18 F-fluorocholine PET-CT is considered a second-line method for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism. The aim was to compare the diagnostic performance of 18 F-fluorocholine PET-CT and standard imaging modalities in the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism. The primary objective was to assess the performance of 18 F-fluorocholine PET-CT in cases of negative or discordant standard imaging. The secondary objective was to evaluate the diagnostic performance of both 18 F-fluorocholine PET-CT and standard imaging in relation to patient characteristics. We conducted a retrospective, monocentric study, including 156 patients who underwent parathyroidectomy between 2017 and 2023. All patients underwent preoperative 18 F-fluorocholine PET-CT and had an indication for surgery due to primary hyperparathyroidism. A total of 156 patients were included in the study, the majority of whom were women (78%). Seven patients had multigland disease (4.49%). Sensitivity was 60.14% for cervical ultrasound, 46.21% for [99mTc]-MIBI scintigraphy, and 95.97% for 18 F-Fluorocholine PET-CT. 18 F-Fluorocholine PET-CT showed a higher sensitivity than cervical ultrasound and [99mTc]-MIBI scintigraphy, especially for multiple parathyroid adenomas (100, 57.14, and 42.86%, respectively). Univariate analysis showed better results for cervical ultrasound in men (p = 0.005). Larger adenomas showed better performance on [99mTc]-MIBI scintigraphy (p = 0.026), and elevated PTH levels were associated with significantly worse performance on 18 F-fluorocholine PET-CT (p = 0.023). Multivariate analysis showed that scintigraphy performance was worse in the presence of thyroid nodules (p = 0.049, RR = 2.046, 95% CI 1.005–4.166). 18 F-fluorocholine PET-CT is a valuable imaging modality for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism, with superior performance compared to conventional imaging modalities. [99mTc]-MIBI scintigraphy showed reduced diagnostic performance in the presence of thyroid nodules.

Background ESTIMABL2, a multicentre randomised phase 3 trial in patients with low-risk differentiated thyroid cancer (ie, pT1am or pT1b, N0 [no evidence of regional nodal involvement] or Nx [involvement of regional lymph nodes that cannot be assessed in the absence of neck dissection]), showed the non-inferiority of a follow-up strategy without radioactive iodine (131I) administration compared with a postoperative 131I administration at 3 years post-randomisation. Here, we report a pre-specified analysis after 5 years of follow-up. Methods Patients treated with total thyroidectomy with or without prophylactic neck lymph node dissection, without postoperative suspicious findings on neck ultrasonography, were randomly assigned to the no-radioiodine group or to the radioiodine group (11 GBq-30 mCi after recombinant human thyrotropin-stimulating hormone). Follow-up consisted of annual thyroglobulin and thyroglobulin antibody determinations during levothyroxine treatment and neck ultrasonography in odd-numbered years. An event was defined as abnormal foci of 131I uptake on the post-treatment whole-body-scan requiring subsequent treatment, abnormal neck ultrasonography, elevated thyroglobulin levels, increasing titres or appearance of thyroglobulin antibody (using the same laboratory assay), or a combination of these definitions. Non-inferiority of the proportion of patients without an event in one group compared with the other at 5 years after randomisation was shown if this proportion and its CI did not differ by more than -5%. This study was registered on ClinicalTrials.gov (NCT01837745) and is completed. Findings Of the 776 patients (n=642 [827%] female and n=134 [173%] male, median age 529 years [IQR 426-631]) enrolled, 698 were evaluable at 5 years. The proportions of patients without events were 932% in the no-radioiodine group and 948% in the radioiodine group, for a difference of -16% (90% CI -45 to 14). Events consisted of structural or functional abnormalities (n=11) and biological abnormalities (n=31). Interpretation The non-inferiority of a follow-up strategy compared with postoperative 131I administration in low risk differentiated thyroid cancer was confirmed at 5 years. There is no loss of opportunity in following these patients without postoperative ablation. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

