Endocrinology Center Research Articles

Increasing prevalence of thyroid autoimmunity in childhood type 1 diabetes in the pre-COVID but not during the COVID era

IntroductionStudies assessing longitudinal changes in the prevalence of autoimmune thyroiditis (AIT) among the pediatric population are limited. During the COVID-19 era, several papers proposed a rise in AIT cases. Our study aimed to analyze the prevalence of thyroid autoimmunity (TA) over a 10-year period spanning pre-pandemic and pandemic years in a population who are regularly screened for thyroid disturbances.Materials and methodsThis single-center retrospective cohort study analyzed data from 1,361 children and young adults with type 1 diabetes (T1D) treated between 2013 and 2022 in Hungary’s largest pediatric endocrinology center. Results of anti-thyroid autoantibodies (anti-thyroid peroxidase/ATPO/and antithyroglobulin/ATG/), thyroid function tests (TFTs) and thyroid ultrasound examinations were obtained. Annual prevalence rates of TA and ultrasound-proven thyroiditis were calculated. Mean (± SD) follow-up period was 4.7 (± 2.8) years.ResultsThe overall prevalence of TA among our T1D children was 22.8% ([20.3;25.5], 310 cases) with significantly more girls affected (p<0.001). From 2013 to 2022, TA prevalence rose from 15.9% to 20.6% (p=0.041). The increase was detected during the pre-pandemic years but not in the COVID-19 era. Ultrasound-confirmed thyroiditis was present in 80.0% of examined TA cases. Ultrasound positivity rate was stable during the study period. Among our children with TA, 28.5% exhibited clinically relevant thyroid-stimulating hormone (TSH) abnormalities (most commonly subclinical hypothyroidism) and/or were prescribed thyroid medication. Children with AIT had a significantly elevated risk of thyroid dysfunction compared to those with only thyroid autoantibody positivity (p<0.001).ConclusionOur results show a rise in the prevalence of thyroid autoimmunity among T1D children over the past decade, but our data do not support the assumed role of SARS-CoV-2 in the development of the disease.

Effect of thyroid dysfunction on apoptosis markers: Caspase-3 and Bcl-2 among Iraqi patients

Thyroid hormones are considered vital for cellular life history starting from its proliferation, differentiation, and ending up with its apoptosis. However, there are very limited human studies concerning the effect of thyroid dysfunction on the levels of apoptosis markers. Therefore, the aim of this cross-sectional study was to examine the effect of thyroid dysfunction (hyperthyroidism and hypothyroidism) on the levels of serum caspase-3, B-cell lymphoma (Bcl-2) and thyroid stimulating hormone (TSH) among patients in Babylon, Iraq. The study included 52 male patients (aged 25-50 years) with thyroid dysfunction, visited the Endocrinology center in Al-imam al-Sadiq hospital located in Babylon province, Iraq during the period from November 2023 to May 2024. Patients were split into two groups (patients with hypothyroidism, N=26; patients with hyperthyroidism, N=26), in addition to 26 subjects without thyroid dysfunction as a control group. Levels of serum caspase-3, Bcl-2, and TSH were measured in all study subjects. The results indicated that levels of serum caspase-3 were significantly increased in both patients’ groups compared to the control group (p<0.001), while serum Bcl-2 was significantly increased in patients with hypothyroidism compared to other study groups (p<0.001). Levels of TSH were significantly greater among patients with hypothyroidism comparing to other groups (p<0.001). It can be concluded that patients with hyperthyroidism and hypothyroidism enhance apoptosis through activation of caspase-3 specifically.

Determination Superoxide Dismutase and Glutathione Levels in Serum of Patients with Diabetic Foot Infection in Karbala City

Background: Diabetic foot infections (DFIs) are identified as localized purulence or inflammation that appears at the site beneath the malleoli in a diabetic patient. The goal of this study was to measure the levels of glutathione (GSH) and superoxide dismutase (SOD) in healthy people in Karbala city as well as in patients with type 2 diabetes mellitus who had or did not have diabetic foot ulcers. Materials and Methods:This study involved 120 participants ranging in age from 35 to 75 years, and was conducted at the Imam Al-Hassan Center for Endocrinology and Diabetes in Karbala, Iraq. To seperate the serum, five milliliters of the participants' blood were collected, put within gel tubes, and spun at 4000 xg in a cooled centrifuge. The serum was stored at -20˚C in Eppendorf tubes prior to utilizing it in determination of SOD and GSH levels. Results: Superoxide dismutase (SOD) activity mean levels in DFI group where the result from patient were significantly lower (241.4±35.61) (U / L) (p≤0.001) than in diabetic patients and healthy individuals. Similarly, glutathione (GSH) mean levels in DFI group patients were lower than in diabetic patients and healthy individuals (26.586±2.77) µmole/ml (p≤0.001). Conclusion: These results imply that diabetic foot infections may be influenced by decreased antioxidant levels. This suggests that these antioxidants may be used as possible markers to diabetic those who are more vulnerable.

