Context Acromegaly, characterized by excess growth hormone (GH) and insulin-like growth factor-1 production, is typically caused by a pituitary somatotroph adenoma. Disease activity and treatment responses vary widely according to its structural-functional classification comprising clinical, pathologic, morphologic, and biochemical features, particularly adenoma size and invasiveness on pituitary MRI and GH-granulation pattern.Objective To evaluate the association between clinicopathologic acromegaly subtypes and long-term survival.Methods This multicenter, bidirectional cohort study assessed all-cause mortality in adults with somatotroph adenomas classified into 3 different subtypes. Patients with Type 1 acromegaly have noninvasive or invasive microadenomas that are densely granulated; Type 2 noninvasive macroadenomas are densely or sparsely granulated; and Type 3 invasive macroadenomas are sparsely granulated. The primary outcome was all-cause mortality, analyzed by subtype.Results The cohort comprised 550 patients, including 50.5% women, with a mean age at diagnosis of 42.3 years (standard deviation 13.7) and a median follow-up after diagnosis of 11.3 years (interquartile range 4.1-19.8). 172 patients (31.2%) had Type 1, 143 (26%) Type 2, and 235 (42.7%) Type 3. Overall mortality was 12.9%. Rates varied significantly across subtypes (P = .003): Type 1 had the lowest mortality at 7.0%, followed by Type 2 at 12.0%, and Type 3 at 17.9%. On multivariate Cox regression, Type 2 (hazard ratio [HR] = 2.76, 95% CI: 1.86-7.81, P = .009), and Type 3 (HR = 4.69, 95% CI: 1.65-13.3, P = .004) exhibited significantly higher mortality risk vs Type 1, independent of treatment modalities and presence of comorbidities.Conclusion Applying a structural-functional acromegaly classification enables distinction of significant differences in long-term survival outcomes.

Disclosure: O.A. Velasco-Espinosa: None. A. Rocha-Haro: None. R. Flores-Cárdenas: None. D. Cuevas-Ramos: None. Background: Adrenoleukodystrophy (ALD) is a rare X-linked disorder caused by mutations in the ABCD1 gene, leading to the toxic accumulation of very long-chain fatty acids (VLCFAs) in the nervous system and adrenal glands. Adrenal insufficiency is a common manifestation, often presenting subtly, even without typical MRI abnormalities, making early diagnosis crucial for management. Clinical Case: A 32-year-old man with a strong family history of ALD presented at age 17 with seizures, which progressed to spastic paraparesis, urinary incontinence, and mild cognitive impairment. Biochemical testing revealed elevated VLCFA levels and adrenal insufficiency. Genetic analysis identified a novel hemizygous mutation in the ABCD1 gene (c.668_669del, p.Ala223Glyfs*77), which was also identified in three family members, including the patient. Brain MRI showed only mild occipital periventricular hyperintensities (Loes score 2), while spinal MRI revealed thoracic cord atrophy. The patient underwent hematopoietic stem cell transplantation (HSCT) from an HLA-matched unrelated donor. Post-transplant, he experienced complications including febrile episodes, cutaneous and systemic graft-versus-host disease (GvHD), adrenal crisis, and infections (CMV, HSV, and E. coli). Seizure frequency decreased with adjustments to antiepileptic therapy and Immunosuppressive therapy was adjusted as needed.At one year post-HSCT, the patient remained clinically stable with no new seizures or radiological progression. Immunosuppression was successfully tapered. Due to ongoing corticosteroid therapy, adrenal function could not be re-evaluated. Chronic oral lichenoid stomatitis persisted. Conclusions: This case highlights the variable and often subtle presentation of ALD, even within families, emphasizing the importance of early diagnosis and genetic testing. Timely HSCT can help stabilize disease progression, though careful multidisciplinary management, particularly with respect to adrenal function and immunosuppressive therapy, is crucial given the risks of complications, including adrenal crisis and graft-versus-host disease. Presentation: Monday, July 14, 2025

