A False Pituitary Tumor

A false pituitary tumor describes pituitary enlargement due to intracranial hypotension. Reported previously primarily in the neurological literature, we present this case referred to endocrinology for evaluation of a pituitary mass. A 24-year-old male was referred to endocrinology for evaluation of pituitary enlargement without a hypo-enhancing lesion on magnetic resonance imaging (MRI). The main symptom reported was headache that was worse in the standing position and in the afternoon. He had no symptoms or signs of pituitary mass-effect, or hormone excess or deficiencies. Past medical history was relevant for a history of nerve schwannoma status post resection with subsequent spinal fusion. Biochemical evaluation of pituitary hormones was normal. Upon review of his pituitary MRI, other abnormalities seen were suggestive of intracranial hypotension. Based on his history and imaging findings, he was diagnosed with intracranial hypotension causing a "false pituitary tumor" rather than pituitary enlargement or abnormality. Further evaluation revealed multiple spinal leaks that were patched. His symptoms subsided within a few days of repair. Endocrinologists should be aware of the possible misdiagnosis of a pituitary mass due to intracranial hypotension.

Effect of metabolic surgery on immunosuppressive medication use in patients with rheumatic diseases

BACKGROUND

Obesity is an inflammatory condition associated with higher rheumatic disease (RD) incidence, increased disease activity, and functional impairment.

OBJECTIVE

We aimed to assess whether metabolic and bariatric surgery (MBS) decreases immunosuppressant use in patients with RD.

SETTING

Bariatric surgery academic centers of excellence.

METHODS

We conducted a retrospective review of MBS procedures in patients using immunosuppressants for RD between 2008 and 2020 at 2 academic institutions. Patient data were analyzed at 3-, 6-, 12-, and 24-month follow-up intervals. We examined paired differences in the number of preoperative medications relative to different postoperative follow-up periods using McNemar tests for the prednisone-only comparisons and paired t tests for all other comparisons.

RESULTS

We identified 53 patients with RD who underwent MBS (mean age = 53 years; mean follow-up = 19 months). Of these patients, 64% had Roux-en-Y gastric bypass, 30% sleeve gastrectomy, and 6% duodenal switch. Rheumatoid arthritis was the most common RD (42%), followed by psoriasis (19%) and lupus (11%). Mean percent total weight loss and change in body mass index were 31.3% and 15.9 kg/m², respectively, at 24-month follow-up. At 24 months, 10 patients (30%) stopped prednisone (P = .007), and 13 patients (33%) showed a reduction in immunosuppressant use (disease-modifying antirheumatic drugs or glucocorticoids) (P = .01). One patient started glucocorticoids postoperatively, and 2 patients had an increase in immunosuppressant use. At the last encounter, 5 patients were off immunosuppressants, and all medication classes, except biological disease-modifying antirheumatic drugs, showed significant reductions.

CONCLUSION

There is significant decrease in the use of immunosuppressant agents after MBS in patients with RD. Further studies are needed to confirm the correlation.

OR10-4 Sex as an Independent Variable in Satiety

Background

Satiety is the result of postprandial physiologic events that determine the timing for the next meal by inhibiting the sensation of hunger. It is orchestrated by the brain-gut-axis, with gastric emptying and accommodation being key components of satiety and appetite sensations. Several indices have been used to quantify satiety. Longer time to empty 50% of the stomach content (GEt1/2) during a gastric emptying for solid study (GES), and lower SQ for fullness, lower SQ for satisfaction, and higher SQ for hunger after a meal challenge measured by visual analog scales (VAS) are all associated with prolonged satiety and are therefore protective against caloric overconsumption and to the development of obesity. Although obesity prevalence is higher in female compared to male subjects, there is little data on how sex affects biological indices of satiety.