OBJECTIVE:To assess the prevalence of pancreatic lesions in patients hospitalized for newly diagnosed or uncontrolled diabetes mellitus and identify potential predictive factors for pancreatic pathology. METHODS:We conducted a retrospective, single-center observational study at Brest University Hospital between February 2016 and February 2022. Adult patients hospitalized for newly diagnosed diabetes or uncontrolled diabetes mellitus who underwent a computed tomography (CT) scan within six months of admission were included. Patients with type 1 diabetes, prior pancreatectomy, or a known history of pancreatic adenocarcinoma were excluded. Clinical, biological, and imaging data were analyzed. RESULTS:Among 412 patients analyzed, 53 (12.9 %) presented pancreatic abnormalities (PA), including 11 cases (2.7 %) of malignant pancreatic lesion. Predictive factors for PA (P < 0.05) included (odds ratio [95 % confidence interval]): age ≥ 65 years (2.00 [1.52;5.27]); body mass index ≤ 26.4 kg/m2 (2.65 [1.1;4.98]); LDL/HDL ratio ≤ 3.0 (4.75 [2.03;11.10]); and presence of at least one clinical warning sign (alcoholic use, steatorrhea, abdominal pain) (2.29 [1.21;4.33]). Using all four criteria together, 68 of 412 CT scans would have been avoided, with no missed cases. CONCLUSIONS:The prevalence of pancreatic lesions in patients hospitalized for diabetes-related glycemic imbalance was significant although malignancy remained low. Age ≥ 65 years, low body mass index, and altered lipid profile may help identify patients requiring pancreatic imaging. Future prospective studies should refine these criteria to develop screening strategies for early pancreatic cancer detection in high-risk selected diabetic populations.

ImportanceWhether F18-choline (FCH) positron emission tomographic (PET)/computed tomographic (CT) scan can replace Tc99m-sestaMIBI (MIBI) single-photon emission (SPE)CT/CT as a first-line imaging technique for preoperative localization of parathyroid adenomas (PTA) in patients with primary hyperparathyroidism (PHPT) is unclear.ObjectiveTo compare first-line FCH PET/CT vs MIBI SPECT/CT for optimal care in patients with PHPT needing parathyroidectomy and to compare the proportions of patients in whom the first-line imaging method resulted in successful minimally invasive parathyroidectomy (MIP) and normalization of calcemia 1 month after surgery.Design, Setting, and ParticipantsA French multicenter randomized open diagnostic intervention phase 3 trial was conducted. Patients were enrolled from November 2019 to May 2022 and participated up to 6 months after surgery. The study included adults with PHPT and an indication for surgical treatment. Patients with previous parathyroid surgery or multiple endocrine neoplasia type 1 (MEN1) were ineligible.InterventionsPatients were assigned in a 1:1 ratio to receive first-line FCH PET/CT (FCH1) or MIBI SPECT/CT (MIBI1). In the event of negative or inconclusive first-line imaging, they received second-line FCH PET/CT (FCH2) after MIBI1 or MIBI SPECT/CT (MIBI2) after FCH1. All patients underwent surgery under general anesthesia within 12 weeks following the last imaging. Clinical and biologic (serum calcemia and parathyroid hormone levels) assessments were performed 1 and 6 months after surgery.Main Outcomes and MeasuresThe primary outcome was a true-positive first-line imaging-guided MIP combined with uncorrected serum calcium levels of 2.55 mmol/l or less 1 month after surgery, corresponding to the local upper limit of normality.ResultsOverall, 57 patients received FCH1 (n = 29) or MIBI1 (n = 28). The mean (SD) age of patients was 62.8 (12.5) years with 15 male (26%) and 42 female (74%) patients. Baseline patient characteristics were similar between groups. Normocalcemia at 1 month after positive first-line imaging-guided MIP was observed in 23 of 27 patients (85%) in the FCH1 group and 14 of 25 patients (56%) in the MIBI1 group. Sensitivity was 82% (95% CI, 62%-93%) and 63% (95% CI, 42%-80%) for FCH1 and MIBI1, respectively. Follow-up at 6 months with biochemical measures was available in 43 patients, confirming that all patients with normocalcemia at 1 month after surgery still had it at 6 months. No adverse events related to imaging and 4 adverse events related to surgery were reported.ConclusionsThis randomized clinical trial found that first-line FCH PET/CT is a suitable and safe replacement for MIBI SPECT/CT. FCH PET/CT leads more patients with PHPT to correct imaging-guided MIP and normocalcemia than MIBI SPECT/CT thanks to its superior sensitivity.Trial RegistrationClinicalTrials.gov Identifier: NCT04040946