Disclosure: J.A. Puentes-López: None. M.F. Rivera-López: None. M.D. Burguete-Bojalil: None. F.J. Gomez-Perez: None. D. Cuevas-Ramos: None. A previously healthy 31-year-old woman started with headache, decreased visual acuity, galactorrhea, and secondary amenorrhea. Laboratory results showed (normal reference) high calcium of 12.5 mg/dL (<10.3), ionized calcium 6.2 mg/dL (<5.3), and phosphate 4.6 mg/dL (<4.2), creatinine 1.3 mg/dL (<1.2), prolactin 473 ng/mL (<25), and TSH 3.3 (<2.5), with normal free T4 0.93 (<1.3), and low hemoglobin 10 g/dL (>13), and platelets 86,000 (>147000). Additional tests revealed normal 25-hydroxyvitamin D 37 ng/mL (<40), and low 1,25-dihydroxyvitamin D 6.1 pg/mL. (>19), PTH 5.7 pg/mL (>12), PTHrP <1.2 pmol/L (<1.5), and high urinary calcium of 335 mg/24 h (<250). Because of hyperprolactinemia, additional pituitary hormonal evaluation confirmed high prolactin 347 ng/mL, central hypogonadism, and normal ACTH (15 pg/mL, >10), IGF-1 (187 ng/mL, >87), morning cortisol (8.6 µg/dL, >5). She was referred to endocrinologist and hematologist, for a possible prolactinoma, and evaluation of hypercalcemia without hyperparathyroidism, and for study of bicytopenia, and hepatosplenomegaly confirmed with ultrasound, respectively. A peripheral blood smear showed 11% blast cells, and bone marrow aspiration confirmed CD20+ B-cell acute lymphoblastic leukemia (ALL), BCR:ABL-negative, standard risk. Patient was hospitalized for induction chemotherapy with the vincristine, cyclophosphamide, and daunorubicin (CALGB regimen) plus rituximab. Pituitary MRI showed a 11x8 mm intra and paraselar hypointense heterogeneous lesion, in contact with right cavernous sinus. 18-FDG PET-CT showed an abnormal hypermetabolic pituitary gland suggesting malignancy infiltration. After ruling out PTH-independent causes of hypercalcemia, including hypervitaminosis D, PTHrp secretion, hyperthyroidism, and familial hypocalciuric hypercalcemia, the hypercalcemia was attributed of ALL bone activity (usually related with elevated IL-6 and TNF-α), which stimulate osteoclastic bone resorption. Hyperprolactinemia resolved after chemotherapy (4.2 ng/mL) without therapy with dopamine agonists, and menstrual cycles resumed. Therefore, prolactin elevation was considered an acute-phase reactant due to the active hematologic malignancy, which also explained her secondary amenorrhea. New MRI showed reduction of the pituitary lesion suggesting it was infiltrated by ALL. She continued anti-leukemic treatment with consolidation and CNS prophylaxis. Three months later, laboratory results showed normalization of serum calcium (9.0 mg/dL), phosphate (3.6 mg/dL), butt secondary hyperparathyroidism (PTH 106.90 pg/mL) related with 25-hydroxyvitamin D deficiency (14 ng/mL). This case illustrates the coexistence of two endocrinopathies linked to hematologic malignancy, both resolving favorably with chemotherapy. ALL infiltration should be considered in the differential diagnosis of a pituitary lesion. Presentation: Monday, July 14, 2025

