Discover and read the best of Twitter Threads about #endocrinology
Most recents (18)
Interesting to see anti #obesity and #diabetes #medication management from the perspective of PharmDs
I'm always pro-collaborative care!
Here are some learning points and fact checks:
#AACE2023 #endocrine #endocrinology #pharmacology
1/
I'm always pro-collaborative care!
Here are some learning points and fact checks:
#AACE2023 #endocrine #endocrinology #pharmacology
1/
- "Tirzepatide is a dual agonist"
👉It ↑GIP activity but GLP-1R agonism is less than that of endogenous GLP-1
- "Hypoglycemia is not a concern if you're not on insulin"
👉Risk of hypoglycemia ~1.4% vs. 0.2% in placebo in SURMOUNT-1
nejm.org/doi/full/10.10…
2/
👉It ↑GIP activity but GLP-1R agonism is less than that of endogenous GLP-1
- "Hypoglycemia is not a concern if you're not on insulin"
👉Risk of hypoglycemia ~1.4% vs. 0.2% in placebo in SURMOUNT-1
nejm.org/doi/full/10.10…
2/
- "In this pt with uncontrolled #diabetes, A1c 7.4, we decreased glargine by 10% [when we started tirzepatide]"
👉 Not sure where the evidence is here, but the SURPASS-5 trial protocol reduced basal by 20% in participants with baseline A1c<8
jamanetwork.com/journals/jama/…
3/
👉 Not sure where the evidence is here, but the SURPASS-5 trial protocol reduced basal by 20% in participants with baseline A1c<8
jamanetwork.com/journals/jama/…
3/
I usually tweet about #obesity but since I recently had a pt with type 2 #diabetes go from 100 units/d insulin to 0 with tirzepatide, this is a good time to review #insulin management when you start a GLP1 / GIP
#endocrine #endocrinology #research #clinicians
1/
#endocrine #endocrinology #research #clinicians
1/
SURPASS-5: tirzepatide + basal insulin vs. placebo
Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study
Result: At end of study, insulin was ⬇️11% for 15-mg tirzepatide group vs. ⬆️75% for placebo
jamanetwork.com/journals/jama/…
2/
Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study
Result: At end of study, insulin was ⬇️11% for 15-mg tirzepatide group vs. ⬆️75% for placebo
jamanetwork.com/journals/jama/…
2/
SUSTAIN-5: semaglutide 1.0 + basal insulin vs. placebo
Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study
Result: At end of study, insulin ⬇️15% for 1-mg semaglutide group vs. ⬇️4% for placebo
academic.oup.com/jcem/article/1…
3/
Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study
Result: At end of study, insulin ⬇️15% for 1-mg semaglutide group vs. ⬇️4% for placebo
academic.oup.com/jcem/article/1…
3/
An 80-YO ♂️ diabetes, ischaemic heart disease, & end stage kidney disease requiring haemodialysis:
a radio-opaque nodule in X-ray.
1/2
#radiology #Emergency #healthcare
thelancet.com/article/S0140-…
a radio-opaque nodule in X-ray.
1/2
#radiology #Emergency #healthcare
thelancet.com/article/S0140-…
Continuous glucose monitoring device causes consternation on chest x-ray
2/2
#endocrinology #medicine
doi.org/10.1016/S0140-…
thelancet.com/article/S0140-…
2/2
#endocrinology #medicine
doi.org/10.1016/S0140-…
thelancet.com/article/S0140-…
The radio-opaque object had a complex internal
structure consisting of a microchip, a battery, and an
electronic circuit.
The subcutaneous continuous glucose monitoring
transmitter device had been displaced from deltoid muscle to the patient’s back.
#MedicalStudents
structure consisting of a microchip, a battery, and an
electronic circuit.
The subcutaneous continuous glucose monitoring
transmitter device had been displaced from deltoid muscle to the patient’s back.
