Can J Diabetes 41 (2017) S2–S16 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: w w w. c a n a d i a n j o u r n a l o f d i a b e t e s . c o m Abstracts ORAL PRESENTATIONS ABSTRACTS 1 Postoperative Recurrences in Patients Operated for Pheochromocytomas and Paragangliomas: New Data Supporting Lifelong Surveillance JESSICA CHBAT*, NADIA GAGNON, ISABELLE BOURDEAU, JESSICA MORAMARCO, ANDRE LACROIX, HAROLD OLNEY Montreal, QC Background: Pheochromocytoma (PHEO) and paragangliomas (PGL) (PPGL) may recur after initial surgery and the long-term postoperative management is unclear. Recent guidelines suggested screening for recurrence with yearly metanephrines for 10 years and lifelong in high risk patients (young, genetic disease, large tumors and/or PGL). In addition, very recent data suggest that recurrence rate is lower than previously estimated and mainly occur within the ﬁrst ﬁve years of follow-up. Objective: To evaluate the characteristics and delay of recurrent PPGL in our center. Methods: We retrospectively analysed characteristics of patients with PPGL who had recurrent disease between 1994 and 2017. We collected data on clinical presentation, imaging, functional status, genetic testing, treatment and outcomes of patients with recurrent disease. Results: Our cohort included 29 patients. The mean age at diagnosis was 45.9 and 54.5 at recurrence. Thirteen patients had PHEO and 16 had PGL. The mean delay of recurrence was 7.8 years, with 13 patients (44.8%) recurring before 5 years of follow-up, 10 (34, 5%) between 5–10 years, 4 (13,8%) between 10–15 years and 2 at 21 (PGL) and 48 (PHE) years of follow up respectively. Nine of the 14 patients (64,3%) genetically tested had an identiﬁable germline mutation. Four patients with PHEO had initial tumors size of less than 5 cm. Conclusion: In our cohort, postoperative recurrence of apparently benign PPGL occurred after more than 10 years of follow up in 20,7% of cases, supporting that patients operated for PPGL should have a lifelong follow-up surveillance. 2 Parity and Lactation Are Not Associated with BMD Loss or Incident Major Fragility Fractures Over 15 Years: Canadian Multicentre Osteoporosis Study (CaMos) SANDRA COOKE-HUBLEY*, GAO ZHIWEI, GERALD MUGFORD, STEPHANIE M. KAISER, DAVID GOLTZMAN, WILLIAM D. LESLIEK, SHAWN DAVISON, JERILYNN C. PRIOR, CHRISTOPHER S. KOVACS St. John’s, NL Background: Pregnancy and especially lactation cause loss of bone mass and microarchitecture that may not be completely restored. Although cross-sectional studies in older women have reported that parity and lactation are neutral or protective against fragility fractures, longitudinal data are lacking. CaMos is a randomly selected cohort of >6000 women who have been followed for up to 15 years, with annual, veriﬁed incident fractures, and 5-yearly bone density assessments. Objective: To determine whether parity or lactation is related to BMD loss or incident major fragility fractures. Methods: All women who completed the 15 years of follow-up were included (n=3437). In step-wise multivariate analyses, a dose-response effect of lactation on fragility fractures or BMD change (baseline to 10 years) was assessed by analyzing three groups: breastfed ≤1 month, breastfed 2–6 months, and breastfed >6 months. Parity was assessed as a continuous variable in separate analyses. Results: Increasing parity and breastfeeding duration had no relationship with incident major fragility fractures (total of 79 clinical spine, 33 hip, 188 forearm, 77 shoulder), or spine/hip/neck BMD, after controlling for 20 covariates (including age, menopausal status, vitamin D intake, estrogen use, prior fracture). Strengths include the random cohort, duration, and capturing of incident fractures. Limitations include the self-reporting of recalled breastfeeding duration. Conclusion: Parity and lactation have no long-term association with fragility fracture risk or BMD change in older women. 