Summary:A 39-year-old woman presented with a 5-year history of severe intermittent headaches, rhinitis, hemoptysis, unintentional weight loss of 40 kg over a year, and unilateral vision loss. Then, she noticed polyuria, amenorrhea, muscle weakness, and cold intolerance. Diagnosis of granulomatosis with polyangiitis (GPA) was confirmed with elevated c-ANCA levels and PR3-positive antibodies. Physical examination revealed hypotension, absence of pubic and axillary hair, and classical signs of hypothyroidism. The patient reported multiple previous hospitalizations due to episodes of hypernatremia, hypotension, and hypoglycemia. The biochemical evaluation showed early signs of chronic kidney disease and central adrenal, thyroid, and gonadotropin deficiencies. Pituitary MRI revealed a heterogeneous pituitary gland with peripheral enhancement, central necrosis, and extension to adjacent structures, as well as the absence of posterior pituitary bright spot on T1-weighted imaging. A diagnosis of GPA with pituitary involvement was established. Remission therapy with corticosteroids and rituximab was started. After disease control, pituitary hormonal deficiencies persisted, requiring long-term hormone replacement therapy. Learning points:Pituitary involvement in cases with GPA is a rare manifestation frequently misdiagnosed. It is important to be aware of hypophysitis as a GPA activity complication that warrants a prompt diagnostic approach and treatment. The pathophysiology of hypophysitis may be mediated by a granulomatous lesion or due to vascular damage. Pituitary dysfunction in GPA may occur at any moment, as an initial manifestation or as a concomitant syndrome together with other organ compromise. Deficiency of arginine vasopressin and central hypogonadism are the most frequent pituitary hormonal alterations. Pituitary dysfunction usually persists despite remission of systemic activity, requiring long-term hormone replacement therapy and surveillance.

Antecedentes: La deficiencia de hormona del crecimiento en adultos (DHCA) es un trastorno clínico que se produce debido a una reducción en la producción de hormona del crecimiento por la glándula hipófisis, influenciada por factores relacionados con la edad y el sexo. Esta condición puede tener un impacto considerable en la composición corporal, el metabolismo y la calidad de vida. Objetivo: Establecer la postura de la Sociedad Mexicana de Nutrición y Endocrinología en la evaluación, diagnóstico y tratamiento de la DHCA. Método: Discusión de la literatura internacional y consenso para el diagnóstico y tratamiento de la DHCA. Resultados: Se muestra la revisión de la literatura internacional, epidemiología, causas, evaluación, diagnóstico y tratamiento de la DHCA. Conclusiones: Este posicionamiento permite la actualización y postura de la evaluación, las causas, el diagnóstico y el tratamiento de la DHCA.

Antecedentes: La deficiencia de arginina-vasopresina central, antes llamada diabetes insípida, se refiere a la deficiencia parcial o total de la síntesis y/o secreción de esta hormona por diferentes causas. Objetivo: Actualizar los cambios en conceptos clave y etiología. Método: Se realizó distribución de los temas entre los miembros del grupo y mediante reuniones virtuales para llevar a cabo la revisión sistemática de la literatura. Resultados: Se actualiza el nombre a deficiencia de argininavasopresina central en sustitución a diabetes insípida central. Se resume la etiología más relevante de este padecimiento. Conclusiones: Este posicionamiento permite la actualización en conceptos clave y etiología de la deficiencia de argininavasopresina central.

Abstract Disclosure: C.D. Martínez-Franco: None. F.J. Gomez-Perez: None. M. Vilatobá: None. R. Flores-Cárdenas: None. D. Cuevas-Ramos: None. Kidney Donors with Metabolic Syndrome Have Increased Risk for Chronic Kidney Disease Introduction: Metabolic syndrome (MetS) has a prevalence of 56% in Mexico, been a common cause of progressive deterioration of renal function. Renal donors usually have good health at the time of donation, but some cases already present MetS or develop it over time. Objective: to evaluate the risk of MetS on chronic kidney disease (CKD) in kidney donors. Methods: we performed a comparative, longitudinal, observational and prolective study at a tertiary care hospital from 1980 to 2023. MetS was defined with ATPIII criteria. Renal function was assessed with the CKD-EPI formula to obtain the eGFR prior to the date of transplantation and at last follow-up. Student's t test, chi-square test, Kaplan-Meier, and multivariate Cox regression analyses were performed to assess the independent risk of MetS on renal function. Results: A cohort of 406 patients was collected, 283 cases (58% women), where 96 (34%) showed MetS criteria, and 187 (66%) without them used as control. There was no significant baseline difference on CrCl before donation between control group (97±19 ml/min) vs. MetS group (95±17 ml/min, p=0.45). The median follow-up was 25 (20.2-29.7) years. To assess the outcome of CrCl <60 mL/min, 4 groups were analyzed according to their MetS status at baseline - last follow-up. The fastest decreased on CrCl was seen at group 3 (No MetS - With MetS) after 17 (95%CI 14-19) years of follow-up, then group 4 (MetS - MetS) after 19 (3-34) years, followed by group 2 (With MetS - No MetS) with 23 (10-35) years, and finally group 1 (No MetS - No MetS), after 27 (23.7-30.5) years (p<0.0001). Group 1 was taken as reference to calculate CKD risk between groups. MetS showed a statistically significant risk as an independent determinant for CKD at follow-up with a HR=1.6 (0.7-3.3, p=0.21), HR=2.9 (1.2-7.0, p=0.01) and HR=2.2 (1.1-4.4, p=0.02) for group 2, 3 and 4, respectively. Conclusions: Having or developing MetS on kidney donors caused significantly higher risk of presenting CKD at last follow-up. Clinicians should be aware of such risk to implement strategies for prevention and treatment of MetS, with close and chronic surveillance of such patients. Presentation: 6/1/2024