#MedicalStudents
T3 testing is not routinely needed in managing patients with primary #hypothyroidism
1. Primary hypothyroidism is a common hormonal disorder, which is treated with levo-thyroxine (T4) replacement.
#MedTwitter #endocrinology
1. Primary hypothyroidism is a common hormonal disorder, which is treated with levo-thyroxine (T4) replacement.
#MedTwitter #endocrinology
2. In order to assess the adequacy of T4 dose, some clinicians routinely order #T3 along with #T4 and #TSH (thyroid stimulating hormone). Is routine T3 testing really needed in cases of primary hypothyroidism?
3. Clinician would be able to determine the adequacy or over-replacement of levo-thyroxine (T4) dose on the basis of T4 and TSH levels.
*In cases of over-replacement, T4 will be elevated and TSH suppressed.
*In cases of adequate dosing of T4, TSH and T4 levels would be normal.
*In cases of over-replacement, T4 will be elevated and TSH suppressed.
*In cases of adequate dosing of T4, TSH and T4 levels would be normal.
How do we diagnose Cushing's? We have 3 screening tests:
1. 24-hour Urinary Free cortisol
2. dexamethasone suppression test
3. Late night salivary cortisol
Late night salivary cortisol is THE BEST first test for Cushing's. Let's explore why the other two have their problems:
1. 24-hour Urinary Free cortisol
2. dexamethasone suppression test
3. Late night salivary cortisol
Late night salivary cortisol is THE BEST first test for Cushing's. Let's explore why the other two have their problems:
When can't we trust the dexamethasone suppression test?
1⃣.changes in Cortisol Binding Globulin (CBG)
⏫ CBG- increased estrogen (pregnancy, oral contraceptives, hormone replacement therapy), SERM
⏬ CBG- cirrhosis, nephrotic syndrome, critical illness
1⃣.changes in Cortisol Binding Globulin (CBG)
⏫ CBG- increased estrogen (pregnancy, oral contraceptives, hormone replacement therapy), SERM
⏬ CBG- cirrhosis, nephrotic syndrome, critical illness
When can't we trust the dex suppression test?
2⃣ changes to dex metabolism
⏫ dex metabolism (CYP3A4 inducer)- anti seizure meds, pioglitazone, alcohol
⏬ dex metabolism- antidepressants (fluoxetine), diltiazem, cimetidine
ALWAYS measure a morning dex level with the cortisol!
2⃣ changes to dex metabolism
⏫ dex metabolism (CYP3A4 inducer)- anti seizure meds, pioglitazone, alcohol
⏬ dex metabolism- antidepressants (fluoxetine), diltiazem, cimetidine
ALWAYS measure a morning dex level with the cortisol!
Empagliflozin is now my go-to SGLT2i for pts with #diabetes and #CKD or #CHF, over cana or dapa or ertu.
Why?
A: EMPA-KIDNEY: nejm.org/doi/full/10.10…
and EMPEROR-Reduced and EMPEROR-Preserved
1/
Why?
A: EMPA-KIDNEY: nejm.org/doi/full/10.10…
and EMPEROR-Reduced and EMPEROR-Preserved
1/
EMPA-KIDNEY is unique because it enrolled GFR 20-45 *without* proteinuria whereas others (DAPA CKD, CANVAS) enrolled pts with CKD+proteinuria, though DAPA-CKD conducted a subgroup analysis for UACR < and > 1000
The primary outcome was a composite of progression of #kidney disease (defined as #ESRD, a sustained decrease in eGFR to <10, a sustained decrease in eGFR of ≥40% from baseline, or death
from #renal causes) or death from #cardiovascular causes
from #renal causes) or death from #cardiovascular causes
1) Welcome to a new #accredited (0.75h CE/#CME) #tweetorial on challenging case presentations for pts with #cardiometabolic disease, #CaReMe #FOAMed.
Our expert author is Claire Davies. @claireyrivs is a specialist diabetes & endocrinology #pharmacist working in Gateshead in 🇬🇧.
Our expert author is Claire Davies. @claireyrivs is a specialist diabetes & endocrinology #pharmacist working in Gateshead in 🇬🇧.
