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j.jcjd.2017.08.009

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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.
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