The Clinical and Diagnostic Value of Albuminuria in the Diagnosis of Chronic Kidney Disease

Chronic kidney disease (CKD) is one of the most widespread problem in the health care system with severe social and economic outcomes. The danger of CKD lies in complications arising from kidney failure, concomitant cardiovascular diseases, diabetes mellitus (DM), obesity. Despite the fact that the morbidity and mortality caused by CKD can be prevented by early diagnosis and treatment, unfortunately, today the diagnosis of this disease in the world is at a low level. The objective: to analyze the relationship between albuminuria and arterial hypertension (AH), heart failure, obesity, carbohydrate metabolism disorders. Materials and methods. 704 patients (400 men and 304 women) who visited the communal non-commercial enterprise “Vinnytsia Regional Clinical Specialized Endocrinology Center” were examined. Patients were divided into groups. The main group included patients with various disorders of carbohydrate metabolism (gestational diabetes, prediabetes, pancreatogenic diabetes). The second group included patients with hypertension, obesity, various pathologies of the thyroid gland, acromegaly, and osteoporosis. For all study participants the urine albumin-to-creatinine ratio (UACR) was determined using the test strip method in outpatient settings. In addition to UACR, to determine the stage of CKD, an estimated glomerular filtration rate (eGFR) based on blood creatinine was measured in all patients. Results. During the study it was established that type 1 and type 2 diabetes mellitus and pancreatogenic diabetes mellitus, obesity, prevailed among men who are in the risk group by gender for the development of complications. At the same time, prediabetes and thyroid pathology were more common among women. The eGFR index progressively decreased with increasing duration of type 1 and type 2 diabetes. The initial stages of nephropathy are characterized by an increase in eGFR, then its gradual decrease to a normal level, which can be mistakenly assessed as the absence of pathological changes in the kidneys. That is why the determination of only eGFR without UACR is not sufficient to establish a diagnosis of CKD. Routine determination of albuminuria is one of the ways to identify individuals at high risk of cardiovascular disease. Conclusions. It has been established that the prevalence of CKD depends on the timeliness of diagnosis, the duration and state of diabetes compensation, the use of hypoglycemic drugs with proven nephroprotective effect, especially in patients with type 1 diabetes. Early appointment of renal protective therapy to patients from risk groups according to international recommendations is effective in slowing the progression of CKD, delaying dialysis and reducing mortality from cardiovascular causes and overall mortality.

Oral glucose-lowering drugs and long-term risk of benign prostatic hyperplasia

Background. One of the most prominent threats for masculine health is comorbidity between benign prostatic hyperplasia (BPH) and diabetes mellitus type 2. Many publications suppose influence of hyperglycemia on lower urinary tract obstruction. Question about influence of the most common oral glucose-lowering drugs – biguanides (metformin hydrochloride) and third-generation sulfonylurea (glimepiride) has not been answered yet. Aim. To assess whether glucose-lowering drugs affect risk of benign prostatic hyperplasia (BPH) in men with type 2 diabetes who initiated first-line treatment with either metformin or sulfonylurea monotherapy from 2012 until 2022 in the National Medical Research Center for Endocrinology. Materials and methods. Single centre, retrospective, comparative study. Retrospective analysis of in-/outpatient medical cards. Primary outcome measures: Rates of subsequent BPH, identified based on community prescriptions for BPH-related treatment or hospital BPH diagnoses, and rates of transurethral resection of the prostate (TURP). Rates in metformin hydrochloride and sulfonylurea users were compared overall and stratified by 6-month haemoglobin A1c (HbA1c) using Cox regression. Results. In 95 metformin initiators with a median follow-up of 10 years, the 10-year cumulative BPH incidence was 25.7% (25 cases; 95% CI 24.2–27.1). Compared with 95 sulfonylurea users [median follow-up 8 years, 10-year cumulative incidence 27.4% (17 cases; 95% CI 16.2–18.6)], the crude HR for BPH was 0.83 (95% CI 0.77–0.89) and adjusted HR in the ITT analyses was 0.97 (95% CI 0.88–1.06). For TURP, the adjusted HR was 0.96 (95% CI 0.63–1.46). In the as-treated analysis, adjusted HR for BPH was 0.91 (95% CI 0.81–1.02). Conclusion. Compared with sulfonylurea, metformin did not substantially reduce the incidence of BPH in men with diabetes.

