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AACE Annual Meeting 2021 Abstracts Editorial Board June 2021 Volume 27, Number 6S AACE Annual Meeting 2021 Abstracts Editorial board Editor-in-Chief Pauline M. Camacho, MD, FACE Suleiman Mustafa-Kutana, BSC, MB, CHB, MSC Maywood, Illinois, United States Boston, Massachusetts, United States Vin Tangpricha, MD, PhD, FACE Atlanta, Georgia, United States Andrea Coviello, MD, MSE, MMCi Karel Pacak, MD, PhD, DSc Durham, North Carolina, United States Bethesda, Maryland, United States Associate Editors Natalie E. Cusano, MD, MS Amanda Powell, MD Maria Papaleontiou, MD New York, New York, United States Boston, Massachusetts, United States Ann Arbor, Michigan, United States Tobias Else, MD Gregory Randolph, MD Melissa Putman, MD Ann Arbor, Michigan, United States Boston, Massachusetts, United States Boston, Massachusetts, United States Vahab Fatourechi, MD Daniel J. Rubin, MD, MSc Harold Rosen, MD Rochester, Minnesota, United States Philadelphia, Pennsylvania, United States Boston, Massachusetts, United States Ruth Freeman, MD Joshua D. Safer, MD Nicholas Tritos, MD, DS, FACP, FACE New York, New York, United States New York, New York, United States Boston, Massachusetts, United States Rajesh K. Garg, MD Pankaj Shah, MD Boston, Massachusetts, United States Staff Rochester, Minnesota, United States Eliza B. Geer, MD Joseph L. Shaker, MD Paul A. Markowski New York, New York, United States Milwaukee, Wisconsin, United States CEO Roma Gianchandani, MD Lance Sloan, MD, MS Elizabeth Lepkowski Ann Arbor, Michigan, United States Lufkin, Texas, United States Chief Learning Officer Martin M. Grajower, MD, FACP, FACE Takara L. Stanley, MD Lori Clawges The Bronx, New York, United States Boston, Massachusetts, United States Senior Managing Editor Allen S. Ho, MD Devin Steenkamp, MD Corrie Williams Los Angeles, California, United States Boston, Massachusetts, United States Peer Review Manager Michael F. Holick, MD, PhD Dennis Styne, MD Editorial Board Boston, Massachusetts, United States Sacramento, California, United States Ejigayehu Abate, MD Michael S. Irwig, MD Auryan Szalat, MD Jacksonville, Florida, United States Washington, District of Columbia, United States Jerusalem, Israel fi Sonia Ananthakrishnan, MD Linda S. Jaffe, MD Mira So a Torres, MD, FACE, ECNU Boston, Massachusetts, United States Boston, Massachusetts, United States Worcester, Massachusetts, United States John L.D. Atkinson, MD Sina A. Jasim, MD, MPH Vera Vera Fajtova, MD Rochester, Minnesota, United States St. Louis, Missouri, United States Boston, Massachusetts, United States Irina Bancos, MD Irwin Klein, MD Joseph G. Verbalis, MD Rochester, Minnesota, United States Manhasset, New York, United States Washington, District of Columbia, United States Elena I. Barengolts, MD Matthew C. Leinung, MD, FACE Xiangbing Wang, MD, PhD Chicago, Illinois, United States Albany, New York, United States New Brunswick, New Jersey, United States Shehzad Basaria, MD Virginia A. LiVolsi, MD Jingwei Wu, PhD Boston, Massachusetts, United States Philadelphia, Pennsylvania, United States Philadelphia, Pennsylvania, United States Rajib K. Bhattacharya, MD, FACE Ildiko Lingvay, MD, MPH, MSCS Kevin C.J. Yuen, MBChB, MD, FRCP(UK), FACE Kansas City, Kansas, United States Dallas, Texas, United States Phoenix, Arizona, United States Glenn D. Braunstein, MD Alan Malabanan, MD Farhad Zangeneh, MD Los Angeles, California, United States Boston, Massachusetts, United States Falls Church, Virginia, United States Lynn Burmeister, MD Lyle Mitzner, MD Donald Zimmerman, MD Minneapolis, Minnesota, United States Boston, Massachusetts, United States Chicago, Illinois, United States Endocrine Practice Vol 27 No. 6S June 2021 A1 Endocrine Practice 27 (2021) S1eS23 Contents lists available at ScienceDirect Endocrine Practice journal homepage: www.endocrinepractice.org ADRENAL DISORDERS Abstract #977113 Abstract #984425 Use of Mifepristone in a Hypercortisolemic Patient Diffuse Large B-cell Lymphoma Presenting As with End Stage Renal Disease on Hemodialysis Shrinking Bilateral Adrenal Masses Author Block: Albert Coo - Diabetes and Endocrine Associates, Author Block: Jennifer Fuh - University of New Mexico; Privia Medical Group; Rebecca Ray, APRN, FNP-C - Co-author, Kristen Gonzales, MD - co-author, University of New Mexico; Corcept Therapeutics; James J. Smith, PhD. - Co-author, Corcept Laura Shevy, MD - co-author, University of New Mexico; Therapeutics Patricia Kapsner, MD - co-author, University of New Mexico Introduction: There is currently no published data on the use of Introduction: Metastases from lung, breast, or colon cancer are mifepristone (Korlym®, Corcept Therapeutics) in patients with common causes for bilateral adrenal masses in areas without End Stage Renal Disease (ESRD) on hemodialysis diagnosed prevalent tuberculosis. Adrenal