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/
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/
![](https://pbs.twimg.com/media/Eb3Ouo3WsAAOclc.jpg)
![](https://pbs.twimg.com/media/Eb3P1zyXQAAqh6d.jpg)
![](https://pbs.twimg.com/media/Eb3QUs1X0AYfVfi.jpg)
![](https://pbs.twimg.com/media/Eb3Q4K-WoAAQxXQ.png)
The liver! (Fig1)
Fig2: Sick liver, low cholesterol
Fig3: Patients with #cirrhosis & adrenal insufficiency often have HDLs <10!
6/
![](https://pbs.twimg.com/media/Eb3VAooXQAAB2HB.jpg)
![](https://pbs.twimg.com/media/Eb3VNmtXkAEO38m.jpg)
![](https://pbs.twimg.com/media/Eb3VkHjXgAArRqu.png)
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/
![](https://pbs.twimg.com/media/Eb3e9ZIX0AAyQ3l.jpg)
⭐️Common in #Cirrhosis
⭐️Cortisol ⬆️<9 in stim test
⭐️Associated (caused by?) with low cholesterol
⭐️Deadly
⭐️Think of it like an ACLF organ failure
8/
![](https://pbs.twimg.com/media/Eb3h3Q8WAAIsYyt.png)
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
![](https://pbs.twimg.com/media/Eb3iIKRXsAEcr_s.png)