The milestones of the life and scientific-pedagogical path of Mikhail Ivanovich Balabolkin (to the 90th anniversary of the birth of Professor M.I. Balabolkin)

The article is dedicated to the 90th year of the birth of Professor Mikhail Ivanovich Balabolkin. He was a well-known endocrinologist, Doctor of Medical Science, Director of the Institute of Diabetes of The National Medical Research Center for Endocrinology of the Russian Academy of Medical Sciences, Head of the Departments of Endocrinology at the Moscow Medical and Dental Institute named after N.A. Semashko, and subsequently at the Moscow Medical Academy named after I. M. Sechenov. Mikhail Ivanovich will forever remain in the memory of all his students and colleagues. The article contains not only biographical data on the professor’s professional and scientific activities, the history of the creation of the departments of endocrinology, which he headed, but also memories of people who were well acquainted with Mikhail Ivanovich. Particular attention in the article is paid to the personal qualities of M.I. Balabolkin, his family, attitude towards his professional team and hobbies.

Evaluating the patient's serum for thyroid stimulating immunoglobulin and Cytotoxic -T-lymphocyte associated protein 4 in Graves hyperthyroidism

Graves' disease (GD) is a common autoimmune disorder that causes an excess of thyroid hormone production. It is mainly due to the production of IgG antibodies that activate the thyrotropin receptor. The aim of this study is to measure the levels of Cytotoxic -T-lymphocyte associated protein 4 and thyroid stimulating immunoglobulin in individuals with GD. It also seeks to establish the connection between thyroid stimulating immunoglobulin and thyroid stimulating hormone (TSH), as well as to assess the predictive value of CTLA4 for Graves' disease. The study was a case-control investigation conducted at the Alrusafa Center for Diabetes and Endocrinology. It involved a total of 45 people diagnosed with Graves' illness. The healthy group consisted of 45 individuals who had no previous medical history or clinical indications of hyperthyroidism or any other chronic condition. Blood samples from 90 individuals diagnosed with Graves' illness and a control group were analyzed to measure the levels of CTLA4, TSI by ELISA. The findings indicated a robust and statistically significant association (P.value<0.01) serum levels of CTLA4 in the patients for Graves' disease comparing to the control group. The patient samples included 13 men (28.89%) and 32 women (71.11%). There was no significant relationship found between TSI and TSH.

Genetic landscape of Romanian PPGLs.

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours that originate from chromaffin cells and occur in the adrenal medulla and in the sympathetic or parasympathetic ganglia. Nearly 70% of PPGLs result from germline or somatic mutations in a single driver gene. The aim of this study was to characterize thegenetic background and clinical characteristics related to genetic profile of patients with PPGLs from Romania. We retrospectively retrieved data of 125 patients consecutively registered, diagnosed with PPGLs in a tertiary referral center of endocrinology from Romania, between 1976 and 2022. We identified 88 (70.4%) women, and 37 (29.6%) men, with a mean age at diagnosis of 48.5 ± 15 years. From these 125 patients, 80 (64%) were submitted to the genomic study; 35% (n = 28) had a germline mutation (20 RET, 3 VHL, 1 SDHB, 1 NF1, 1 SDHD, 1 FANCA, 1 CASR) while 65% (n = 52) presented sporadic disease. Patients with hereditary disease had significantly lower age at diagnosis comparing to sporadic cases (37 ± 15 vs. 49.9 ± 12.2 years, p = 0.001). Bilateral tumors developed in twelve patients from the hereditary group. Metastatic disease was described in 4 out of 80 patients (2 of them with hereditary disease). Patients from sporadic group tended to have a right lateralisation of the tumour compared to hereditary cases, where the tumour was more often left sided. RET pathogenic variant (p.Cys634Trp) associated with MEN2A syndrome was the most prevalent in Romanian population with PPGLs and could be considered as a founder effect. Patients with hereditary disease are diagnosed at a younger age and develop bilateral tumors more frequently compared to sporadic cases.

Metabolic syndrome among patients with type 2 diabetes in Jordan: A cross-sectional study.