A 46-year-old woman was troubled by a 3-year history of constant headaches and arthralgias. She was treated with paracetamol with no symptom resolution. An abnormal fasting glucose level prompted endocrine evaluation. On physical examination, she casually mentioned that her wedding ring no longer fit, and she also confirmed an increase in shoe size. There were no characteristic facial features for acromegaly and there was no evidence of acral enlargement. Biochemical evaluation, including insulin-like growth factor type 1 (IGF-1) measurement and oral glucose loading with growth hormone (GH) measurement confirmed excess GH production and a diagnosis of acromegaly. Pituitary magnetic resonance imaging showed a central pituitary microadenoma. After transsphenoidal surgical resection, tissue immunohistochemistry revealed a densely granulated somatotroph adenoma. Currently, the patient is asymptomatic with biochemical disease control, normal fasting glucose levels, and no pituitary hormone deficiencies. This patient is illustrative of a type 1 acromegaly with mild clinical manifestations. Clinicians should be aware of acromegaly subtypes to avoid delay in diagnosis and to individualize therapy.

Antecedentes: La deficiencia de arginina-vasopresina central, antes llamada diabetes insípida, se refiere a la deficiencia parcial o total de la síntesis y/o secreción de esta hormona por diferentes causas. Objetivo: Actualizar los cambios en el tratamiento médico para pacientes adultos. Método: Se realizó distribución de los temas entre los miembros del grupo y mediante reuniones virtuales para llevar a cabo la revisión sistemática de la literatura. Resultados: Se actualiza el abordaje terapéutico más adecuado para los pacientes con deficiencia de arginina-vasopresina central. Conclusiones: Este posicionamiento permite la actualización en el tratamiento médico de la deficiencia de arginina-vasopresina central.

Context: Dopamine agonists (DA), mainly cabergoline, are the primary therapy for prolactinomas. Risks factors related with biochemical recurrence after DA withdrawal are not completely understood. Objective: To assess hyperprolactinemia recurrence risk factors after dopamine agonist (DA) withdrawal in prolactinomas. Design: Retrospective, comparative, observational cohort study. Survival, and multivariate regression analyses were performed to estimate biochemical remission (prolactin (PRL) 3-25 ng/mL after at least 6 months of DA withdrawal), and recurrence (>25 ng/ml and/or tumor regrowth) at follow-up. Results: 1140 patients with hyperprolactinemia were evaluated. Prolactinoma was confirmed in 182 cases. Micro- (n=95), and macroprolactinoma (n=75) were more frequent in women (99% and 73%, respectively), while giant prolactinomas (n=12) were more common in men (75%). Cabergoline was the most frequently (92-95%) DA used with a median dose of 1.2 (0.25-4.0), 2.2 (1.5-3.5), and 2.8 (1.5-8.0) mg/week (p<0.001), respectively. Higher tumor size at diagnosis was significantly related to biochemical recurrence (p<0.02). However, independently of tumor size at diagnosis, and the DA cumulative dose received, once patient have achieved an 80% volume reduction, tumors were unlikely to decrease further (p=0.02). Among cases under remission at last follow-up, almost half with microprolactinomas (n=51, 54%), and macroprolactinomas (n=35, 46%) persisted with tumor remnants. Multivariate regression analysis confirmed that tumor remnant at last follow-up was not significantly associated with recurrence risk (p=0.81). Duration of therapy was the only variable significantly associated with remission (p<0.01). Conclusion: Probability of biochemical recurrence after withdrawal of DA therapy in micro and macroprolactinomas was not significantly associated with tumor remnant. Duration of DA therapy was the only variable significantly associated with remission.