2) She is a member of UKCPA Diabetes & Endocrinology committee @UKCPADiabetes & works across #diabetes, #endocrinology, & emergency/acute care in Secondary Care. She is currently involved in development of regional guidelines & education to support medicines optimisation for PLWD
3a) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company.
1/Feeling lucky? Or feeling evidence based?
A #tweetorial about how to read a #pituitary #MRI using data and know if there’s cavernous sinus invasion w/the Knosp score.
#medtwitter #FOAMed #radres #neurorad #FOAMrad #neurosurgery #medicalstudent #meded #USMLE #endocrinology
A #tweetorial about how to read a #pituitary #MRI using data and know if there’s cavernous sinus invasion w/the Knosp score.
#medtwitter #FOAMed #radres #neurorad #FOAMrad #neurosurgery #medicalstudent #meded #USMLE #endocrinology
2/The hardest part of a pituitary MRI is deciding if there is cavernous sinus invasion. It makes sense that the more lateral a tumor goes on MRI, the more likely it has invaded the sinus—bc it is going the direction of the sinus. But how far is far enough?
3/This is important bc each time a radiologist makes a call on imaging, they make a bet & they are betting their credibility. And unlike other bets, there is only 1 wager—all in! So it is important to not call it when you might be wrong, bc overcalls destroy credibility.
Welcome everyone to our 2nd Pediatric on Squares Board Review Course
We are starting today until the coming 8 days
Hope it’ll be helpful and enjoyable course
✏️ Note that you still can join and register on the course with accessibility to all recorded session until 27th of August
We are starting today until the coming 8 days
Hope it’ll be helpful and enjoyable course
✏️ Note that you still can join and register on the course with accessibility to all recorded session until 27th of August
Day 1
2nd session: Keys to Answer MCQs
3rd session: Neonatology review
By: Prof. Abdulrahman Alnemari @aalnemri
#Pediatric #Neonatology #NICU #MCQ
2nd session: Keys to Answer MCQs
3rd session: Neonatology review
By: Prof. Abdulrahman Alnemari @aalnemri
#Pediatric #Neonatology #NICU #MCQ
1/n) ICMR released Standard Treatment Workflows (STWs) volume 3 which contains 11 specialties with 52 diseases. It is accessible at stw.icmr.org.in/stws and on the Mobile App.
@MoHFW_INDIA @DeptHealthRes #STW
@MoHFW_INDIA @DeptHealthRes #STW
2/n) Standard Treatment Workflows (STWs) on #𝐃𝐞𝐫𝐦𝐚𝐭𝐨𝐥𝐨𝐠𝐲 containing 14 major diseases. It is accessible at stw.icmr.org.in/stws and on the Mobile App. @MoHFW_INDIA @DeptHealthRes
3/n) Standard Treatment Workflows (STWs) on #Endocrinology containing 06 major diseases. It is accessible at stw.icmr.org.in/stws and on the Mobile App. @MoHFW_INDIA @AyushmanNHA @WHOSEARO #diabetes
I'll be adding short important points which would hopefully help in remembering certain concepts during #PLAB preparation, to this thread🧵every now and then as I take them out from my scattered notes. Feel free to comment your tips and tricks which would help others, as well 👇
Please don't take any of these as medical advice 😂🙏. Real life stuff is much more nuanced. These are just clinchers for the sake of the exam.
#PLAB
#PLAB
1. Drug contraindications...
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
#PLAB
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
#PLAB
Niveles elevados de glucosa en sangre (hiperglucemia) en pacientes con #COVID19
Abro 🧵👇🏼
1/15
#SARSCoV2 #Diabetes #Glucose
Abro 🧵👇🏼
1/15
#SARSCoV2 #Diabetes #Glucose
Primero algunos (4) conceptos:
1️⃣ Insulina
Es una pequeña proteína producida por el páncreas. Le indica a nuestras células que deben absorber la glucosa que les llega a través del torrente sanguíneo
2/15
#Insulin #pancreas #metabolism
1️⃣ Insulina
Es una pequeña proteína producida por el páncreas. Le indica a nuestras células que deben absorber la glucosa que les llega a través del torrente sanguíneo
2/15
#Insulin #pancreas #metabolism
2️⃣Adiponectina
La adiponectina es una hormona producida por las células que almacenan la grasa (adipocitos), tiene dos funciones principales: hacer que las células sean más sensibles ante la insulina, y...