Metabolic syndrome is a major public health problem worldwide and an independent predictor of cardiovascular disease in patients with type 2 diabetes (T2DM). This study aimed to determine the prevalence of metabolic syndrome and its individual components among Jordanian patients with T2DM. A cross-sectional design was conducted among T2DM patients at the National Center for Diabetes, Endocrinology and Genetics in Jordan. Data were collected using a structured questionnaire and clinical data extracted from medical records. The National Cholesterol Education Program-Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) diagnostic criteria were used to define metabolic syndrome. Among 1017 participants aged between 22 and 90 years, the overall prevalence of IDF defined metabolic syndrome was 84.2% (72.5% and 96.2% among males and females, respectively). Using ATP III criteria, overall prevalence was 79.1% (77.4% and 80.8% among males and females, respectively). Advancing age, female gender, nonadherence to a diet regimen, sedentary lifestyle or insufficient physical activity, and duration of diabetes ≥10 years were significantly associated with increased odds of metabolic syndrome, regardless of the definition used. Current smoking status and family history of cardiovascular diseases were significantly associated with increased likelihood of ATP III defined metabolic syndrome. The prevalence of metabolic syndrome among Jordanian patients with T2DM is extremely high. The main modifiable risk factors of metabolic syndrome among these patients include nonadherence to a diet regimen, insufficient physical activity, being overweight/obese and smoking. It is recommended that healthcare providers counsel patients on the importance of maintaining physical activity, smoking cessation, and adherence to a diet regimen.

Correlation of Lipid Profile and BMI with Fasting Blood Glucose

The prevalence in Libya of overweight people has more than tripled from 19.5% in 1984 to 63.5% in 2009, while the rate of obesity has more than doubled over the past three decades leading to a much higher incidence of Type 2 diabetes T2DM. This makes investigation of links between BMI and lipid profiles in Libyan T2DM patients of vital importance. This study was conducted to determine the cor-relation between body mass index (BMI) and lipid profiles in patients with T2DM attending outpatient clinics in the Diabetes and Endocrinology Centre (Ibn Al-Nafees Hospital) Tripoli, Libya. The second objective was to compare BMI, FBS and lipid profiles between T2DM patients and a control group. The study was carried out during the period of June and July 2024 included 122 T2DM patients and 55 healthy subjects. The subject’s serum was analysed for total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). The possible correlation of BMI with lipid values were analysed. The Pearson’s co-efficient between the BMI and the lipid parameters did not show any significant correlation in T2DM patients. Comparisons of various parameters between T2DM patients and the control group showed that the mean values of fasting glucose levels, weight, BMI, TG, HDL-C and LDL-C were significantly higher in the T2DM group than the control group. There was no correlation found between BMI and lipid profiles in T2DM patients. Type 2 diabetic patients have significantly higher mean weight, BMI, FBS, TG, HDL-C and LDL-C compared with healthy controls

25-year experience of surgical treatment of thyroid diseases in a multidisciplinary hospital

BACKGROUND: Every year there is an increase in the number of patients with thyroid diseases, thus improving surgical treatment methods with decreased traumatic effect and postoperative complications, remains relevant. AIM: To summarize the results of 25-year work of the team (surgeons and endocrinologists) of specialists from the multidisciplinary hospital of Saint Petersburg and the departments of the North-Western State medical university named after I.I. Mechnikov on the diagnosis and treatment of patients with surgical pathology of the thyroid gland. MATERIALS AND METHODS: The results of surgical treatment of 3977 patients with thyroid diseases operated accoding to the traditional Kocher approach, asymmetric “floating” mini-approach and video-assisted mini-approach were analyzed. RESULTS: In the analyzed time period, a rapid increase in the number of minimally invasive techniques for surgical operations on the thyroid gland is characteristic, which are used for nodular euthyroid goiter, multi-nodular euthyroid goiter and toxic thyroid adenoma. With the help of traditional approach, surgical intervention was performed mainly for diffuse toxic goiter and multinodular toxic goiter. The introduction of new techniques and approaches in the provision of medical care to patients with surgical diseases of the thyroid gland can significantly improve the results of treatment. CONCLUSIONS: 25-year experience of the endocrinological center of the Elizabethan Hospital demonstrates that collaboration of departments and doctors of a multidisciplinary hospital allows to introduce new approaches to treating surgical thyroid diseases and improve its results without increasing the number of postoperative complications.

