Krisnin

Clinical lecturer Author Acute Illness Management; Clinical Assessment Dedicated 2 advancement of clinical practice! #FOAMed #TweetAnatomy respect 4all always!

[Krisnin @ChrisMulryan]

@AddisonsUK can be #life threatening if it is not recognised & treated quickly

Good news: lifesaving treatment is quick & effective 💉

#TweetAnatomy on #InternationalAddisonsDay MCQs about this condition 4 @WeParamedics @WeNurses @RCNStudents #StNProject answers later! @cpdme

[Krisnin @ChrisMulryan]

My toothache has made me realise how often I say pro inflammatory cytokines.

[Krisnin @ChrisMulryan]

@lizfoulis @StNurseProject @RCNStudents @WeStudentNurse

[Royal College of Physicians @RCPhysicians]

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[Krisnin @ChrisMulryan]

@dianelewis6039 @dianelewis6039 your amazing and you celebrate those who need to be celebrate #NHS

[Krisnin @ChrisMulryan]

That tweet from @dianelewis6039 always raises my spirits. A person I only know in #Twitter but a person respect!

[Krisnin @ChrisMulryan]

@dianelewis6039 @dianelewis6039 am looking forward to my northeast invitation when we cull COVID. We are all going to be stronger together.

[Krisnin @ChrisMulryan]

I had to explain this a few times in the last few weeks. Here is my summary.

Tried to keep my twitter as a #covid free zone but this just needed #Clarification #Immunology

[Krisnin @ChrisMulryan]

@PH11LWR @jasaunders90 So we can be that specific about antibodies and not antigen baffles me,

[Krisnin @ChrisMulryan]

@smayman @StNurseProject Thank you if you fancy a bit of adult colouring this weekend to help with #anatomy & #Physiology knowledge then you could try this out.

https://t.co/pBVKDSKGKR

[Jeremy Heit, MD, PhD @JeremyHeitMDPHD]

Hi everyone - I've had a number of requests to share this figure from my talk today, so here you all go! #ASNR2020 @stanfordneuroi1

[Krisnin @ChrisMulryan]

@Pituitary_org 🥇 Elevated ACTH is correct 🥇

The lack of cortisol present in the blood stimulates increased secretion of ACTH to try and return cortisol levels to normal.

Negative feedback from cortisol terminates this

#TweetAnatomy on #InternationalAddisonsDay

[Krisnin @ChrisMulryan]

Q10: In primary adrenocortical insufficiency what effect will be seen on the #ACTH levels in the blood?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine @Pituitary_org

[Krisnin @ChrisMulryan]

@WeMedSts @AddisonsUK An Insidious onset means Primary Chronic is ✅

Pro-opiomelanocortin is a precursor of both ACTH & melanocyte-stimulating hormone (MSH)

When a feedback loop stimulates for ACTH, secretion of pro-opiomelanocortin leads to stimulation of melanocytes increasing the pigmentation

[Krisnin @ChrisMulryan]

Q9: Hyperpigmentation of the skin is associated with which one of the following adrenocortical conditions?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine @WeMedSts @AddisonsUK

[Krisnin @ChrisMulryan]

In secondary adrenocortical insufficiency, the cortex is healthy: the problem is it fails to receive ACTH stimulus from pituitary.

Aldosterone secretion by the adrenal is triggered by RAA System which is independent of the pituitary so no Na+ Deficiency

#TweetAnatomy

[Krisnin @ChrisMulryan]

Q8: In secondary adrenocortical insufficiency the blood sodium level will most likely be?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine #PhysicianAssociate #MedEd

[Krisnin @ChrisMulryan]

@WeMedSts @AddisonsUK Waterhouse-Friderichsen-Syndrome is rapid failure of the adrenals as a result of bleeding into the cortex

Bacterial infection a major trigger. Neisseria Meningitidis is most synonyms

Can be another virulent organism – DIC – Sepsis.