3 Grade 1 Vertebral Height Loss is Not Associated with Decreased Quality of Life TAYYAB S. KHAN, GEORGE IOANNIDIS, ALEXANDRA PAPAIOANNOU, COURTNEY KENNEDY, CLAUDIE BERGER, BRIAN LENTLE, JACQUES BROWN, CHRISTOPHER S. KOVACS, DAVID HANLEY, JERRILYNN PRIOR, DAVID GOLTZMAN, STEPHANIE KAISER, SUZANNE MORIN, WILLIAM LESLIE, SHAWN DAVISON Milton, ON Radiographic vertebral fractures are classiﬁed into grade I (20– 25%), grade II (25–40%), and grade III (≥40%) vertebral height loss. While grades >2 are counted to predict fracture risk, grade 1 is typically discounted. The relationship between grade 1 height loss and quality of life (QoL) has not been assessed longitudinally. Data from the Canadian Multicentre Osteoporosis (CaMOS) study were used to determine the association between grade 1 height loss and changes in QoL assessed using the physical (PCS) and mental component summaries (MCS) of SF-36 questionnaire over ﬁve years, after adjusting for covariates. We included 1450 males and 3770 females, mean age was 65.4 years, and mean PCS and MCS scores were 47.0 and 53.9, respectively. At baseline, 4450 (85.3%) had no vertebral height loss, 394 (7.6%) had grade 1, 243 (4.7%) had grade 2, and 133 (2.6%) had grade 3 height loss. Multivariable linear regression analysis identiﬁed no statistically signiﬁcant association between grade 1 vertebral height loss 1499-2671 The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. https://doi.org/10.1016/j.jcjd.2017.08.010 Abstracts / Can J Diabetes 41 (2017) S2–S16 at baseline and changes in PCS or MCS, or between grades 2 or 3 and changes in MCS with or without adjustment for covariates over 5 years. Grades 2 and 3 were associated with a signiﬁcant decrease in PCS over 5 years without, but not with, adjustment for confounders. Grade 1 vertebral height loss was not associated with decreased QoL over ﬁve years. Further studies are needed to assess their utility as markers of bone fragility. 4 An Overview of the Etiology, Clinical Manifestations, Management Strategies and Complications of Hypoparathyroidism from the Canadian National Hypoparathyroidism Registry (CNHR) ALIYA KHAN, RAFIK EL-WERFALLI, ADAM WALDBILLING, NAMRAH SIRAJ, TAYYAB KHAN, REEMA SHAH, ZUBIN PUNTHAKEE, ADAM MILLAR, MANOELA BRAGA, JEM YOUNG Oakville, ON The CNHR was formed in 2014 and enrolment of prevalent and incident cases began following approval by McMaster University ERB. Objectives: Identify the etiology and presenting symptoms of patients with hypoparathyroidism as well as the current treatment practice in Canada. The complications of hypoparathyroidism were also evaluated. Material and Methods: 95 patients with chronic hypoparathyroidism aged >18 years registered in the CNHR were evaluated. We reviewed etiology, clinical presentation, biochemical proﬁle, management strategies, markers of skeletal health, bone mineral density (BMD), fracture risk and complications including nephrolithiasis/nephrocalcinosis, and basal ganglia calciﬁcation. Results: Most patients (66/95) had postsurgical hypoparathyroidism, followed by idiopathic/autoimmune disease (26/95) and pseudohypoparathyroidism (3/95). The mean age of onset was 41.1years, with mean duration of follow upof 2.4 years. Almost all patients were taking calcium supplements (91.6%); calcitriol was taken by 86.3% and 3 patients were receiving parathyroid hormone. Nephrolithiasis or nephrocalcinosis were present in 26.1% of treated patients despite a mean calcium phosphate product <4.4 mmol2/L2 Basal Ganglia calciﬁcation was present in 7 of the 23 patients reviewed Hospitalization was required in 37 of the 95 patients for symptoms of hypocalcemia. Conclusion: 1. Hypoparathyroidism is associated with a signiﬁcant disease burden and leads to hospitalization in a large number of patients. 2. Renal complications were present in 26.6% of treated patients despite maintenance of a calcium phosphate product in the desired range (<4.4 mmol2/L2). The ideal calcium phosphate product needs to be reconsidered. 