Ожирение и депрессия у детей и подростков: проблема коморбидности и профилактики

<p><strong>The relevance:</strong> currently, scientists talk about the epidemic of obesity among children and adolescents, which is associated with significant risks and deterioration of mental and physical health of the young generation. <strong>Objective:</strong> to study association between depression and obesity in children and adolescents. The paper presents a literature review of the widely discussed problem of the relationship between depression and obesity, as well as the results of our own empirical study obtained on a sample of patients from the Center for Treatment and Prevention of Metabolic Diseases and Obesity, FGBU «National Medical Research Center for Endocrinology» of the Ministry of Health of Russia. <strong>Sample.</strong> The study involved respondents aged 7 to 17 years (M=12,5, SD=2,5), a total of 153 people with SDS BMI from 1,2 to 4,2 (M=2,8, SD=0,5), of which 52% were female and 48% were male. The study included a diagnostic interview with the child and parents, each child was asked to fill out the Children's Depression Inventory (Maria Kovacs 1992). The <strong>results</strong> suggest a high level of comorbidity of obesity and depressive symptoms among children and adolescents ¾ 52% of girls and 27% of boys who participated in the study have symptoms of depression of varying degrees of severity. Also, more severe forms of obesity were recorded in boys compared to girls at the initial application for specialized care, which indirectly indicates a greater concern for health and appearance on the part of girls and their families. The overwhelming majority of parents of children note unhealthy eating habits, low physical activity and sleep disorders in their children. It is <strong>concluded</strong> that it is necessary to raise awareness of children, parents, teachers and child specialists of different profiles about the relationship between depressive symptoms and obesity, as well as the importance of appropriate diagnosis and the development of comprehensive treatment and prevention programs for both obesity and depression.</p>

LGBTQ+ Supportive and Inclusive Care Practices: Survey Data From the T1D Exchange Quality Improvement Collaborative

OBJECTIVE Living with type 1 diabetes is challenging, but more barriers exist when one also identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities). Acknowledging the importance of identifying this population and providing personalized care, the Health Resources and Services Administration mandated institutions to document sexual orientation and gender identity (SOGI) data. To understand the current state of SOGI documentation in the T1D Exchange Quality Improvement Collaborative, a survey assessing LGBTQ+ supportive and inclusive care practices was given to affiliated sites. RESEARCH DESIGN AND METHODS Thirty-three pediatric and 21 adult care centers were surveyed via Qualtrics. The survey included questions about their electronic health record documentation of patient-identified gender, pronouns, sexual orientation, and sex assigned at birth (SAAB). Care centers also reported on the legality of gender-affirming care in their municipalities, as well as their willingness to change SAAB after patients meet requirements. Fisher’s exact tests were used to evaluate response frequencies. RESULTS All 33 of the pediatric centers and 81% (17 of 21) of the adult centers responded to the survey. Sixty-four percent of pediatric centers had established strategies to support SOGI documentation, whereas only 50% of adult centers had implemented strategies. Some adult centers could not confirm whether they documented SOGI. Differences were seen between the pediatric and adult endocrinology centers in their documentation of gender identity (P = 0.04) and pronouns (P = 0.02). CONCLUSION Although most endocrinology centers documented gender identity and pronouns, fewer documented sexual orientation. Further work is needed to improve SOGI documentation and assess its impact on LGBTQ+ patients with diabetes.

8236 Hepatocyte Vitamin D Receptor (VDR) Regulates Liver Regeneration

Abstract Disclosure: J.E. Gunton: None. Harendran Elangovan [1], Rebecca A. Stokes [1], Jeremy Keane [1], Sarinder Chahal [1], Caroline Samer [1], Miguel Agoncillo [1], Josephine Yu [1], Jennifer Chen [1], Michael Downes 2, Ronald M. Evans 2, Christopher Liddle [1],2, Jenny E. Gunton [1] [1]Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia 2 Salk Institute for Biological Studies, La Jolla, CA. USA Background: Vitamin D signals through the vitamin D receptor (VDR) to induce its end-organ effects. Hepatic stellate cells control development of liver fibrosis in response to stressors and vitamin D signaling decreases fibrogenesis. VDR expression in hepatocytes, however, is low in healthy liver, and the role of VDR in hepatocyte proliferation is unclear. Methods: In these studies, hepatocyte-VDR null mice (hVDR) were used to assess the role of VDR and vitamin D signaling in hepatic regeneration. Mice underwent 2/3 partial hepatectomy and liver regeneration and function were studied. Results: hVDR mice had impaired liver regeneration with impaired hepatocyte proliferation. This was associated with significant differential changes in bile salts. Notably, mice lacking hepatocyte VDR had significant increases in expression of conjugated bile acids after partial hepatectomy, consistent with failure to normalize hepatic function by the 14-day time point tested. CDCA (chenodeoxycholate) is an FXR ligand, which was increased after surgery in controls but not in hVDR mice. FXR signaling is important for hepatocyte proliferation. Real-time PCR of hVDR and control livers showed significant changes in expression of cell cycle genes including cyclins D1 and E1 and cyclin-dependent kinase 2. Gene expression profiling of hepatocytes treated with vitamin D or control showed regulation of groups of genes involved in liver proliferation, hepatitis, liver hyperplasia / hyperproliferation and liver necrosis / cell death. Conclusions: Together these studies demonstrate an important functional role for VDR in hepatocytes during liver regeneration. Combined with the known profibrotic effects of impaired VDR signaling in stellate cells, these studies provide a mechanism whereby vitamin D deficiency would both reduce hepatocyte proliferation and permit fibrosis, leading to significant liver compromise. Presentation: 6/2/2024

