Citations

Context: Testosterone is a steroid hormone produced primarily in the testes in men and ovaries in women, playing crucial roles in androgenic, anabolic, and psychological functions, including muscle growth, bone formation, erythropoiesis, risk-taking, and aggression, making it important for athletes. Sports performance is linked closely to testosterone level, prompting athletes to explore legal and illegal ways to boost testosterone. This review examines testosterone physiology and legal strategies for optimizing testosterone levels in athletes, as well as their practical applications. Evidence Acquisition: Database search. Study Design: Narrative review. Level of Evidence: Level 5. Results: Maintaining healthy testosterone levels requires energy balance and optimal nutrition with adequate macronutrients and micronutrients, especially for athletes prone to dieting and food restriction. Testosterone boosters are marketed widely but lack strong evidence for efficacy and may pose risks. While some substances show promise, further research is needed. Sleep is critical as testosterone secretion is linked to the rapid eye movement phase, highlighting the need for proper sleep hygiene and addressing sleep disorders. Moderate-to-high intensity free-weight resistance exercises are most effective for increasing testosterone, while the effects of sexual activity remain unclear. Endocrine-disrupting chemicals can lower testosterone levels and should be avoided. While cold-water immersion may decrease testosterone, sauna bathing appears to be neutral. Radiofrequency electromagnetic radiation from modern electronic devices may harm the hypothalamic-pituitary-gonadal axis, warranting limited use. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, may decrease testosterone levels, suggesting cautious use. Seasonal changes in testosterone levels require further study. Testosterone-optimizing strategies excluding banned substances may aid in treating functional low testosterone or reducing harm in anabolic-androgenic steroid users. Conclusion: Educating athletes on safe and effective strategies to increase testosterone is crucial, with ongoing research needed to explore additional methods. Strength-of-Recommendation Taxonomy: B.

Abstract Disclosure: P.L. castellanos: None. S.E. Meek: None. A.M. Chindris: None. V.J. Bernet: None. Approximately 250 cases of papillary thyroid cancer (PTC) within a thyroglossal duct cyst (TGDC) have been reported worldwide. The presence of PTC within a TGDC is rare representing less than 1 % of all TGDC cases. This report describes the case of a young male with PTC in a TGDC suspicious nodules. We present this case along with a review of the literature related to this very uncommon finding. Papillary thyroid carcinoma is a very rare disease but always should be considered when speaking of a mass at the level of the central neck. There is a considerable controversy regarding the role of thyroidectomy to treat thyroglossal duct cyst carcinoma since the treatment of choice is Sistrunk procedure and the only indications to make a thyroidectomy will be aggressive disease and more than 45 years old according to some articles but without any consensus now. With a cure rate of 95 % and recurrence rate of 3 -10 % when this cancer is treated by Sistrunk operation, it doesn’t seem necessary to do an extent surgery if there is not enough thyroid compromised. Long term follow up is necessary to exclude the development of thyroid cancer. Presentation Date: Saturday, June 17, 2023

Introduction: Nearly half of the adult population in the United States has been diagnosed with hypertension. Adrenal hormonal hypersecretion is a leading cause of secondary hypertension. Adrenal vein sampling (AVS) may assist in differentiating between unilateral and bilateral adrenal hormonal hypersecretion to identify patients who are candidates for adrenalectomy. We reviewed the use of AVS at our institution along with associated outcomes after adrenalectomy. Materials and Methods: A retrospective chart review was conducted of patients with a diagnosis of primary hyperaldosteronism (PA) or adrenocorticotropic hormone-independent Cushing syndrome (AICS) and who underwent adrenalectomy between January 1, 2010, and December 1, 2021. Patient data of baseline characteristics, preoperative workup, including AVS, and postoperative outcomes were collected and analyzed. Results: Seventy-one patients were identified in the study period (48 PA and 23 AICS). Computed tomography scan identified unilateral adrenal nodules in 52 patients (29 left; and 23 right), bilateral nodules in 13 patients, and no nodules in 6 patients. AVS was performed in 45 patients with PA (93%) and 5 patients with AICS (21%). After surgery, the number of PA patients with hypokalemia or requiring potassium supplementation significantly decreased after adrenalectomy (before surgery: 33 [68.7%]; and after surgery: 5 [10.4%], P < .01). The number of medications required for hypertension in AICS patients also significantly decreased. No major adverse events were noted. Conclusions : Our long-term experience demonstrates the ongoing use of AVS during workup of patients with primary hyperaldosteronism and for select patients with adrenocorticotropic hormone-independent Cushing syndrome. However, a low level of discordance between imaging and AVS findings in PA patients suggests that there may be a subset of patients in whom preoperative AVS is not necessary.

