status. The patient became aphasic, began clenching her fists, and was shaking. A sodium level post-procedure was obtained and was 113. A head CT scan was performed and no central involvement was noted. The patient was managed with 3% hypertonic saline and her symptoms resolved. Over the next 2 days patient's sodium level normalized and the patient was discharged from the hospital. Discussion: This is the first reported case of hyponatremia secondary to water immersion endoscopy. While there is an abundance of reports describing hyponatremia in urologic and gynecologic procedures those procedures generally use glycine and mannitol as their irrigate. With regards to GI procedures, hyponatremia secondary to polyethylene glycol-electrolyte preparation has infrequently been reported. Free water irrigation/immersion is generally regarded as safe during gastroenterological procedures. Our case, brings awareness to the possibility of symptomatic hyponatremia following prolonged enteroscopy with the use of large volume water irrigation/immersion. Absorption of ingested water and most solutes occur in the proximal small intestine. If a large amount of fluids are necessary then normal saline can be utilized instead of water. Limiting water to 1.5 liters and suctioning excess water can help minimize these complications. Clinicians should be aware of this serious complication when performing these procedures.
started on octreotide for symptomatic management with further workup of MEN1. The patient showed hepatic lesion concerning metastasis on follow up MRI of abdomen. Repeat EUS with FNA of hepatic lesion showed pathology result suggestive of metastasis.(Figure ) Discussion: CT is used as primary method to localize the lesion, given that it is readily available and takes shorter time to obtain imaging. Though one study reported sensitivity of CT being .80%, another study reported CT sensitivity of 58%. As also demonstrated in this case, it can be a challenge to localize VIPoma with a single imaging test, and may require multi-modality approach, including CT, MRI, PET, and EUS. Modality used in our study, EUS, has shown detection rate of approximately 90%. To demonstrate this, EUS was able to detect lesions in 33% of the patients that tested negative on initial CT. It is important to keep in mind that VIP levels may be false negative given that VIPoma may secrete VIP intermittently. This case and literature review implore that in the setting of clinical suspicion with or without VIP elevation, even if CT is negative, it does not necessarily rule out VIPoma and further imaging should still be considered.
Background Polycystic Ovary Syndrome (PCOS), the most common endocrine disorder in reproductive‐age women, is characterized by androgen excess and ovarian dysfunction. PCOS women have an increased prevalence of components of the metabolic syndrome, such as increased blood pressure (BP), insulin resistance and obesity. Whether African American women with PCOS have worse cardiometabolic profile than Caucasian remains unknown. Aims To determine the prevalence of components of the metabolic syndrome in patients of different ethnicity with PCOS in the state of Mississippi. Methods University of Mississippi Medical Center (UMMC) de‐identified patient data from 2013–2017 was obtained from electronic medical records (EMR) using UMMC’s Research Data Warehouse. Cardiometabolic risk factors were analyzed and compared between African American and Caucasian PCOS women. Data is expressed as mean. SEM and statistical analysis was performed using SPSS. Results During the 2013 to 2017 period, EMR of 1,200 PCOS patients were obtained and analyzed from a total of 784,666 patients that were evaluated at UMMC. Compared to Caucasians, African American women with PCOS have significantly higher mean arterial BP (97.06±0.52 vs 94.23±0.48 mmHg p<0.001), hemoglobin A1C (6.03±0.08 vs 5.63±0.07 % p<0.001) and Body Mass Index (39.30±0.43 vs 36.05±0.39 p<0.001). About 44% of patients with PCOS have a BMI more than 40 (morbid obesity). Conclusions Morbid obesity is highly prevalent in patients with PCOS in the Mississippian population cared for at UMMC. African American women with PCOS have a significantly higher prevalence of cardiometabolic risk factors than Caucasians. Lifestyle modifications should be implemented to ameliorate the prevalence of cardiometabolic risk factors in patients with PCOS. Support or Funding Information Funding for this research is supported by NIH R01 HL135089 (JFR), P20 GM12334(LLY, ETF, JFR, DGR) and PO1HL51971 (JFR).
Polycystic Ovary Syndrome (PCOS), the most common endocrine disorder in young women, is characterized by hyperandrogenemia, and is associated with obesity and insulin resistance. It is suggested that hyperandrogenemia is the cause of these metabolic complications. Current treatment for obesity in PCOS is lackluster, which is why new therapies are being investigated. Sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors such as Empagliflozin (EMPA) have been shown in diabetics to reduce body fat and insulin resistance. We have previously reported that exposure of female rats to dihydrotestosterone (DHT) before puberty resembles many characteristics found in PCOS: increase in food intake (FI), body weight (BW), fat/lean mass, blood pressure, and renal injury. We want to test the hypothesis that EMPA improves obesity and metabolic complications in a PCOS‐like rat model. Methods Forty four‐week old female SD rats were randomized to either placebo (PBO) or DHT exposure (7.5mg/90 days). Body weight was measured weekly. Body composition was analyzed monthly by EchoMRI. Fasting plasma was analyzed monthly for glucose and insulin. A 24‐hour urine was collected in metabolic cages monthly to assess the concentration of urinary glucose. After 10 wks of DHT, rats were randomized to receive drinking water alone or with EMPA (10mg/kg/day) for another 3 wks. FI was measured daily. At the end of the treatment, body composition, fasting plasma, and glucosuria were assessed. Morning plasma was collected for leptin and adiponectin after 3 wks of EMPA treatment. Results In PCOS rats, EMPA decreased fat mass (21.1 ± 2.7 g vs 12.2 ± 0.8 g, p=0.0019), leptin (0.86 ± 0.16 ng/mL vs 0.45 ± 0.05 ng/mL, p<0.05), and adiponectin (19.2 ± 1.3 mg/mL vs 14.4 ± 1.0 mg/mL, p<0.05) and increased glucosuria (89 ± 8 mg/dL vs 4065± 400 mg/dL, p < 0.0001). In PCOS rats, EMPA did not affect BW (309.0 ± 11.0 g vs 293.7 ± 6.1 g, p=0.6288), cumulative FI (251.8 ± 8.5 g vs 261.1 ± 6.5 g, p=0.8123), or lean mass. In PCOS rats, EMPA did not affect fasting glycemia, fasting insulin (17.6 ± 1.3 mU/mL, p= vs 18.0 ± 1.7 mU/mL, p=0.9922), or insulin sensitivity through the quantitative insulin‐sensitivity check index (0.302 ± 0.003 vs 0.299 ± 0.003, p=0.8615). While causing increased glucosuria in PBO rats, EMPA did not affect fat mass, BW, cumulative food intake, lean mass, fasting glycemia, or insulin sensitivity. In summary, SGLT‐2 inhibition had beneficial effects on fat mass and leptin in PCOS‐like rats. This occurred in the absence of changes in food intake, fasting glycemia, and insulin sensitivity. This suggests that SGLT‐2 inhibition is exerting a positive impact on the cardiometabolic profile in female hyperandrogenemia via more than excessive loss of glucose in the urine alone. Therefore, EMPA could be a novel therapeutic approach to treat obesity in PCOS women to ameliorate the adverse cardiometabolic profile associated with this pathology. Support or Funding Information AHA 0830239N and 12SDG8980032, EFFERG, and NIH R21 DK‐113500 and P20 GM‐121334
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