#TweetAnatomy on #InternationalAddisonsDay

[Krisnin @ChrisMulryan]

Q7: Waterhouse-Friderichsen-Syndrome is traditionally associated with which one of the following conditions?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine @WeMedSts @AddisonsUK 👀

[Krisnin @ChrisMulryan]

@WeNurses @AddisonsUK After successful treatment with Hydrocortisone reassess the person and be prepared to give a further dose of hydrocortisone at 6⃣ hours 🕕.

Don’t wait for specific endocrine advice if not immediately available, maintain stability: don’t allow a re-crisis 🚨🚨

#TweetAnatomy

[Krisnin @ChrisMulryan]

Q6: After initial treatment for an Addisonian crisis with haemodynamic instability. When should a second dose of treatment be given if required? 💉🤮

#TweetAnatomy on #InternationalAddisonsDay #Endocrine @WeNurses @AddisonsUK

[Krisnin @ChrisMulryan]

@WeParamedics @AddisonsUK Perfect:

Hydrocortisone is the mainstay of treatment for ‘Addisonian Crisis’ give by injection to have a rapid onset & avoid being vomited back.

Fluid may also be needed to maintain BP but don’t delay hydrocortisone: IM to save time.

#TweetAnatomy on #InternationalAddisonsDay

[Krisnin @ChrisMulryan]

Q5: When suspected an adrenal (Addisonian) crisis should be treated with which one of the following as a priority?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine #MedEd @WeParamedics @AddisonsUK

[Krisnin @ChrisMulryan]

@AddisonsUK @UHL_ClinEd 🥇That Right🏆:

📢 It’s the lack of ACTH that causes secondary adrenocortical insufficiency.

📣This said: Pituitary adenoma, Sarcoidosis & Haemorrhage into / infarction of the pituitary gland can all result in a lack of ACTH Secretion

#TweetAnatomy on #InternationalAddisonsDay

[Krisnin @ChrisMulryan]

Q4: Secondary adrenocortical insufficiency is caused by which one of the following?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine #AdvancedPractice @AddisonsUK @UHL_ClinEd

[Krisnin @ChrisMulryan]

@AddisonsUK @StNurseProject 🥉Not Quite:

The adrenal cortex like many organs in the body has a lot of redundancy built into it. Clinical signs & symptoms don’t usually present until 90% of the function has been impaired.

#TweetAnatomy on #InternationalAddisonsDay #Endocrine

[Krisnin @ChrisMulryan]

Q3: In chronic primary adrenocortical insufficiency approximately how much of the cortical function must be impaired before the condition becomes clinically evident?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine #PhysicianAssociate @AddisonsUK @StNurseProject

[Krisnin @ChrisMulryan]

@AddisonsUK @WeStudentNurse 🥇Spot On:

All are potential causes of primary adrenocortical insufficiency. Thomas Addison first described TB as a cause.

Autoimmunity is now 'the most common' cause in the developed world.

#TweetAnatomy on #InternationalAddisonsDay #Endocrine

[Krisnin @ChrisMulryan]

@AddisonsUK can be #life threatening if it is not recognised & treated quickly

Good news: lifesaving treatment is quick & effective 💉

#TweetAnatomy on #InternationalAddisonsDay MCQs about this condition 4 @WeParamedics @WeNurses @RCNStudents #StNProject answers later! @cpdme

[Krisnin @ChrisMulryan]

Q2: Which one of the following is the most common cause of primary adrenocortical insufficiency (Addison’s Disease) in the developed world?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine #AdvancedPractice @AddisonsUK @WeStudentNurse

[Krisnin @ChrisMulryan]

🥈Sorry Not Quite:

Adrenocortical insufficiency causes a lack of all hormones that are secreted by the adrenal cortex.

While cortisol is the best recognised in #Addisons disease there is also deficiency of androgens & aldosterone.

#TweetAnatomy on #InternationalAddisonsDay

[Krisnin @ChrisMulryan]

Q1: Primary adrenocortical insufficiency is associated with a deficiency of which one of the following hormones?

#TweetAnatomy on #InternationalAddisonsDay #Endocrine @WeStudentNurse