3/15
#FatTissue #Endocrinology #Hormones
La adiponectina es una hormona producida por las células que almacenan la grasa (adipocitos), tiene dos funciones principales: hacer que las células sean más sensibles ante la insulina, y...
3/15
#FatTissue #Endocrinology #Hormones
100 years ago, #insulin was discovered—today, it is inaccessible for millions.
The Lancet journals reflect on this life-saving treatment and the "golden opportunity to improve access to insulin and #diabetes care" the centenary represents: hubs.li/H0Rp3p40 #Insulin100⬇️
The Lancet journals reflect on this life-saving treatment and the "golden opportunity to improve access to insulin and #diabetes care" the centenary represents: hubs.li/H0Rp3p40 #Insulin100⬇️
The discovery of insulin ranks among the leading triumphs of medical research, with effects on #endocrinology, #medicine, and society that reverberate 100 years later.
Track "the birth of an idea" in @TheLancetEndo, by Robert Hegele and Grant Maltman: hubs.li/H0Rbx1D0
Track "the birth of an idea" in @TheLancetEndo, by Robert Hegele and Grant Maltman: hubs.li/H0Rbx1D0
Although insulin has changed the lives of countless people with #diabetes, writes David Beran et al, the time for celebration has not yet arrived due to the absence of concrete action on #insulin access.
Read the Comment in @TheLancetEndo: hubs.li/H0QMPY00 #Insulin100
Read the Comment in @TheLancetEndo: hubs.li/H0QMPY00 #Insulin100
#Endocrinology #Endotwitter @RpratleyMD @ethanjweiss @parthaskar @SaifiTaban @AlbalawiZaina @drkevinfernando @drricardocorrea @CMichaelGibson @cpcannon @Sonia_ButaliaMD @mmamas1973 @SABOURETCardio FOLLOW us here for accredited programs at the speed of Twitter!
1) Welcome to a tweetorial on #insulinhesitancy in contemporary #T2D management. This serialized program is accredited for 0.5h by @academiccme: #physicians, #nurses, #pharmacists! I am @AliceYYCheng . . .
. . . and this educational activity is intended for healthcare providers and is supported by grants from AstraZeneca, Bayer, Chiesi, and NovoNordisk.
Every speciality who is on (or wants to be) the ‘Mucor’ team- how many are willing to admit a patient with Mucor under their care and manage (even after surgical debridement). How many were admitting before and will admit after the pandemic? (1/n)#Mucormycosis #COVID19India
Some hypothetical consultations in the emergency before and after the pandemic:
#ENT : We will operate and transfer back
#Ophthalmology : Call us during the Surgey, we will coordinate with ENT in the OT, if needed
#Neurology : Continue Amphotericin (2/n)
#ENT : We will operate and transfer back
#Ophthalmology : Call us during the Surgey, we will coordinate with ENT in the OT, if needed
#Neurology : Continue Amphotericin (2/n)
#Endocrinology : Send us a consultation after admission under primary, we will control sugars
#Neurosurgery :No active neurosurgical intervention required
#Nephrology :We will do renal modification of Amphotericin
#Medicine/ #Infectiousdisease Admit under any of the above
#Neurosurgery :No active neurosurgical intervention required
#Nephrology :We will do renal modification of Amphotericin
#Medicine/ #Infectiousdisease Admit under any of the above
This week we are going to cover some #Endocrinology topics for #medstudenttwitter.
Going to start with some fundamentals to get us going as grasping these basics really makes interpretation much easier!
Going to start with some fundamentals to get us going as grasping these basics really makes interpretation much easier!