Antecedentes: La deficiencia de arginina-vasopresina (AVP) central, antes llamada diabetes insípida, se refiere a la deficiencia parcial o total de la síntesis y/o secreción de esta hormona por diferentes causas. Objetivo: Actualizar los conceptos del cuadro clínico y abordaje diagnóstico. Método: Se realizó distribución de los temas entre los miembros del grupo y mediante reuniones virtuales para llevar a cabo la revisión sistemática de la literatura. Resultados: Se actualiza el cuadro clínico y el abordaje diagnóstico de la deficiencia de AVP central. Conclusiones: Este posicionamiento permite la actualización en el cuadro clínico y abordaje diagnóstico de la deficiencia de AVP central.

Sara Arellano (Hospital General de Mexico), Patricia Aguilar (Hospital Regional IMSS, Merida, Yuc.), Benito Dominguez (Hospital de Especialidades, IMSS, Torreon, Coah.), Ana Laura Espinosa de Los Monteros, Baldomero Gonzalez Virla, Ernesto Sosa, Moises Mercado, Gerardo Guinto (Hospital de Especialidades, Centro Medico Nacional S. XXI, IMSS), Ignacio Martinez (Hospital de Especialidades, Centro Medico Monterrey, IMSS, N.L.), Enrique Hernandez (Hospital General de Zona, Leon, Gto.), Alfredo Reza (Instituto Nacional de Ciencias Medicas y Nutricion), Lesly Portocarrero (Instituto Nacional de Neurologia y Neurocirugia), Alma Vergara (Centro Medico Nacional 20 de Noviembre, ISSSTE) Francisco Javier Velazquez, (Centro Medico La Raza, IMSS), Estanislao Ramirez (Hospital Regional, IMSS, Oaxaca, Oax.).

Background: Abdominal obesity has been associated with an increased risk of insulin resistance, metabolic syndrome, and diabetes. Central fat removal procedures such as liposuction, lipectomy, and abdominoplasty are among the most common surgical procedures. The impact of the latter on the former is controversial and understudied. The authors aimed to explore the effect of subcutaneous fat elimination procedures on insulin resistance measures and adipokine levels. Methods: Relevant studies regarding the effects of surgical subcutaneous fat removal on glucose, insulin, adipokines, and lipid metabolism, as well as blood pressure, were identified by searching PubMed and Ovid–Cochrane without limits in date, type of publication, or language. After the selection process, 24 studies were obtained. The results of the articles were summarized using descriptive statistics. For the final analysis, a randomized effects model was used to evaluate heterogeneity; averages and meta-analytic differences were expressed with a confidence interval of 95%. Results: All studies reported a reduction in weight (−2.64 kg; 95% CI, −4.32 to −0.96; P = 0.002; I 2 = 36%; P of I 2 < 0.001) and body mass index after liposuction. A significant improvement in triglycerides (−10.06 mg/dL; 95% CI, −14.03 to −6.09; P < 0.001; I 2 = 48%; P of I 2 = 0.05), serum glucose concentration (−4.25 mg/dL; 95% CI, −5.93 to −2.56; P < 0.001; I 2 = 68%; P of I 2 < 0.001), serum insulin concentration (−2.86 μIU/mL; 95% CI, −3.75 to −1.97; P < 0.001; I 2 = 59%; P of I 2 = 0.003), and serum leptin concentration (−7.70 ng/mL; 95% CI, −11.49 to −3.92; P = 0.0001; I 2 = 96%; P of I 2 < 0.001) was consistently observed. Conclusion: In addition to weight loss, there is a significant decrease in leptin, triglyceride, glucose, and insulin serum concentrations after liposuction, a fact that should be considered in future discussions.