Methods

This retrospective cohort study included patients with overweight and obesity who underwent anthropometric measurements, body composition evaluation, and satiety tests. After an 8-hour overnight fast, patients were provided a radiolabel breakfast (320kcal, 30% fat) to measure GES by scintigraphy over 4 hours and appetite sensations. We measured appetite sensations (hunger, fullness, and satisfaction) with 100-mm VAS every 30 minutes for 4 hours at baseline (before eating breakfast, i.e. VAS0') and after breakfast (VAS30' to VAS240'). The SQ for each appetite sensation was calculated with the following formula: (VAS0' – VAS30')/320. We performed univariate and multiple regression analyses to estimate the contribution of biological and anthropometric variables to GEt1/2.

Results

We included 743 subjects: 557 females (75%), mean age 40±11 years, mean BMI 33±8kg/m². Compared to males, female participants had significantly higher BMI and lower height, weight, waist-to-hip ratio (W/H), and percentage lean mass (%LM). Compared to males, female participants had a slower GEt1/2 (123 vs. 98 minutes, p<0.0001), lower SQ for fullness (-15 vs. -12 mm, p=0.008), and lower SQ for satisfaction (-14 vs. -11 mm, p=0.01). Females had higher but not significant SQ for hunger. On univariate analysis, height, BMI, and %LM had a negative but significant correlation with GEt1/2 (R=-0.3, p<0.0001; R=-0.1, p=0.02; and R=-0.2, p=0.0003; respectively). On multiple regression analysis, when taking into consideration age, sex, height, W/H, and %LM, only sex (parameter estimate [PE]=6.8, p=0.02), height (PE=-82, p=0.0005), and W/H (PE=49, p=0.004) were independent predictors of GEt1/2.

Conclusion

This study highlights the sex differences in indices of satiety measured by GEt1/2 with a GES, and by SQ for hunger, fullness, and satisfaction with VAS. Sex is a strong independent predictor of GEt1/2. These observations highlight the importance of considering sex as a variable to understand the pathophysiologic mechanisms involved in obesity's heterogeneity.

Presentation: Sunday, June 12, 2022 11:45 a.m. - 12:00 p.m.

Effectiveness of anti-obesity medications approved for long-term use in a multidisciplinary weight management program: a multi-center clinical experience

BACKGROUND AND AIMS

Randomized clinical trials have proven the efficacy and safety of Food and Drug Administration (FDA) approved anti-obesity medications (AOMs) for long-term use. It is unclear whether these outcomes can be replicated in real-world clinical practice where clinical complexities arise. The aim of this study was to evaluate the effectiveness and side effects of these medications in real-world multidisciplinary clinical practice settings.

METHODS

We reviewed the electronic medical records (EMR) of patients with obesity who were prescribed an FDA-approved AOM for long-term use in academic and community multidisciplinary weight loss programs between January 2016 and January 2020.

INTERVENTION

We assessed percentage total body weight loss (%TBWL), metabolic outcomes, and side effect profile up to 24 months after AOM initiation.

RESULTS

The full cohort consisted of 304 patients (76% women, 95.2% White, median age of 50 years old [IQR, 39-58]). The median follow-up time was 9.1 months [IQR, 4.2-14.1] with a median number of 3 visits [IQR, 2-4]. The most prescribed medication was phentermine/topiramate extended-release (ER) (51%), followed by liraglutide (26.3%), bupropion/naltrexone sustained-release (SR) (16.5%), and lorcaserin (6.2%). %TBWL was 5.0%, 6.8%, 9.3%, 10.3%, and 10.5% at 3, 6, 12, 18, and 24 months. 60.2% of the entire cohort achieved at least 5% TBWL. Overall, phentermine/topiramate-ER had the most robust weight loss response during follow-up, with the highest %TBWL at 12 months of 12.0%. Adverse events were reported in 22.4% of patients. Only 9% of patients discontinued the medication due to side effects.

CONCLUSIONS

AOMs resulted in significant long-term weight loss, that was comparable to outcomes previously reported in clinical trials.

Assessment of The Bethesda System for Reporting Thyroid Cytopathology

OBJECTIVES

Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA).

METHODS

Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated.

RESULTS

Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM).

CONCLUSIONS

Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.