involvement in non-Hodgkin’s with hypercortisolism. We present a patient case with ESRD lymphoma with associated adrenal insufficiency is not uncommon. fi demonstrating the safe and ef cacious long-term use of We present a case where diagnosis was complicated and prolonged mifepristone. due to multiple negative needle biopsies and spontaneously Case Description: A 67-year-old woman presented with ESRD on shrinking adrenal masses. hemodialysis due to HIV-associated nephropathy and multiple Case Description: A 51 year old female with cervical cancer post comorbidities (T2DM, hypertension, hyperlipidemia, obesity, hysterectomy in remission, presented to the emergency room for hypothyroidism, HSV, anemia, depression, tertiary hyperpara- abdominal pain, 40 pound weight loss, sweating and nausea. CT thyroidism). She has a history of bilateral adrenal adenomas abdomen was remarkable for bilateral adrenal masses (right 6.1 cm, (2.0 cm left, 1.8 cm right) discovered incidentally in 2008 left 7.9 cm). MRI noted concern for lymphoma. PET/CT showed hy- during a hospital stay. ACTH-independent hypercortisolism was permetabolic adrenal lesions, a T12 spinal lesion, and diffuse bone fi con rmed with 1mg ODST, late-night salivary cortisol, and marrow activity. Biopsy of the T12 lesion with flow cytometry was ACTH. Anuria prevented the collection of the 24-hour UFC. Due negative for neoplasm. Plasma metanephrines, renin, aldosterone, ’ to the patient s poor surgical candidacy, she was conservatively androstenedione, 17-hydroxyprogesterone, random cortisol, testos- managed for 7 years. In 2015, she was started on mifepristone terone, and estradiol were normal. Dehydroepiandrosterone sulfate 300 mg QD. At 2 months, mifepristone was titrated to 600 mg was low and adrenocorticotropic hormone 2.5 times upper normal QD which is the maximum dose for patients with renal limit. Evaluation for infectious causes including histoplasmosis, impairment. No adjustments to the mifepristone dose were tuberculosis, and blastomycosis was negative. Two months after required to accommodate the 3 days a week hemodialysis initial presentation, the patient was hospitalized for worsening schedule. Mifepristone was dosed daily in the evenings of both abdominal pain. CT of the abdomen showed a decrease in size of the the hemodialysis and nonhemodialysis days. Over 55 months, adrenal masses [right 5.2 cm, 39 Hounsfield units (HU), -21% her HbA1c improved from 7.2 to 4.8 % with discontinuation of washout; left mass 5.7 cm, 39 HU, -27% washout], as well as new all insulin; blood pressure normalized with discontinuation of paraaortic and aortocaval lymph nodes. Morning cortisol was low, antihypertensive medications; weight decreased from 198 to and due to concern for adrenal insufficiency, hydrocortisone was 155 lbs with a BMI improvement of 36.2 to 28 kg/m2.Hypo- initiated. Left adrenal core biopsy was negative for malignancy. One kalemia was treated with KCl supplementation. HIV remained month later, patient had a syncopal episode with abdominal pain. CT undetectable. abdomen showed continued shrinkage of the adrenal masses (right Discussion: fi This is the rst published case of a complex patient 3.2cm and left 3.6cm). Two weeks later, patient had pleuritic pain, with ESRD on hemodialysis using mifepristone to control and CT angiogram demonstrated new enlarged mediastinal, left hypercortisolism. The long-term use of mifepristone in this axillary, and left supraclavicular lymph nodes. Left axillary lymph patient resulted in clinically meaningful improvements in hy- node core biopsy yielded inadequate tissue, so open biopsy was perglycemia, hypertension, and weight loss while offering an pursued, revealing double-hit high grade B cell lymphoma. Chemo- acceptable safety profile. therapy was initiated, and subsequent imaging demonstrated further https://doi.org/10.1016/j.eprac.2021.04.472 decrease in size of adrenal masses. 1530-891X Adrenal Disorders Endocrine Practice 27 (2021) S1eS23 Discussion: High index of suspicion for lymphoma in the setting of monitoring is needed for most patients in the form of routine bilateral adrenal masses should be maintained even with negative screening with serial BP monitoring, MRI brain and spine, needle biopsies and diminishing size of adrenal masses. Needle ophthalmological and audiological exams to prevent complications biopsy may be inadequate, thus consider open biopsy if needle with vision, hearing loss, neurological, and renal impairments from biopsy is negative with high clinical suspicion for lymphoma. tumor growth. https://doi.org/10.1016/j.eprac.2021.04.473 https://doi.org/10.1016/j.eprac.2021.04.474 Abstract #984820 Abstract #988358 Like Mother, Like Son e VHL Syndrome A Case of Gender Misassignment; Due To Rare Enzyme Disorder Author Block:
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