Phenylalanine (Phe) kinetics are increasingly used in studies of amino acid kinetics, because the metabolic fate of Phe is limited to incorporation into protein (protein synthesis, Sp) and catabolism via hydroxylation ( Q pt) to tyrosine (Tyr). Besides an infusion of labeled Phe to measure Phe flux ( Q p), a priming dose of Tyr and an independent Tyr tracer are used to measure Tyr flux ( Q t) and Q pt. Alternatively, Q t, Q pt, and Sp can be approximated by using equations, based on Phe and Tyr concentrations in body proteins, that eliminate the need for a Tyr tracer. To evaluate the accuracy of this approach, data were obtained from 12 type I diabetic patients and 24 nondiabetic control subjects who were studied with the full complement of tracers both with and without insulin infusion. Sp approximations closely matched measured values in both groups (mean difference <2%, all values <5%), but the agreement was poor for Q pt (error range = −8 to +43%) and Q t (error range −22 to +41%). Insulin status had no effect on these comparisons. The lower approximation error for Sp vs. Q pt is due to the small contribution (∼10%) of Q pt to Q p. Approximation error for Q pt( r > 0.99) can be explained by variability in the ratio of Tyr to Phe coming from protein breakdown, ( Q t − Q pt)/ Q p. Ideally, all fluxes should be directly measured, but these data suggest that whole body Sp can be approximated with an acceptably small margin of error. However, the same equations do not yield reliably accurate values for Q pt or Q t.

In human protein turnover studies with isotopically labeled leucine (Leu) as a tracer, plasma ketoisocaproate (KIC) enrichment is extensively used as a surrogate measure of intracellular leucine enrichment. To test how accurately arterial ketoisocaproate (A-KIC) represents leucine isotopic enrichment in the hepatic (HV) and femoral veins (FV), which drain liver and muscle beds, we measured Leu and KIC enrichments in samples collected from HV, FV, and femoral artery (A) in 24 control and 6 type I diabetic subjects after a primed, continuous infusion ofl-[1-13C,15N]-Leu. Studies were performed during insulin deprivation or insulin replacement in the diabetic group, whereas the effect of normal saline or three different doses of insulin infusion (0.25, 0.50, and 1 mU ⋅ kg−1⋅ min−1) were assessed in healthy controls. The ratios of baseline isotopic enrichments of A-KIC to HV Leu and FV Leu were 0.93 ± 0.01 and 0.94 ± 0.02, respectively, in normal subjects and 1.07 ± 0.04 and 1.05 ± 0.03, respectively, in diabetic subjects ( P < 0.01, diabetic vs. normal subjects). Insulin did not change A-KIC-to-HV Leu ratios in either group, but the A-KIC-to-FV Leu ratio decreased during insulin infusion in normal subjects ( P < 0.05). In conclusion, A-KIC represents a reliable surrogate measure of HV Leu enrichment at different levels of circulating insulin in humans. The present data support the use of A-KIC as a surrogate precursor pool for hepatic protein synthesis.

Background . Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective . Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting . Retrospective cohort. Outcome Measure . Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results . Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, P = 0.52 ), 12 months (7.3% versus 8.0%, P = 0.081 ), 18 months (7.7% and 7.6%, P = 0.64 ), and at 24 months (7.3% versus 7.8%, P = 0.10 )). Seven TP patients (50%) experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, P = 0.38 ). Limitations . Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion . This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.

Studies were conducted to determine whether regional free fatty acid (FFA) release is differentially regulated by insulin. Systemic, leg, and splanchnic palmitate rate of appearance ([9,10-(3)H]palmitate) was measured in 26 healthy adults using the euglycemic-hyperinsulinemic clamp technique to achieve a physiological range of plasma insulin concentrations. We found that insulin inhibited systemic, leg, and splanchnic palmitate release in a dose-dependent fashion over the range of insulin infused (0-1.0 mU x kg(-1) x min(-1)). Progressive hyperinsulinemia changed the leg from a net producer to a net FFA consumer, whereas the splanchnic bed converted from a net FFA consumer to a net producer. At the 0.5 mU x kg(-1) x min(-1) insulin infusion rate, leg FFA release was almost completely suppressed, whereas even with the 1.0 mU x kg(-1) x min(-1) insulin infusion rate, splanchnic FFA release decreased by only approximately 65% (P &lt; 0.05 leg vs. splanchnic). These results demonstrate the regional heterogeneity of insulin-regulated FFA release in vivo, and indicate that visceral adipose tissue lipolysis is more resistant to insulin suppression than is leg lipolysis in humans.