HepatoADrenal syndrome
Say WHAT?!
⌚️It's #tweetorial o'clock
Be prepared to:
1⃣Define adrenal insufficiency of critical illness
2⃣never look @ a lipid panel the same
3⃣respect how sick ppl w/#cirrhosis get
#MedTwitter #meded #livertwitter
1/
Say WHAT?!
⌚️It's #tweetorial o'clock
Be prepared to:
1⃣Define adrenal insufficiency of critical illness
2⃣never look @ a lipid panel the same
3⃣respect how sick ppl w/#cirrhosis get
#MedTwitter #meded #livertwitter
1/
First, what is AI (adrenal insufficiency)?
1⃣Critical illness can make the HPA axis😢
Fig1
⬇️Cortisol release
⬇️ACTH response
⬇️Tissue response to cort
2⃣Definition
Fig2-3
➡️Random cort <10➡️AI!
➡️Random cort >9➡️ACTH stim
➡️Cort⬆️<9➡️AI!
2/
1⃣Critical illness can make the HPA axis😢
Fig1
⬇️Cortisol release
⬇️ACTH response
⬇️Tissue response to cort
2⃣Definition
Fig2-3
➡️Random cort <10➡️AI!
➡️Random cort >9➡️ACTH stim
➡️Cort⬆️<9➡️AI!
2/
Second: adrenal insufficiency(AI) is real, common & matters
1⃣Fig1:People who die from sepsis have:
⬆️baseline cort
⬇️ACTH response
2⃣Fig2:This time: correlation is causation
➡️norepi🚫work in AI
➡️give steroids, norepi work
3⃣Fig2: steroids (may) help for AI
3/
1⃣Fig1:People who die from sepsis have:
⬆️baseline cort
⬇️ACTH response
2⃣Fig2:This time: correlation is causation
➡️norepi🚫work in AI
➡️give steroids, norepi work
3⃣Fig2: steroids (may) help for AI
3/
Adrenal insufficiency(AI) in #cirrhosis
1⃣1/3 stable outpatients have some AI
2⃣>1/2 noncritical decompensated inpatients
➡️Risk⬆️Sepsis,HRS,death
3⃣AI⬆️risk of death as much as ACLF
4⃣Super common in ICU
➡️⬆️mortality
Associated with low cholesterol...WHAT?
4/
1⃣1/3 stable outpatients have some AI
2⃣>1/2 noncritical decompensated inpatients
➡️Risk⬆️Sepsis,HRS,death
3⃣AI⬆️risk of death as much as ACLF
4⃣Super common in ICU
➡️⬆️mortality
Associated 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 test
⭐️Associated (caused by?) with low cholesterol
⭐️Deadly
⭐️Think of it like an ACLF organ failure
8/
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
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