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Introduction Parathyroid crisis is a characterized by severe hypercalcemia associated with multiple organ dysfunction. Case 90 years-old Caucasian man was hospitalized for progressive confusion over 3 days and was noted to have a critically elevated serum calcium (S Ca) 16.8 mg/dl (8.6-10.0) with albumin 4.1 mg/dl. Patient had a good functional status prior to the hospitalization. On further evaluation, patient was diagnosed with primary hyperparathyroidism with a high suspicion for parathyroid cancer, with labs showing a markedly elevated PTH 1183 pg/ml (15-65) and ionized Ca >1.85 mmol/L (1.15-1.35). Of note, S Ca was normal at 9.5 mg/dl (no albumin) approximately 20 months prior to the hospitalization. Parathyroid ultrasound showed a 1.8×1.7×1.1 cm left superior parathyroid mass with ill-defined margins. Sestamibi scan confirmed a left superior parathyroid mass. CT neck/chest/abdomen/pelvis with contrast showed a 1.8×1.1×1.9 cm left superior parathyroid mass with enhancement and punctate non-obstructing right kidney stones. Hypercalcemia responded extremely well to medical management (calcitonin, 4 mg of zoledronic acid infusion and 13 days of cinacalcet 30 mg daily) resulting in normalization of S Ca. However, patient required a prolonged hospitalization for aspiration pneumonia and severe electrolyte disturbances. Since patient was not a good surgical candidate and hypercalcemia resolved on medical management, patient was discharged to a rehab facility with the plan to pursue parathyroidectomy as outpatient. S Ca worsened progressively and was 10.4 mg/dl (albumin 3.6 mg/dl) with PTH 130 pg/ml on day 15 after discharge. Cinacalcet was added when hypercalcemia further worsened to 11.7 mg/dl (albumin 3.6 mg/dl) on day 38. However, patient was hospitalized again for altered mental status, recurrent severe hypercalcemia (S Ca 15.7 mg/dl, albumin 3.8 mg/dl, PTH 1299 pg/ml), hypokalemia and urinary tract infection. In the ED, patient developed complete heart block that responded to atropine. Interestingly, hypercalcemia was recalcitrant to aggressive medical management during this hospitalization (zoledronic acid 4 mg infusion, calcitonin IM- increased up to 6 mg IM q6hr, cinacalcet- increased to 60 mg PO BID and IV fluid resuscitation with furosemide as needed). S Ca was 14.2 mg/dl (albumin 3.4 mg/dl) on day 8 of hospitalization. Therefore, urgent left superior parathyroidectomy was performed. Surgical pathology revealed a 3.1 gm parathyroid adenoma. Post-operative day#1 labs showed normal PTH 17.3 pg/ml, S Ca 12.1 mg/dl and albumin 3.2 mg/dl. S Ca and patient's mental status normalized over next few days. Discussion Urgent parathyroidectomy has shown to have excellent outcomes in patients with parathyroid crisis. Our patient's severe hypercalcemia initially responded excellently to medical management but recurred within few weeks and developed resistance to medical management. Our case highlights the importance of performing surgical exploration as soon as possible after initial medical stabilization in patients with parathyroid crisis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Aim Previous evidence suggests that some fields of cognitive function are man dominated while others are woman dominated. Recent research has additionally associated sexual orientation with cognitive function. However, data on the effect of sexual orientation on various cognitive subdomains are limited. We aim to explore the variability in a range of cognitive subdomains (working memory, language, attention, processing speed, and executive functioning) by cis-gender hetero versus homo sexual orientation. Methods We combined NHANES 2011–2012 and NHANES 2013–2014 datasets to study the individuals (60-69 years old) with both sexual health and cognitive assessment data. We analyzed the data to assess the performance of heterosexual and homosexual men and women on various cognitive function assessments. We used 1) word learning and recall modules from the Consortium to Establish a Registry for Alzheimer's disease (CERAD) to examine new verbal learning, immediate and delayed memory; 2) the Animal Fluency test (AFT) to evaluate verbal sematic fluency and 3) the Digital Symbol Substitution test (DSST) to assess attention and processing speed. Mentally impaired individuals or participants who were unable to understand or read English, Spanish, Korean, Vietnamese, traditional or simplified Mandarin, or Cantonese were not asked questions regarding sexual orientation and hence, were excluded from final analysis. Simple Linear regression models were used to quantify the association of sexual orientation and cognitive function. Statistical significant was specified at P < 0.05. Results Our study population consists of 61 homosexual adults (39 men and 22 women) and 3087 heterosexual adults (1486 men and 1601 women). Comparison of heterosexual men and women demonstrated differences typically found between the genders, with heterosexual women performing significantly better on all cognitive function assessments. Homosexual men scored significantly higher than heterosexual men on all cognitive function assessments and performed in the direction of heterosexual women in all cognitive domains. In fact, mean scores for homosexual men were even higher than for heterosexual women in the four of the six cognitive domains tested (CERAD 2 and delayed recall, AFT and DSST). Homosexual women did not differ from heterosexual women and homosexual men on any of the measures of cognitive performance. Therefore, as expected, homosexual women scored higher points than heterosexual men on most cognitive assessments (CERAD 1,3 and delayed recall, and DSST). Conclusion Homosexual men were gender-atypical and performed in the direction of heterosexual women in cognitive domains related to working memory, language, attention, processing speed, and executive functioning. Homosexual women were sex-typical with cognitive skills similar to heterosexual women. These findings underscore the need for further studies to understand the association of sexual orientation with cognitive functioning. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.