6927 Metyrapone To Reset The Nocturnal Cortisol Rhythm In Mild Autonomous Cortisol Secretion (MACS) - Safety And Impact On Cardiometabolic Risk Factors

Abstract Disclosure: S. Berry: None. A. Iqbal: None. J.D. Newell-Price: Consulting Fee; Self; HRA Pharmaceuticals. M. Debono: Consulting Fee; Self; HRA Pharmaceuticals. Grant Recipient; Self; HRA Pharmaceuticals. Speaker; Self; HRA Pharmaceuticals. Background: MACS is associated with increased cardiometabolic risk including hypertension, type 2 diabetes and dyslipidemia. In MACS, serum and salivary cortisol and cortisone levels are significantly higher in the nocturnal period but follow the usual daytime pattern. Combined early and late evening dosing with the short-acting 11-beta hydroxylase inhibitor, metyrapone, has previously been shown to acutely ‘re-set’ this abnormal part of the cortisol curve to normal. We have now assessed the impact of long-term evening metyrapone on cardiometabolic dysfunction in MACS. Method: A retrospective, controlled, longitudinal study evaluated the safety and tolerability of nocturnal metyrapone and its impact on cardiometabolic risk factors. We included all patients (n=15) who were initiated on metyrapone treatment, 250mg-500mg at 6pm and 250mg at 10pm, for MACS at a tertiary endocrinology center between 2015 and 2022. Age and sex-matched controls were selected from patients with adrenal incidentalomas and non-suppressed serum cortisol following 1mg overnight dexamethasone suppression testing. Systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, HbA1c and non-HDL cholesterol were assessed at baseline and after 6 months. Morning serum cortisol values were evaluated to check for adrenal axis over-suppression. Wilcoxon signed-rank test was used to compare pre/post-treatment, and Mann-Whitney U test was used to compare metyrapone group to controls. Results: Metyrapone was tolerated by 12/15 patients - two stopped due to diarrhea and one due to high androgens in a female. There were no occurrences of adrenal crises. The morning cortisol after metyrapone was 365 nmol/L (IQR 254-431nmol/L, n=13). ACTH increased from 4.5 pg/ml to 7.5 pg/ml (SE±2.15, n=12) after treatment. In the metyrapone group compared to controls, there were significant decreases in SBP (-26.4 SE±8.1mmHg, p=0.008, n=9) and DBP (-12.9 SE±5.5mmHg, p=0.024). Four patients in the control group had up-titration of antihypertensive medication between measurements compared to only one in the metyrapone group. The differences between groups in HbA1c, weight and non-HDL cholesterol were not statistically significant. However, the increase in HbA1c was less in the metyrapone group compared to the control group by 3.0 SE±4.5mmol/mol, as was the non-HDL cholesterol by 0.4 SE±0.33mmol/L (n=10). Conclusion: Evening metyrapone is associated with significant reductions in SBP and DBP in patients with MACS, without causing adrenal insufficiency and with preservation of normal morning serum cortisol. Monitoring 9am cortisol is important to avoid over-treatment. A larger, powered, prospective study is needed to definitively investigate the broader metabolic outcomes and assess the clinical utility of metyrapone in MACS. Presentation: 6/3/2024

