The first afternoon session at #AACECVMET is "Endocrine Hypertension and Cardiovascular Effects" by Richard Auchus, MD, PhD, FACE (@EndocrinologyM), moderated by L. Maria Belalcazar, MD, FACE (@utmbhealth)! #EndoTwitter #WeAreAACE
@EndocrinologyM @utmbhealth Pheochromocytoma Cardiovascular & Metabolic complications include commonly tachycardia & HTN, but also MI, ventricular rupture, catecholamine cardiomyopathy, hemorrhagic stroke, aortic dissection, and hyperglycemia+fatty liver+ weight loss together! #AACECVMET #Endotwitter
@EndocrinologyM @utmbhealth Primary Aldosteronism is excess renin-independent aldosterone & the most common cause of secondary HTN! There are low rates of screening & diagnosis (<1% ever screened). It has higher end-organ damage than primary HTN. It is curable or treatable with targeted therapy. #AACECVMET
@EndocrinologyM @utmbhealth 14-fold increase in rate of atrial fibrillation in patients with primary aldosteronism, worsened by hypokalemia! #AACECVMET
@EndocrinologyM @utmbhealth Note: Screening for primary aldosteronism is more about whether renin is suppressed than about whether aldosterone is high! Most meds increase PRA & Aldo (except BB decrease PRA) so if PRA is suppressed, the screen is valid. Can always rescreen after off meds! #AACECVMET #AACE
@EndocrinologyM @utmbhealth Dr. Auchus's advice for screening for primary aldosteronism: #AACECVMET #EndoTwitter @TheAACE Picture stating "NO EX...
@EndocrinologyM @utmbhealth @TheAACE "Conn-Shing" Syndrome: large adrenal adenomas sometimes produce both aldosterone and cortisol! Arlt et al (JCI Insight 2017) noted elevated cortisol metabolites in APA that resolved with surgery. #AACECVMET #AACE
@EndocrinologyM @utmbhealth @TheAACE Pearls to using MRAs: Start low and go slowly (labs in 1-2 weeks, titrate up in 4-6 weeks; goal: normal BP &K); switch to epleronone if side effects; amiloride is an alternative though not ideal. Finerenone if DM+CKD. #AACECVMET #AACE

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More from @NadiaJamilMD

Oct 2
Excited for the second session of Day 2 of #AACECVMET where Ralph A. DeFronzo, BMS, MD, MS, BS (@UTHealthSA) talks about "SGLT2 Inhibitors and GLP-1 RAs: Cardio-Renal Metabolic Drugs for the Ages", moderated by Joseph A. Vassalotti, MD (@Joe_Vassalotti) #EndoTwitter #diabetes Image
@UTHealthSA @Joe_Vassalotti Ominous Octet for hyperglycemia: increased lipolysis, increased glucose reabsorption (kidney), decreased glucose uptake (muscle), neutrotransmitter dysfunction, increased HGP (liver), increased glucagon secretion, decreased insulin secretion, decreased incretin effect #AACECVMET
@UTHealthSA @Joe_Vassalotti SGLT2 inhibitors: reduce HbA1C, corrects a novel pathophysiologic defect, reversal of glucotoxicity, promotes weight loss, reduces blood pressure, no hypoglycemia, and complements action of other antidiabetic agents = improves glycemic control and CV risk factors #AACECVMET
Read 19 tweets
Oct 2
Day 2 of #AACECVMET starts with "Protecting Our Patients: Implementing Immunization Recommendations Within a Culture of Vaccine Confidence" by Kenneth Izuora, MD, MBA, FACE, moderated by Betul Hatipoglu, MD @TheAACE #AACE #EndoTwitter
@TheAACE During flu seasons, influenza vaccinations reduce all-cause mortality in adult patients with type 2 diabetes by 50% #AACECVMET #MedTwitter #AACE
@TheAACE AACE's Updated Diabetes Guidelines include vaccine recommendations for adults with diabetes mellitus: #AACECVMET #EndoTwitter #MedTwitter Image
Read 5 tweets
Oct 1
Up next is "Healthcare Disparities in Cardiovascular Disease: Social and Nutrition Deserts" by Joshua J. Joseph, MD, MPH, FAHA (@joshuajosephmd), moderated by S. Sethu K. Reddy, MD (@endocrineguru) at #AACECVMET #AACE #Endotwitter
@joshuajosephmd @endocrineguru There are higher rates of diabetes mortality (2-fold death disparity) in rural areas as compared to urban areas, and a higher mortality in Black patients compared to White patients. #AACECVMET #AACE #HealthDisparities
@joshuajosephmd @endocrineguru Diabetes prevalence & hospital admissions correlate w/ residential security maps. The 1930s Home Owners Loan Corporation redlining score has an impact today: 1 unit-higher HOLC grades assoc w/ 54% higher DM mortality & 67% higher rate of diabetes years of life lost #AACECVMET
Read 8 tweets
Oct 1
Session 2 of #AACECVMET that I'm attending is "Nonalcoholic Fatty Liver Disease: The Global Pandemic" by Dr. Scott Isaacs, MD (@EmoryMedicine)! #WeAreAACE
@EmoryMedicine Pathogenic drivers of NAFLD: genetics, epigenetics, dysbiosis, dysfunctional adipose tissue, insulin resistance, and calorie excess #AACECVMET
@EmoryMedicine All stages of NAFLD show increased mortality over a 30yr period, with mortality increasing with fibrosis stage #AACECVMET #NAFLD
Read 9 tweets
Oct 1
Kicking off Day 1 of @TheAACE Cardiometabolic Conference with "AACE Guideline Update: Developing a Diabetes Mellitus Comprehensive Care Plan" by Lawrence Blonde, MD (Ochsner Medical Center), moderated by S. Sethu K. Reddy, MD (CMU College of Medicine) #WeAreAACE #EndoTwitter
@TheAACE Grade B rec: Artificial intelligence systems, authorized by the FDA for detecting greater than mild diabetic retinopathy, can be used as an alternative to traditional screening approaches...facilitate diagnosis of vision-threatening retinopathy #AACE #Diabetes
Grade A: In T2DM and established ASCVD (or high risk) use GLP-1 RAs with proven CV benefits to reduce the risk of myocardial infarction, stroke, or CV death regardless of other glucose-lowering or cardiovascular therapies and independent of A1C #AACE #AACECVMET
Read 8 tweets

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