Los adenomas hipofisarios clínicamente no funcionantes (AHCNF) se caracterizan por la ausencia de hipersecreción hormonal con un espectro de manifestaciones clínicas, desde su curso asintomático hasta la presencia de síntomas compresivos o apoplejía hipofisaria. El tratamiento de elección es la cirugía, sin embargo existen diferentes tratamientos adyuvantes que permiten mejorar el pronóstico. La evidencia actual continúa aumentando la información sobre el diagnóstico y tratamiento de esta enfermedad. El objetivo del presente documento es actualizar la posición de la Sociedad Mexicana de Nutrición y Endocrinología respecto al diagnóstico, tratamiento y seguimiento de las personas que viven con AHCNF, realizando una revisión de la literatura por el Grupo de Trabajo de Neuroendocrinología de nuestra sociedad y estableciendo recomendaciones aplicables a nuestra población.

Abstract Disclosure: J.M. Zuarth-Vazquez: None. R.G. Rebollar-Vega: None. C. Ramírez-Rentería: None. W.E. Hernández-Núñez: None. M. Torres-Morán: None. A.L. Franco-Álvarez: None. J. Eseiza-Acevedo: None. M. Aguilar-Soto: None. D. Cuevas-Ramos: None. E. Sosa-Eroza: None. M. Mercado: None. A. Gamboa-Dominguez: None. L.C. Hernández-Ramírez: None. Introduction: Inherited pituitary neuroendocrine tumors (PitNETs) are considered rare and may present either as isolated lesions or in association with other endocrine tumors. Despite significant progress in the understanding of their molecular basis, the precise pathophysiological mechanisms in many patients with familial and sporadic pituitary tumors are unknown. Although the clinical presentation may point towards a specific genetic cause, a combination of careful clinical assessment and state-of-the-art genetic testing is required. Objective: To describe 4 cases of PitNETs with heterogeneous clinical presentations and genetic causes from a cohort of Mexican patients with neuroendocrine tumors. Methodology: Patients were recruited under informed consent from two different reference hospitals in Mexico City. Germline genetic testing was performed using either a custom-made or a commercial next-generation sequencing (NGS) panel. When available, relevant variants were confirmed in tissue samples. Genetic results were correlated with clinical, biochemical, and imaging characteristics. Results: Case 1 is an 18-year-old male with gigantism due to a 3-cm GH/prolactin-secreting PitNET, that was not cured after transsphenoidal surgery (TSS). Genetic testing showed a CDKN1B (NM_004064.5) c.356T>C, p.I119T variant of uncertain significance. No relevant family history was informed. Currently, the patient is treated with monthly octreotide LAR. Case 2 is a patient with young-onset acromegaly (15y) due to a GH-secreting PitNET. She was initially treated with bromocriptine and then underwent TSS without achieving remission. Radiotherapy was therefore indicated, resulting in panhypopituitarism. The likely pathogenic variant of AIP (NM_003977.4) c.872_877del, p.V291_L292del, was identified. Case 3 was diagnosed at the age of 15 with gigantism, treated with TSS and radiotherapy, subsequently demonstrating biochemical cure. Whole-exome sequencing showed the AIP pathogenic variant c.910C.T, p.R304*, indicative of familial isolated pituitary adenoma, confirmed by the history of two paternal first cousins with gigantism. Finally, a 54-year-old man (case 4), with a personal and family history of neurofibromatosis type 1, was incidentally diagnosed with a 16 mm, apparently non-functional PitNET, for which he is awaiting surgery. The pathogenic NF1 (NM_001042492.3) variant c.147C>A, p.Y49* was identified. Conclusions: Our data confirm that inherited PitNETs encompass a variety of clinical phenotypes. Modern NGS-based genetic testing is an effective method for identifying such cases. Precise molecular testing has an impact on the timely diagnosis of these lesions, as well as on their prognosis and the need for genetic counseling. Presentation: Saturday, June 17, 2023

La hiperprolactinemia es una causa muy frecuente de consulta en la práctica cotidiana, pero solamente en algunos casos de hiperprolactinemia significativa y persistente se puede identificar un adenoma del lactotropo como la causa. En este trabajo se presentan algunas recomendaciones de abordaje, diagnóstico y tratamiento de la hiperprolactinemia/ prolactinoma, con énfasis en escenarios de difícil decisión o en situaciones especiales como el embarazo o la edad pediátrica. Sin pretender ser considerado una guía clínica o un consenso, la Sociedad Mexicana de Nutrición y Endocrinología A. C., y en particular el Grupo de Trabajo en Neuroendocrinología, presentan este documento en el que se sintetiza información reciente y relevante que ha sido analizada y organizada por especialistas relacionados con el tema.