3. Fracture risk was low in the absence of traditional osteoporosis risk factors. 5 The Man without LDL: Solving the Genetic Conundrum Underlying a Profoundly Abetalipoproteinemic Phenotype Using Next-Generation Sequencing LINDA R. WANG, ADAM I. MCINTYRE, ROBERT A. HEGELE London, ON Abetalipoproteinemia (ABL) is a rare autosomal recessive disorder in the MTTP (microsomal triglyceride transfer protein) gene, characterized by absence of apolipoprotein B (apoB)-containing lipoproteins including LDL, VLDL, and chylomicrons. Patients present in infancy with fat malabsorption and develop severe sequalae of lipid-soluble vitamin deﬁciency including retinal degeneration, S3 ataxia, and coagulopathy. Peripheral acanthocytosis is pathognomonic. Familial hypobetalipoproteinemia (FHBL) is an autosomal codominant disorder affecting the APOB gene. FHBL homozygotes are virtually indistinguishable from ABL patients, but heterozygotes beneﬁt from half-normal levels of LDL and cardiovascular protection. We describe a 41-year-old male patient with longstanding abetalipoproteinemic phenotype who was generally healthy and responded to empiric therapy. He had acanthocytosis and a remote history of malabsorption, but was free of retinopathy, coagulopathy, myopathy and neuropathy. Contrary to expectations, DNA sequencing revealed neither ABL nor homozygous FHBL; rather, he had numerous rare heterozygous deleterious mutations involving several relevant genes, including both MTTP and APOB. By sequencing his available family members and correlating their phenotypes, we deduced that the most likely causal mutations are consistent with compound heterozygous FHBL—an extraordinarily rare entity only described once in medical literature. We review the literature on ABL and FHBL, and summarize their genetic inheritance, biochemistry, clinical manifestations, diagnosis, and treatment. We present the implications of our case on the candidate mutations for FHBL, the strengths and weaknesses of in silico predictive software compared to clinical data, and the importance of early treatment on clinical outcome. 6 Bullying and Poverty are Associated with Increased Risk of Childhood Overweight and Obesity LAETITIA GUILLEMETTE*, ALLISON FEELY, JONATHAN MCGAVOCK Winnipeg, MB Purpose: Obesity is a complex condition, but most interventions focus on diet and exercise and neglect socioeconomic factors. We examined whether social and economic factors are associated with obesity risk among adolescents. Methods: We assessed the association between exposure to certain adverse childhood events (poverty deﬁned as household income in the lowest quintile of equivalised income; bullying in the past 12 months) and obesity risk within a population-based prospective cohort of 6973 randomly sampled Irish youth studied at 9 and 13 years of age. We also studied the impact of psychosocial factors: self-esteem (Piers Harris questionnaire) and behavioural diﬃculties (Strengths and Diﬃculties Questionnaire) as predictors of overweight and obesity at 13 years. Results: Poverty, behavioural diﬃculties, and low self-esteem at age 9 years were more common among youth with overweight and obesity at 13 years. Bullying (1.26, 95% conﬁdence interval [CI] 1.03– 1.53) and higher household income (0.84, 95%CI 0.74–0.91) at 9 years predicted incident overweight and obesity at 13 years in mutually adjusted models further adjusted for gender, self-esteem, and behavioural diﬃculties. Alternatively, bullying (0.74, 95%CI 0.65– 0.84) and more behavioural diﬃculties (0.98, 95%CI 0.97–0.99) predicted the chances of maintaining a healthy weight after the same adjustments. Conclusion: Adolescents who developed overweight and obesity between 9 and 13 years experienced a greater social and economic burden than their peers. Prevention programs for childhood overweight and obesity may need to consider these risk factors to be more effective.