Thread by @AshFWH

Being a mum to minis means I’m usually the retweeter but here goes...

I read the Science article this morning ‘Blood abnormalities found in people with Long Covid’ science.org/content/articl…

I stopped, jolted ajar, at the words ...

‘low levels of cortisol’

🧵 1/13

My vet brain engaged and thought back to my favourite animal medical riddle to solve.

The first time I solved it as a new grad was with the help of a fabulous vet student... we are all equal when it comes to enthusiasm...

🧵 2/13

The second time I solved it I saved the life of a 14 year old Border Collie, Molly, who thanked me by attempting to take a swipe at my hand some weeks later...

There were more. One diagnosis every few years in practice, as overall it’s considered to be low prevalence

3/13

I remember them all because, turns out, it’s near on the best disease to diagnose in Veterinary medicine as it’s well managed with cheap meds

Hypoadrenocorticism.

Addison’s Disease.

It’s at this point I thank my vet hero, mentor & VALE legend of a person, Dr Sue Foster

4/13

Hypoadrenocorticism

‘Naturally occurring primary adrenocortical failure occurs from atrophy or destruction of all 3 adrenal cortical layers, which results in inadequate secretion of both mineralocorticoids and glucocorticoids.’

ncbi.nlm.nih.gov/pmc/articles/P…

🧵 5/13

Hypoadrenocorticism

🐩 Primary

🐕 Immune-mediated destruction of the adrenal cortex

🐕 Infection, neoplasia, amyloidosis, trauma, or coagulopathy

🐕 Autoimmune polyglandular syndrome (more common in humans)

🐕 Atypical

🐕 Iatrogenic

6/13

🐩 Secondary (ACTH deficiency)

🐕 Iatrogenic

🐕 Neoplasia, inflammation

🐩 Tertiary is a thing too apparently

🐩 Isolated aldosterone insufficiency

ncbi.nlm.nih.gov/pmc/articles/P…

🧵 7/13

So... tonight I searched

‘Does Covid affect adrenal glands’ and low and behold... scientists have been doing their thing...

Is there a role for the adrenal glands in long COVID?

nature.com/articles/s4157…

The word that jumps out at me here is ‘subclinical’...

🧵 8/13

So ...

Three likes and four retweets on this is not nearly enough!

We’ve all got the hormones!

Let’s welcome

@NatureRevEndo to the Covid Roundtable.

Btw... One Health

#covidisairitseverywhere

🧵 9/13

https://twitter.com/naturerevendo/status/1532004367217438720

‘Histological studies did not find extensive degen of the adrenocort cells that might have led to complete functional adrenal insuff’

Adrenals are susceptible to vascular damage, ‘viral replication, inflam factors & improper tapering off of long-term steroid replacement’

10/13

But I’m here to ask questions.

As all scientists should.

Cortisol is essential 4 many biological effects in the body. For suppressing inflammatory responses, maintaining BP, endothelial integrity, effects on connective tissue, the list goes on

ncbi.nlm.nih.gov/pmc/articles/P…

🧵 11/13

Some Covid-19 patients are responding to exogenous cortisol.

Could adrenal insufficiency be part of the reason why?

Does ‘subclinical’ mean it’s time to redefine the tests?

Who’s monitoring the Na & K in Long Covid patients?

What else is impacting Na & K in Covid?

12/13

@crwequine @annikalmoksa @Littlefishb1ue @vet_mum @JayneFlan @DRTomlinsonEP @PMGPSC @YouAreLobbyLud @DrShaneRRR @ToshiAkima @ChaserTechAu @fitterhappierAJ @MackayIM @NjbBari3 @loscharlos @ColinKinner @yaneerbaryam @TraceySpicer @vera_tenacious @VascoN95 @DrEricDing #BN

🧵 13/13