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background: Anaplastic thyroid carcinoma (ATC) is a rare and frequently fatal type of thyroid cancer. The degree of heterogeneity in survival rates for ATC is incompletely studied. This study evaluated the factors associated with overall survival (OS) of patients with ATC using multicenter real-world data from a national tertiary care center network in France. Methods: In this multicenter, retrospective cohort study, all patients with ATC diagnosed between 2010 and 2020 were identified from the national database of the French ENDOCAN-TUTHYREF network. Factors associated with OS were examined in multivariable analyses using Cox proportional hazards models. Results: The study included 360 patients. Of these, 220 (61%) were female and the median age was 72 years (interquartile range: 62-80). The percentages of patients with pure and mixed (synchronously-transformed) ATC (p-ATC and st-ATC) were 62.5% and 26.7%, respectively. The median OS was 6.8 months [confidence interval, CI: 5.5-8.1]: not reached for stage IVa, 11.4 months [8.2-17.8] for IVb, and 4.6 months [3.5-5.7] for IVc. Surgery, radiation therapy to the neck, chemotherapy, and best supportive care were administered to 69 (19.2%), 214 (59.4%), 254 (70.6%), and 66 (18.3%) patients, respectively. In a multivariable analysis, including stage IVb-IVc patients, significantly higher OS was observed in patients with Eastern Cooperative Oncology Group performance-status of 0-1 (hazard ratio [HR], 0.6; [CI, 0.4-0.9], p < 0.02), stage IVb [HR, 0.5; CI, 0.4-0.8, p < 0.001], and multimodal treatment (surgery and chemoradiotherapy) [HR, 0.07; CI, 0.04-0.1, p < 0.001]. Variables associated with significantly worse OS included: p-ATC (vs. st-ATC) [HR, 1.83; CI, 1.33-2.51, p = 0.001] and a neutrophil-to-lymphocyte ratio (NLR) >5.05 [HR, 2.05, CI, 1.39-3.05, p < 0.001]. Conclusions: Factors independently associated with improved OS in ATC included: European Cooperative Oncology Group performance status, disease stage, multimodality treatment, synchronously transformed ATC, and lower NLR. Long-term OS was observed in selected patients with ATC who underwent multimodal treatment.

OBJECTIVE:Hypothyroidism is the most common complication of hemithyroidectomy for thyroid nodules. This retrospective cohort study investigated the prognostic factors for hypothyroidism following hemithyroidectomy. METHODS:We included patients who underwent hemithyroidectomy between 2016 and 2017, excluding those with history of preoperative hypothyroidism or malignancy on histopathological examination. The primary endpoint was development of hypothyroidism during follow-up (TSH≥2 above normal). RESULTS:Twenty-six of the 128 included patients (20%) developed postoperative hypothyroidism. The following independent prognostic factors were found: preoperative TSH level>1.5 mIU/L (OR 2.11; P=0.013), and remaining thyroid volume adjusted for body surface area<4.0mL/m2 (OR 1.77; P=0.015). Twenty-one patients (81%) had first TSH values above the upper limit of normal. Postoperatively, first TSH level correlated significantly with the preoperative value (R=0.5779, P<0.001). Levothyroxine was prescribed to 16% of patients, with a mean dose of 0.92μg/kg/day. CONCLUSION:Patients with TSH>1.5 mIU/or remaining thyroid volume adjusted for body surface area<4.0mL/m2 should have intensified clinical and biological follow-up in the first year after surgery.

