Rue

GP, Endocrinology student saving the world a gland at a time!

[Rue @endocrinenerd]

Fun fact: Pregnancy is associated with elevated free and unconjugated cortisol, elevated progesterone and prostaglandin E2 levels. This may result in pregnancy associated asthma remission.
https://t.co/w5eb0XxqHG

[Rue @endocrinenerd]

@advocatemahere Thank you. Tadzifambira nyaya dzacho dze academic injustice. Went down well with my morning coffee @advocatemahere .

[Rue @endocrinenerd]

@TheAtlantic @vauhinivara The idea contaminates the dignity of reasoning itself! Many African academics, journalists, and writers produce exactly that kind of disciplined prose and AI detectors often mislabel it.

[Rue @endocrinenerd]

@Shadaya_Knight wasuma

[Rue @endocrinenerd]

@Staar__Boy @drabdulhameed07 Thank you for mentioning the thyroid gland! Always forgotten in the battle!

[Rue @endocrinenerd]

That concludes this exciting and clinically relevant topic. Any ideas on other topics we could explore?

[Rue @endocrinenerd]

Meta-analysis evidence: Fludrocortisone combined with hydrocortisone in septic shock significantly reduces in-patient, 28-day & 90-day mortality. It is likely due to their combined anti-inflammatory and volume repletion effects.

🚩🚩Statistically significant risk of reinfection!

[Rue @endocrinenerd]

@DrShahira39 Yes treatment of the cancer is paramount, but hypercortisolism may affect the overall prognosis negatively. Great work!

[Rue @endocrinenerd]

Did you know the use of fludrocortisone for postural hypotension is considered "0ff label" in the UK?
RCTs showed an improvement of both supine & upright BPs with fludrocortisone. However, these studies have small sample sizes and did not include a safety assessment of the drug.

[Rue @endocrinenerd]

Let's discuss fludrocortisone, a very potent mineralocorticoid.
It serves as an aldosterone replacement in adrenal insufficiency, maintaining blood pressures through sodium reabsorption, potassium excretion & subsequent volume expansion.

[Rue @endocrinenerd]

Endogenous cortisol in released in a pulsatile circadian rhythm. Synthetic glucocorticoids (which mimic cortisol) sadly are not. This may result in sleep disturbances in patients taking these medications.
Clinicians should watch out for this side-effect!

[Rue @endocrinenerd]

High-dose glucocorticoids are not gentle on the stomach!
They increase gastric acid & pepsin production, reduce the protective gastric mucous & weaken its mucosa.
Co-prescribing with a proton pump inhibitor is a smart protective strategy.

[Rue @endocrinenerd]

Long-term glucocorticoid use can reduce the QoL in elderly patients through osteoporosis & fractures, muscle wasting & atrophy, diabetes, increased cardiovascular disease risk, cataracts & neuropsychiatric conditions. Benefits vs risks of prolonged therapy should be weighed.

[Rue @endocrinenerd]

It is good clinical practice for patients recently on or currently taking glucocorticoids (and glucocortocoid-induced adrenal failure has not been biochemically confirmed ) to be given stress does of glucocorticoids during stress or illness.

[Rue @endocrinenerd]

Supraphysiological glucocorticoid doses can suppress the HPA axis regardless of route of administration. Recovery after cessation depends on duration, potency, and individual susceptibility. Remember: Any route of administration can cause HPA axis suppression!

[Rue @endocrinenerd]

Synthetic corticosteroids exhibit varying mineralocorticoid & glucocorticoid effects. Hydrocortisone demonstrates both in equal measure, making it useful short-term for inflammatory conditions, but long-term use carries a risk of fluid retention.

[Rue @endocrinenerd]

Corticosteroids are a powerful duo. Glucocorticoids (e.g cortisol) regulate metabolism and suppress inflammation whilst mineralocorticoids (e.g aldosterone) maintain electrolyte and fluid balance. Both are essential for the body’s stress response!

[Rue @endocrinenerd]

When in doubt pertaining management of SChyper, always refer for further guidance. Management is usually multi-disciplinary and patient centred.
Now let's dive into another fascinating corner of endocrinology we commonly come across in primary care - corticosteroids!

[Rue @endocrinenerd]

Whom do we treat? This is the tough part!!!
· ≥65yrs with TSH persistently <0.1 mIU regardless of symptoms
· <65yrs with TSH 0.1-0.4 mIU with osteoporosis, cardiovascular diseases or thyrotoxicosis
· Post-menopausal and not on bisphosphonates nor oestrogens

[Rue @endocrinenerd]

@AkhshayaaG Fascinating!