7627 Prevalence Of True Endocrinopathies In Patients Presenting To An Endocrine Clinic With Fatigue

Abstract Disclosure: C. Dimech: None. K. Barnett: None. F. Hasan: None. Introduction: Fatigue is a common chief complaint, resulting in approximately 7 million physician office visits per year in the US. Fatigue is a non-specific symptom which can be associated with many acute or chronic conditions. In our clinical experience fatigue is a frequent reason for referral to the endocrine clinic, and often assessment does not reveal an endocrine pathology. However, the prevalence of endocrinopathies discovered following endocrinology assessment has not been well studied. Methods: In this retrospective study, we completed chart review of electronic medical records of patients who were evaluated for a chief complaint of fatigue at outpatient endocrinology centers belonging to an integrated health network in the Pittsburgh Metro area. We included patients aged 18-40 years old from 01/01/2019- 12/31/2022. We hypothesized that there is not a significant incidence of endocrinopathies found on evaluation. Results: Extensive clinical and laboratory data were gathered for 226 patients during the study period. 39.9% of patients were self-referred. 60.1% of patients seen were through physician referrals, however 17.9% of these patients had no prior investigations completed. The majority of patients evaluated for fatigue were female (76.5% vs 23.5%). 55.3% of patients were 30-39 years of age. 27% of patients were overweight and 23% were obese with BMI 30 or greater. Nearly half of all patients had a diagnosis of anxiety or depression (51.7% and 48.2% respectively). Of those patients with anxiety, 57.3% were prescribed an SSRI or SNRI. Similarly, 58.7% of patients with depression were prescribed an SSRI/SNRI. Patients most commonly reported other non-specific symptoms such as weight gain, poor sleep and poor mood (51.3%, 38.9%, 25.2% respectively). 54.9% of female patients presenting with fatigue were concerned for thyroid dysfunction whereas 45.3% of male patients were concerned for hypogonadism. 12.3% of patients evaluated never completed the recommended testing. Vitamin D deficiency was notably prevalent in 42.4% of patients tested. One patient was found to have secondary adrenal insufficiency in the setting of chronic exogenous glucocorticoid use for back pain. Of 163 patients tested for thyroid dysfunction, no new diagnoses of thyroid abnormalities were revealed. Conclusion: In this study, laboratory testing from an endocrinology consultation was not useful in detecting newly discovered endocrinopathies as a cause of fatigue. Presentation: 6/2/2024

6482 Knowledge and comfort in addressing eating disorders in people living with Type 1 Diabetes in an academic Endocrinology center

Abstract Disclosure: N. Viera Felicino: None. D. Lam: None. Background: Eating disorders(ED) occur at twice the rate in people living with type 1 diabetes(PWT1D) compared to the general population. Early detection and prevention necessitate a high level of clinical suspicion, as the coexistence of ED and T1D is linked to compromised metabolic control, earlier onset of microvascular complications, elevated mortality rates and diminished quality of life. Despite this, healthcare providers often encounter multiple challenges, such as the tendency for ED/DEB to be well hidden and/or denied, as well as a general discomfort in broaching this sensitive topic. Compounding the issue is the scarcity of literature offering optimal methods for supporting and treating individuals suffering from this dual diagnosis. Here, we conducted a survey at an academic center to assess providers’ overall knowledge and comfort level regarding the intersection of ED/DEB in PWT1D. Methods: A 15 question anonymous survey was distributed to members of our Endocrinology division, including fellows, attendings, and advanced practice providers (APPs) across four practices within an academic center in New York City. The primary objectives of the survey were to gauge participants' understanding in three key areas: general knowledge regarding the prevalence of this dual diagnosis, awareness of associated morbidity, and their professional experiences in providing care to this population. Results: The survey was distributed to a total of 40 participants with 29 responses: 38% Endocrine fellows, 41% attending physicians, and 21% APPs. 97% acknowledged that ED are more prevalent in PWT1D compared to the general population and 25% could identify validated screening tools for ED. Regarding the association between ED in PWT1D and health outcomes, 67% accurately identified the increased risk of developing microvascular complications and 36% recognized the increase in the risk of all-cause mortality. 71% reported caring for a PWT1D who expressed concerns about insulin and weight gain. When asked to rate their comfort level in addressing these concerns, 13.8% and 3.4% reported feeling comfortable and very comfortable, respectively. 86% of respondents expressed unfamiliarity with available resources for providing support to individuals in this group. Discussion: The results of the survey show general acknowledgment of the heightened prevalence of ED among PWT1D and association with morbidity and mortality, but emphasizes gaps in knowledge, a general sense of discomfort, and a shortage of resources to effectively manage individuals within this patient demographic. Our survey highlights the need for enhanced education and resources to better equip healthcare professionals in managing the complex intersection of both disorders. Given that diabetes outcomes are heavily dependent on behavioral adherence, strategies for addressing ED are crucial for comprehensive patient care. Presentation: 6/2/2024