Abstract Disclosure: E. Quak: None. A. Lasne-cardon: None. M. Cavarec: None. B. Lireux: None. V. Bastit: None. N. Roudaut: None. P. Salaun: None. N. Keromnes: None. G. Potard: None. P. Vaduva: None. A. Esvant: None. F. Jegoux: None. O. Crouy-chanel: None. A. Devillers: None. C. Guery: None. C. Lasnon: None. R. Ciappuccini: None. M. Sali dauda: None. B. Legrand: None. A. Estienne: None. J. Grellard: None. S. Bardet: None. B. Clarisse: None. Introduction: Whether F18-choline PET/CT (FCH PET/CT) should replace Tc99m-sestaMIBI SPECT/CT (MIBI SPECT/CT) as a first-line imaging technique for preoperative localisation of parathyroid adenomas in primary hyperparathyroidism (pHPT) is unclear. Methods: We conducted a multicentre randomized open diagnostic intervention phase III trial in adults with primary hyperparathyroidism and indication for surgical treatment. Patients were assigned in a 1:1 ratio to receive first-line FCH PET/CT (FCH1) or MIBI SPECT/CT (MIBI1). In case of negative or inconclusive first-line imaging, patients received second-line FCH PET/CT (FCH2) after MIBI1 or MIBI SPECT/CT (MIBI2) after FCH1. The main aim of the trial was to compare the proportions of patients in whom the first-line imaging method resulted in successful mini-invasive parathyroidectomy (MIP) and cure, defined as the normalisation of serum calcium and parathyroid hormone levels at 1 month. We hypothesized a 30% superiority of FCH1 over MIBI1 for sample size determination (Quak et al, BMC Endocr Disord. 2021, PMID: 33413316). Results: From 11/2019 to 05/2022, 58 patients were assigned to receive FCH1 (n=30) or MIBI1 (n=28). Baseline patient characteristics were similar between groups. FCH1 was positive in 23/29 patients and led to successful MIP and cure in 22/23 patients. MIBI1 was positive in 18/28 and led to MIP in 16/17 operated patients, and video-assisted thoracoscopy (VATS) in 1/17 patient. Cure was obtained in 15/17 patients. The proportion of patients in whom the first-line imaging exam led to successful MIP and cure was 22 (76%) for FCH1 and 13 (50%) for MIBI1 (p=0.047). Diagnostic performances were superior for FCH1 than for MIBI1: sensitivity (92% vs 68%), specificity (100% vs 75%), positive predictive value (100% vs 94%), negative predictive value (67% vs 30%), and area under the ROC curve (96% vs 71%, p=0.022), respectively. Ten patients received FCH2 and 6 patients received MIBI2. FCH2 was positive in 8/10 patients, leading to 7/9 MIP and 2/9 bilateral cervical explorations (surgery recused in 1 patient), and cure in 9/9 patients. MIBI2 was positive in 2/6 patients, leading to 1 MIP and 1 VATS; all 6 patients were cured. No adverse events related to imaging and 4 adverse events related to surgery were reported. Conclusions: The proportion of patients who underwent correct imaging-guided MIP leading to cure was higher for FCH1 than for MIBI1, 76% vs 50% respectively. Diagnostic performances were better for FCH1 than for MIBI1. Cost-benefit analyses should elucidate whether first-line FCH PET/CT in pHPT management is justified. Presentation: Friday, June 16, 2023

Objective: To investigate the glycemic balance before, during and after the 2016 Paris Marathon using a real-time continuous glucose monitoring (RT-CGM) system in patients with type 1 diabetes mellitus in a prospective single-center observational study. Methods: Inclusion criteria were as follows: type 1 diabetes mellitus; age >= 18 years; HbA1c < 9%. Participants performed two 2h-preparatory races (PR) before the Marathon and were monitored with RT-CGM 24h before, during and 72h after each race. Hypoglycemic events were prevented via carbohydrate intake / insulin dose adjustments. The primary outcome was area under the curve (AUC) < 70 and > 200 mg/dl and percentage of time spent in euglycemia, hypoglycemia, and hyperglycemia during the races. Results: Twelve patients (2F/10M; median HbA1c=6.8%) were included and completed the study. Median AUC < 70 and time spent in hypoglycemia (< 70 mg/dl) during the PRs and Marathon were equal to 0. However, no hypoglycemic episodes occurred during Marathon, while two patients experienced hypoglycemia during PR1 and PR2. There was a significant increase in AUC > 200 mg/dl during races between PR2 and Marathon (P = 0.009) although the median time spent > 200mg/dl was not statistically different in Marathon versus PR2 (48.4% versus 18.4%; P = 0.09). Median time spent in euglycemia (70-200 mg/dl) was lower in Marathon versus PR2 (51.6 versus 58%; P= 0.03). Conclusion: Our study proposes a medical support protocol for extreme endurance physical activity in patients with type 1 diabetes mellitus. Our results suggest that RT-CGM, coupled with adjustments in carbohydrate intake and insulin doses, appears to be effective to prevent hypoglycemia during and after exercise. (C) 2022 Elsevier Masson SAS. All rights reserved.