Background: The aim of this study is to compare the effect of dapagliflozin (DAPA) in addition to metformin (MET) at maximum tolerated dose in glycaemic variability (GV) on drug naïve T2DM patients. ClinicalTrials.gov Identifier: NCT04090580 Methods: Newly diagnosed T2DM patients with HbA1c ≥ 7.5% - ≤ 12%, BMI > 25 - <45 kg/m2, were randomized 1:1 to receive DAPA 10 mg + MET or MET alone for 12 weeks. Both groups were monitored using a CGM system for 7 days at baseline and week 12. Primary outcome was defined as the mean difference of MAGE (Mean Amplitude of Glycaemic Excursions). Additional secondary endpoints included mean difference of serum insulin, HbA1c, weight, and time in range. Results: 80 patients completed follow-up at week 12 (DAPA+MET, n=41; MET, n=39). Baseline characteristics included mean age 52.2±10.4 years, weight 80.6±16.5 kg, SBP 133.3±19.3 mmHg, HbA1c 9.3±1.5 %, eGFR 100.5±15.4 ml/min/1.73m2, MAGE 4.2±1.4 mmol/L. Patients treated with DAPA+MET had lower GV at week 12 measured by MAGE (-0.79 [-0.86 DAPA+MET vs -0.06 MET; p=0.018]) and higher time in range (+22.9% [35.8 DAPA+MET vs 12.9 MET; p=0.002]). DAPA group had lower insulin plasma levels (-4.5 µU/mL [-2.8 DAPA+MET vs +1.6 MET; p=0.029]) and body weight (-3.2 kg [-3.22 DAPA+MET vs -0.6 MET; p<0.001]); nominal reductions were observed in HbA1c (-1.82 DAPA+MET vs -1.61 MET; p=0.919) and SBP (-4.96 mmHg [-4.35 DAPA+MET vs +0.60 MET; p=0.277]. Conclusions: Patients with new onset T2DM treated with DAPA + MET during a 12-week period had improvements in glycaemic variability measured by MAGE (-19.63%) and achieved longer periods within target range for glycaemic control in comparison with patients treated only with MET. Plasmatic insulin levels, and weight reduction were also significantly reduced with DAPA; nominal reductions in HbA1c and SBP were observed. All these findings support the early dapagliflozin use in patients with newly onset T2DM. Disclosure A.P.Guerrero-castillo: None. S.C.Juarez-comboni: Employee; AstraZeneca. F.J.Gómez-perez: None. M.A.Gomez-samano: Research Support; AstraZeneca. A.Benitez-renteria: Employee; AstraZeneca. D.Cuevas-ramos: None. M.López-carrasco: None. A.Silva: Stock/Shareholder; AstraZeneca. G.X.Brito: None. L.Palacios-baez: None. I.Manjarrez-martínez: None. S.I.Rodriguez-carranza: None. Funding AstraZeneca Mexico

