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HepatoADrenal syndrome
Say WHAT?!
It's #tweetorial o'clock
Be prepared to:
Define adrenal insufficiency of critical illness
never look @ a lipid panel the same
respect how sick ppl w/ #cirrhosis get
#MedTwitter #meded #livertwitter
1/
Say WHAT?!
It's #tweetorial o'clockBe prepared to:
Define adrenal insufficiency of critical illnessnever look @ a lipid panel the samerespect how sick ppl w/ #cirrhosis get#MedTwitter #meded #livertwitter
1/
First, what is AI (adrenal insufficiency)?
Critical illness can make the HPA axis
Fig1
Cortisol release
ACTH response
Tissue response to cort
Definition
Fig2-3
Random cort <10AI!
Random cort >9ACTH stim
Cort
<9AI!
2/
Critical illness can make the HPA axisFig1
Cortisol releaseACTH responseTissue response to cortDefinitionFig2-3
Random cort <10AI! Random cort >9ACTH stim Cort<9AI!2/
Second: adrenal insufficiency(AI) is real, common & matters
Fig1:People who die from sepsis have:
baseline cort
ACTH response
Fig2:This time: correlation is causation
norepi
work in AI
give steroids, norepi work
Fig2: steroids (may) help for AI
3/
Fig1:People who die from sepsis have:baseline cortACTH responseFig2:This time: correlation is causationnorepiwork in AIgive steroids, norepi workFig2: steroids (may) help for AI3/
Adrenal insufficiency(AI) in #cirrhosis
1/3 stable outpatients have some AI
>1/2 noncritical decompensated inpatients
RiskSepsis,HRS,death
AIrisk of death as much as ACLF
Super common in ICU
mortality
Associated with low cholesterol...WHAT?
4/
1/3 stable outpatients have some AI>1/2 noncritical decompensated inpatientsRiskSepsis,HRS,deathAIrisk of death as much as ACLFSuper common in ICUmortalityAssociated with low cholesterol...WHAT?
4/
Let's step back
Where does cortisol come from?
Cholesterol!
Check out this cool 1967 study using radiolabeled cholesterol infusions to prove that it is necessary for cortisol production
5/
Where does cortisol come from?
Cholesterol!
Check out this cool 1967 study using radiolabeled cholesterol infusions to prove that it is necessary for cortisol production
5/
And who makes cholesterol?
The liver! (Fig1)
Fig2: Sick liver, low cholesterol
Fig3: Patients with #cirrhosis & adrenal insufficiency often have HDLs <10!
6/
The liver! (Fig1)
Fig2: Sick liver, low cholesterol
Fig3: Patients with #cirrhosis & adrenal insufficiency often have HDLs <10!
6/
Does treating hepatoADrenal syndrome help?
I dont know!
One trial in @cmaj was stopped for futility
Steroids for adrenal insufficiency critical illness is controversial overall
What do you think? @Jakob_McSparron @PulmCrit @laxswamy @HalliePrescott
7/
I dont know!
One trial in @cmaj was stopped for futility
Steroids for adrenal insufficiency critical illness is controversial overall
What do you think? @Jakob_McSparron @PulmCrit @laxswamy @HalliePrescott
7/
HepatoADrenal syndrome
Common in #Cirrhosis
Cortisol <9 in stim test
Associated (caused by?) with low cholesterol
Deadly
Think of it like an ACLF organ failure
8/
Common in #Cirrhosis Cortisol <9 in stim testAssociated (caused by?) with low cholesterolDeadlyThink of it like an ACLF organ failure8/
This concludes a #tweetorial on hepatoadrenal syndrome
I hope you enjoyed
I remember stumbling upon this concept in medical school. It blew my mind. It is very humbling what #cirrhosis does to a person while teaching us so much about the body.
Fin
I hope you enjoyed
I remember stumbling upon this concept in medical school. It blew my mind. It is very humbling what #cirrhosis does to a person while teaching us so much about the body.
Fin