The objective of this study was to investigate the association between the onset of TD and treatment efficacy in NSCLC patients who initiated anti-PD-1 blockade (Nivolumab®) and to assess the impact of TD severity and subtype on nivolumab efficacy. This study was performed at a referral oncology center between July 20, 2015 and June 30, 2018. Patients with histologically confirmed stage IIIB/IV NSCLC in progression after one or two lines of treatment and who initiated Nivolumab were included. Thyroid function (TSH ± fT4, fT3) was monitored and patients were classified according to TD status [TD(+) versus TD(−)], severity [moderate thyroid dysfunction: TSH level between 0.1 and 0.4 or 4.0 and 10 mIU/L and severe thyroid dysfunction: TSH ≤ 0.1 or ≥ 10mUI/L) and subtype (isolated hypothyroidism, isolated hyperthyroidism and hyperthyroidism then hypothyroidism)]. Clinical endpoints were overall survival (OS) and progression-free survival (PFS). Among 194 eligible patients, 134 patients (median age, 63 yo; 70.1% male) were included. Forty (29.9%) patients were classified in TD(+) and had a longer OS of 29.8 months (95% CI 18.8-NR) versus 8.1 months (95% CI 5.5–11.5) in TD(−) group (p < 0.001). PFS was also longer (8.7 months (95% CI 5.3–15.1) in TD(+) versus 1.7 months (95% CI 1.6–1.9) in TD(−) group (p < 0.001). In Cox proportional hazards analysis, TD remained an independent predictive factor of OS/PFS. Severity and subtype of TD were not correlated with OS/PFS. This study suggested that TD induced by Nivolumab appears to be an independent predictive factor of survival, irrespective of TD severity and subtype.

Abstract Background: The benefits of post-operative radioactive iodine (RAI) administration have not been demonstrated in patients with low risk differentiated thyroid cancer (DTC). The objective of this randomized phase III trial is to assess in low risk DTC patients the non-inferiority of a follow-up strategy as compared to a systematic adjuvant post-operative RAI administration. Methods: ESTIMABL2 is a French multicentric randomized phase III trial in patients with low-risk DTC treated with total thyroidectomy with or without prophylactic neck lymph node dissection (pT1am N0 or Nx with a sum of the diameters of tumor lesions ≥ 10mm, pT1b N0 or Nx). Two to five months after surgery, in the absence of suspicious lateral neck lymph node on ultrasonography (US), patients were randomized either to the follow-up group (FU, no RAI administration) or to the ablation group and received post-operative RAI (1.1 GBq following rhTSH stimulation). Yearly controls under levothyroxine treatment consisted in thyroglobulin (Tg) and Tg antibodies (TgAb) determinations and neck-US. The primary objective was to assess at 3 years after randomization the non-inferiority of the proportion of patients without tumor-related event in the FU group as compared to the ablation group. Non-inferiority is demonstrated if the rate of patients without event at 3 years does not differ by more than ΔL=-5%. A tumor-related event was defined by the occurrence of subsequent treatment (RAI administration or surgery) for abnormal RAI uptake on the post-therapeutic WBS or by elevated Tg or TgAb levels and/or abnormal neck US during controls. Tg levels on levothyroxine treatment were considered elevated if > 2ng/mL in the FU group and > 1ng/mL in the ablation group. TgAb were considered elevated if > the upper limit range with an increase above 50% on 2 consecutive determinations performed 6 months apart. Results: 776 low-risk DTC patients were included between 2013 and 2017 in 35 French centers within the TUTHYREF network; 83% females, mean age: 52 years, papillary TC: 96%, pT1bNx: 43.6%, pT1bN0: 37.5%, pT1amNx: 12.6%, pT1amN0: 6.3%. Among the 729 patients evaluable at 3 years after randomization, tumor-related events occurred in 18/367 patients (4.9% IC95%=[2.9; 7.6]) in the FU group and in 15/362 patients (4.1% IC95%=[2.3; 6.7]) in the ablation group. Thus, 95.1% of patients in the FU group had no event at 3 years and this percentage is not inferior from the 95.9% of patients observed in the ablation group (difference = -0.8% [95% CI:-3.3%; 1.8%]. The number of subsequent surgery and/or RAI administration was 6 (1.6% IC95%=[0.6; 3.5]) in the FU group and 9 (2.5% IC95%=[1.1; 4.7]) in the ablation group. Conclusion: this phase III trial demonstrates the non-inferiority of a follow-up strategy compared to a systematic adjuvant post-operative administration of RAI (1.1GBq following rhTSH) in low risk DTC patients (PHRC 2012; NCT01837745).

