outcomes of random morning proteinuria measurements to 24-h UP and the roles of the urinary protein creatinine ratio (UPCR) and dipstick tests in pediatric NS, based on International Pediatric Nephrology Association (IPNA) 2022 Guidelines. Method Twenty-four-hour and morning urine samples were collected from 92 pediatric NS patients. These were subjected to automated analyses for 24-h UP, UPCR, and semi-automated dipstick analysis. A blinded doctor performed manual dipstick analysis. Results UPCR had a stronger correlation with 24-h UP than with automated and manual urine dipstick tests. UPCR had the highest sensitivity and specificity for predicting no remission/relapse and high sensitivity but low specificity for complete remission. The optimal UPCR cutoff for remission was 0.44 mg/mg and for no remission/relapse was 2.08 mg/mg. Automated and manual dipstick tests demonstrated limited sensitivity but high specificity and similar AUC values for remission/relapse. Conclusion UPCR was sensitive and specific for diagnosing no remission/relapse and sensitive but not specific for detecting remission. Manual and automated urine dipstick tests were comparable for remission and no remission/relapse detection. This study supports the IPNA 2022 Guidelines, as 2 mg/mg was the optimal UPCR cutoff for no remission/relapse, while for remission the optimal cutoff was 0.4 mg/mg.