Abstract Disclosure: D. Cuevas Ramos: None. G. Garza García: None. W. Hernández Núñez: None. F.J. Gómez Pérez: None. Introduction: Establishing the cause of Cushing’s syndrome remains challenging. Bilateral Inferior Petrosal Sinus Sampling (BIPSS) is the gold standard for distinguishing between Cushing's disease (ACHT-secreting pituitary adenoma) and an ectopic source of ACTH. However, BIPSS is an invasive test and is not widely available. Therefore, we sought to explore the diagnostic efficacy of the 7 mg dexamethasone suppression test (7mg-dexa) for establishing the diagnosis of Cushing's disease (CD). Methods: We reviewed 1375 cases with pituitary adenomas. From them, 191 cases had confirmed diagnosis of CD from 1999 to 2022. Of these, 25 patients underwent 7 mg dexamethasone suppression test together with BIPSS during their diagnosis workup. A diagnosis of CD was established in 21 patients, confirmed after neurosurgery, with a pathology report of ACTH+ secreting pituitary adenoma, and a biochemical resolution of CS. The additional 4 cases showed an adrenal source of CS. Suppression of 50% or more in the afternoon (of day 1 after 7 mg-dexa IV infusion by 7h starting at 7:00 hrs at 1 mg/hr) was considered consistent with CD. A central-to-peripheral plasma ACTH gradient of ≥2 before and after desmopressin stimulation was also considered consistent with CD during the BIPSS. We calculated kappa index to evaluate concordance between diagnostic test. Also, sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated. Results: The mean age was 43±12.1 years, with a BMI of 30±5.6 kg/m2, 86% females. For the basal ACTH values during BIPSS, the S=76%, E=75%, PPV=94%, NPV=37%, LR+=3, LR-=0.3. For the post-stimulation BIPSS, the S=95%, E=75%, PPV=95%, NPV=75%, LR+=3, LR-=0.06. Using the 7mg-dexa, a S=91%, E=75%, PPV=95%, NPV=60%, LR+=3.6, LR-=0.12. Kappa between test was 0.6 before stimulation, and 0.7 after desmopressin stimulation showing acceptable concordance. Conclusion: The 7 mg-dexa showed similar and acceptable diagnostic performance in comparison with basal or stimulated BIPSS. Since 7mg-dexa inhibition test is less invasive and less expensive, further clinical research to evaluate its utility in CD diagnostic approach is in order. Presentation: Saturday, June 17, 2023

Abstract Disclosure: L. Leyva Figueroa: None. F.J. Gomez-Perez: None. F. Gonzalez-Valdivia: None. D. Cuevas-Ramos: None. Background: High C-peptide levels have been associated with microvascular complications, although there is controversial evidence in patients with T2DM. Objective: To correlate fasting serum C-peptide values in patients with T2DM with diabetic nephropathy. Hypothesis: In patients with type 2 diabetes mellitus there is a positive correlation of minimum r=0.3 between fasting C-peptide, albumin/creatinine ratio (ACR) and glomerular filtration rate (eGFR). Research Question: Is there a significant and independent correlation between fasting C-peptide values, ACR, and eGFR in patients with type 2 diabetes mellitus? Methods: Retrospective, cross-sectional, observational, real-world study, in 551 type 2 diabetic patients. Data was collected from the electronic clinical records. Microalbuminuria was defined as an ACR equal or greater than 30, and eGFR was calculated by CKD-EPI 2021. Fasting C-peptide was measured by immunochemiluminescence. Continuous variables were expressed as means +/− standard deviation, while categorical variables will be expressed as percentages. We used one-way ANOVA to compare continuous variables between groups, and Chi-square test to compare categorical variables. Multivariate logistic regression analysis was used to analyze the independent relationship between C-peptide quartiles, eGFR, and ACR, adjusted for weight, insulin, and disease duration. Results: 551 patients were evaluated (63% were women), with mean age of 62 ±11 years old, and a HbA1c of 8.4%. Median (interquartile range) of disease duration was 20 years (12-25), with a C-peptide median level of 1.6 (0.9-2.4 ng/ml), with no significant difference by gender. A statistically significant direct relationship was found between a higher C-peptide quartile and higher ACR (F=9.8, p= 0.03). A significant correlation was also found between C-peptide and ACR (r=0.16, p<0.001), and also with eGFR (r=−0.11, p=0.01). Using a multivariate regression analysis we identified an independent association between C-peptide and ACR (beta=44.7, CI95%, 16-73, p=0.002), and also with eGFR (beta −2.7, CI95% −4.7 to −0.6, p=0.01). Conclusions: A significant and independent association was found between C-peptide levels and kidney function and albuminuria. Future studies may confirm that C-peptide can stand as an early marker for diabetic nephropathy. Presentation: Friday, June 16, 2023