Anaplastic thyroid cancer (ATC) is a rare lethal disease. Lenvatinib is an off-label therapeutic option for ATC in most countries, except in Japan. The aim of this multicenter retrospective survey was to analyze the efficacy and the toxicity profile of off-label lenvatinib treatment in all adults advanced ATC patients, in France. Of the 23 patients analysed (14 males; mean age 64 years), 15 were pure ATC and 8 were mixed tumors (i.e. with a differentiated or poorly differentiated component). Prior treatments included neck external beam irradiation in 74%, at least one line of chemotherapy in 22 cases, two lines of chemotherapy in 11 patients, other TKI in 4 cases. A central RECIST assessment was performed. Since lenvatinib initiation, median PFS was 2.7 months (95% CI; 1.9-3.5) and median OS was 3.1 months (95% CI; 0.6-5.5). OS was significantly longer in case of mixed tumors compared with pure ATC (6.3 vs 2.7 months, P = 0.026). Best tumor response was partial response in two cases and stable disease in seven. Clinical improvement was achieved in seven patients. Lethal adverse events occurred in three patients, consisting in haemoptysis in two cases and pneumothorax in one case. Among long-surviving ATC patients (>6 months), four underwent biopsy of distant metastasis, revealing poorly differentiated histology; three of them had initial mixed ATC histology. Efficacy of lenvatinib appears limited, although pure vs mixed ATC disclose differences in disease aggressiveness and treatment response. Long-surviving ATC patients might benefit from biopsy of persistent disease, searching for histological transition or molecular target.

Objective: To evaluate the diagnostic value of FDG PET-CT metabolic parameters and Deauville-like 5 point-scale to predict malignancy in a population of patients presenting focal thyroid incidentaloma (fTI). Design: This retrospective study included 41 fTI, classified according to cytological and histological data as benign (BL) or malignant lesion (ML). FDG PET-CT semi-quantitative parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG), tumor to liver SUVmean ratio (TLRmax and TLRmean), tumor to blood-pool SUVmean ratio (TBRmax and TBRmean) were calculated. Each fTI was also classified on a Deauville-like 5-point scale (DS) currently used in lymphoma. Comparison between BL and ML was performed for each parameter and a ROC analysis was conducted. Results: All quantitative PET metabolic parameters (SUV parameters, volume based parameters and SUV ratio) were higher in ML compared with BL, yet no significant difference was reported. fTI (uptake) malignancy rate according to DS grades 2, 3, 4, and 5 was, respectively, 25% (1 of 4), 28.6% (2 of 7), 8.3% (1 of 12), and 33.3% (6 of 18) with no significant difference between ML and BL groups. Results of ROC analysis showed that mean TBR had the highest AUC in our cohort (0.66 95%CI [0.41; 0.91]) with a cut-off value of 2.2. Specificity of MTV and TLG was 100% (cut-off values: MTV 9.6 ml, TLG 22.9 g) and their sensitivity was 30 and 40%, respectively. Conclusion: Our study did not highlight any FDG PET/CT parameter predictor of fTI malignancy.