Molecular Identification of Cryptosporidiosis in Diabetes and Cancer patients

Cryptosporidium spp., a primary intestinal parasite and obligate intracellular parasite, infects a wide range of vertebrates, including human. The current study aimed to determine the infection rate of Cryptosporidium spp. among immunocompromised patients attending the Diabetes and Endocrinology Centre and Oncology Department at Al-Diwaniya Teaching Hospitals in Al-Diwaniya Providence, Iraq. The research period extended from the first of October 2023 until the end of February 2024. Eighty-seven stool samples were obtained from immunocompromised patients of various ages and both genders who attended the hospital. Stool samples were examined using the nested PCR technique. The results showed an overall infection rate of 22.98%. Researchers found that the infection rate was 20.83% among diabetic patients and 25.64% among cancer patients. Male patients had a recorded infection rate of 23.07%, whereas females recorded 22.85%. A high infection rate (60%) was observed among patients under the age of 15 and among those coming from rural areas, reaching 34.88%. Additionally, it was found that 42.42% of the infected individuals had contact with animals.

The Association of Overweight and Obesity With Hypertension and Diabetes Mellitus At Al-Diwaniyah Province

Background: Noncommunicable diseases (NCDs) represent a major concern for public health. and one of the main reasons for the global illness burden. Cardiovascular diseases (CVDs) are still the main reason for mortality worldwide and are a major contributor to both health loss and excessive expenditures on healthcare. Aim of study: to determine the prevalence of overweight and obesity among hypertensive or diabetic patients and identify the effect of these conditions on them. Methods: This observational cross-sectional study applied a convenient sample of 322 patients diagnosed with Hypertension or Type 2 diabetes, or both, who attended the Specialized Center for Diabetes and Endocrinology (SCDE) and Internal medicine consultant at Al-Diwaniyah province. An interview-based questionnaire is composed of several questions that have been gathered by researchers and assessed by a number of professionals. From the tenth of September to the beginning of February, the data was collected. Results: A total of 322 participants enrolled in this study, we found that the prevalence rate of obesity and overweight in groups of patients was 37.3% and 53.1%, respectively. There was a significant association between control of blood pressure in the diabetic group (p = 0.007), and there was a significant difference in mean age among the diabetes group, the hypertensive group, and the group with both diseases: 51.02 ±9.64 years, 50.58 ±12.06 years, and 54.14 ±9.97 years, respectively (p = 0.018). The difference in mean BMI among study groups was significant (p = 0.003); the highest mean BMI was seen in patients with both type 2 DM and hypertension, followed by the hypertension group, and the least mean BMI was noted in the diabetic group. Conclusions: The prevalence rate of obesity was higher than that of overweight among study groups. Age and education level were important risk factors for the development of comorbidity among patients. people with hypertension and type 2 diabetes had the greatest mean BMI, followed by hypertension patients, while diabetic patients had the lowest mean BMI (p = 0.003). The study discovered a substantial inverse connection between HDL-C, triglyceride, serum creatinine, and cholesterol in hypertensive patients, while A favorable association was identified among VLDL-C “and” cholesterol, whereas in diabetic patients, there was a significant favorable relationship between “LDL-C,” “VLDL-C,” “cholesterol,” and “TG” and an inverse connection between “HDL-C,” cholesterol, and blood urea.

The Effect of Sociodemographic Characteristics on The Lifestyle Among Type 2 Diabetic Patients in Mosul City

Introduction: Diabetes Mellitus is a condition that causes persistently increased blood glucose levels in the body. It is the second leading cause of years spent disabled globally and is a major cause of death with high mortality rates. Objective: To identify the effect of sociodemographic characteristics on the lifestyle among type 2 diabetes mellitus in Mosul City. Methods and materials: A non-experimental cross-sectional study design was implemented on a total of 400 Type II Diabetic Patients who make periodic visits to Al-Wafaa Specialized Centre for Diabetes and Endocrinology by A non-probability sample. A developed interviewing questionnaire was used to collect information related to sociodemographic, and lifestyle was assessed by using HPLP-II, from October 15th, 2023, to June 1st, 2024. The collected data were compiled and analysed using percentages, mean, standard deviation, minimum, maximum, Spearman’s Correlation and Chi Square using SPSS version 26. P values of 0.05 were used as a cut-off point for the significance of the statistical test. Results: Majority of participants were female, reside in urban areas, married, unable to read and write, unemployed and never smoked (52.3%, 78.7%, 79.0%, 29.7%, 57.4%, and 44.2%) respectively. In addition to that, there was a significant correlation between the sociodemographic characteristics and lifestyle among the participants. The patients scored highest in the interpersonal relations and scored lowest in the physical activity factors. Finally, most of the patients practiced health-promoting lifestyle pattern moderately (63.5%). Conclusions: The study showed that, there is a significant correlation between lifestyle and sociodemographic characteristics of the study participants.