Endocrinology is about communication! 📞📢
Hormones are messengers that travel around the body to act in distant organs and tissues.
There are 2 main types of hormones. Knowing a little about this helps predict hormone behaviour:
Hormones are messengers that travel around the body to act in distant organs and tissues.
There are 2 main types of hormones. Knowing a little about this helps predict hormone behaviour:
STEROIDS🔶 – cortisol, aldosterone, sex hormones. Vit d and thyroid hormones are included in this group as they behave similarly.
Water insoluble - circulate on binding proteins, have long t1/2
Diffuse across lipid membrane to act via NUCLEAR receptors ➡️ SLOW effect on genes
Water insoluble - circulate on binding proteins, have long t1/2
Diffuse across lipid membrane to act via NUCLEAR receptors ➡️ SLOW effect on genes
Strange cause for #cirrhosis
Maybe very #rare #MedEd
53yrs man, voice change, recurrent headaches, male breast enlargement. Stops socialising. Has bleed one day, #endoscopy varices, #biopsy fatty liver cirrhosis
No metabolic syndrome.
MRI Brain done. #livertwitter #radio
1/3
Maybe very #rare #MedEd
53yrs man, voice change, recurrent headaches, male breast enlargement. Stops socialising. Has bleed one day, #endoscopy varices, #biopsy fatty liver cirrhosis
No metabolic syndrome.
MRI Brain done. #livertwitter #radio
1/3
What is the diagnosis?
In patients with cirrhosis, always try to find the cause in those who present early. There is no idiopathic, no cryptogenic. Its all 'missed' cirrhosis.
2/3 #liverpath
#MedTwitter #pathology #radiology #MRI #brain #Neurology #Endocrinology #NeuroTwitter
In patients with cirrhosis, always try to find the cause in those who present early. There is no idiopathic, no cryptogenic. Its all 'missed' cirrhosis.
2/3 #liverpath
#MedTwitter #pathology #radiology #MRI #brain #Neurology #Endocrinology #NeuroTwitter
#diagnosis: #fatty liver related cirrhosis due to #pituatory macro adenoma with high prolactin, high GH, low #thyroid function. #clinical examination, acromegaly features with central obesity. #Examine 1st, then investigate. #MedicalStudent #medicine #MedStudentTwitter
3/3
3/3
Treatment w/SGLT-2, what can & can’t the wonder drugs do 🤷🏻♀️
✅⤵️plasma&interstitial💦
✅⤵️❤️filling pressures&LV remodeling
✅⤴️♥️energy by ⤴️ ketogenesis👉🏻 shift♥️fuel from glucose👉🏻 ketones
✅⤴️erythropoietin👉🏻⤴️RBC ➕⤴️HCT👉🏻⤴️♥️02💨delivery
🛑SGLT-2 do NOT 👇🏻read below👇🏻🛑
✅⤵️plasma&interstitial💦
✅⤵️❤️filling pressures&LV remodeling
✅⤴️♥️energy by ⤴️ ketogenesis👉🏻 shift♥️fuel from glucose👉🏻 ketones
✅⤴️erythropoietin👉🏻⤴️RBC ➕⤴️HCT👉🏻⤴️♥️02💨delivery
🛑SGLT-2 do NOT 👇🏻read below👇🏻🛑
In pts WITHOUT hyperglycemia
⤴️diuresis does not occur👉🏻effects on renal volume excretion is dependent on the threshold of glucose in the nephron
📖DAPA-HF trial👉🏻NO ❌ reduction in diuretic req w/ ➕ of dapaglizflozin
✅ 15% ⤵️in BNP👉🏻LOWER effect size compared w/loops alone
⤴️diuresis does not occur👉🏻effects on renal volume excretion is dependent on the threshold of glucose in the nephron
📖DAPA-HF trial👉🏻NO ❌ reduction in diuretic req w/ ➕ of dapaglizflozin
✅ 15% ⤵️in BNP👉🏻LOWER effect size compared w/loops alone