BACKGROUND:The objective was to compare glycemic control between preprandial and postprandial bolus administration (15 min before [PRE] or immediately after the meal [POST]) in patients with type 1 diabetes using insulin pump and real-time continuous glucose monitoring.METHODS:Between September 2015 and February 2016, a single-centre, open randomized, 2-way crossover study of patients on bolus insulin aspart administration was conducted during two 14-day periods and according to 2 administration regimen schedules (PRE/POST or POST/PRE). Inclusion criteria were as follows: patients with type 1 diabetes, ≥18 and ≤ 65 years old, treated with insulin aspart using a Medtronic® insulin pump and trained on functional insulin therapy. Patients were randomly assigned to either regimen schedule. At the beginning of each period, each patient was provided with a standardized high fat meal. Primary outcome was the area under the curve for interstitial glucose above 140 mg/dL per minute (AUC > 140 mg/dL/min) during each period. Secondary outcomes were time spent in hypo/eu/hyperglycemia, glycemic variability indices, and AUC during 4 hours after high fat meal calculated with continuous glucose monitoring data.RESULTS:Twenty-two patients were included. Mean AUC > 140 mg/dL/min was statistically higher in patients on POST (43.70 mg/dL/min; 95%CI: 34.08 to 53.31) versus PRE insulin aspart regimen (37.24 mg/dL/min 95%CI: 27.63 to 46.85) (P = 0.03). Mean interstitial glycemia and glycemic variability indices were also increased (P < 0.05) on POST regimen. The mean AUC 4 hours after the high fat meal was higher on POST regimen but not statistically different (P = 0.06).CONCLUSIONS:In our study, postprandial administration of insulin aspart appears to mildly increase glycemic excursion and glycemic variability.

Objective: To evaluate the malignancy rate of focal thyroid incidentaloma (fTI) in a population of patients undergoing a 18F-fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET–CT) for a non-thyroid purpose. Design: We conducted a prospective cohort study from January 2013 to November 2014. All consecutive patients referred for a FDG PET–CT were prospectively screened. Patients with known neoplastic thyroid disease were excluded from the analysis. All patients presenting one or more fTI and who accepted to benefit from a complementary thyroid ultrasonography (US) were included and managed according to the French endocrine society consensus. Prevalence of fTI in our population and malignancy rate was assessed. Results: During the inclusion period, 10,171 patients were referred for a FDG PET–CT in our center. Fifty-three patients presenting a known thyroid disease were excluded. Among the remaining 10,118 patients, 127 (1.3%) with 131 fTI were individualized. US could not be performed in 37 patients. The remaining 90 patients (92 fTI) were explored by US ± fine-needle aspiration biopsy (FNAB). US results demonstrated a nodule aspect in 80 cases of which 60 benefited from FNAB. Nineteen of 92 fTI underwent surgery with 10 malignant lesions among the 60 patients performing both US and FNAB. Conclusion: The prevalence of fTI discovered on FDG PET–CT in our population was 1.3% with 10 malignant lesions among the 60 patients performing both US and FNAB.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

This is a case report study of a young man with Congenital Adrenal Hyperplasia (CAH) who has been treated during 2 years by a subcutaneous continuous infusion hydrocortisone (SCIH) to optimize his treatment. Hydrocortisone was delivered via an insulin infusion device. We also studied the evolution of testicular adrenal rest tumors (TARTs) and the quality of life through SF36 survey. Four rates were determined, with a total of 47 mg per day. Biochemical parameters were normalized at 2 months. The SF36 questionnaire showed a progress of well-being. The weight decreased to 106 kg, that is, −5 kg (height: 1.71 m). Unfortunatly, there was no change of the TARTs. Two episodes of dermohypodermitis, with abscess at the infusion site, were observed. This case demonstrates the feasibility of prolonged SCIH therapy in patients with CAH, reporting positive effects on quality of life and on BMI.