MD @FCMSCSP | Trained in IM and endocrine @FMUSPoficial | Reloading training @PittGIM @UPMC
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Feb 14 • 6 tweets • 2 min read
❗️Sodium metabolism may be confusing, but breaking it down in pieces may be useful for understanding it!
🤷♂️🤔 Why Na goes down when glucose go up?
🤔It can get even more confusing. If you’re treating HHS - why 0.45% normal saline is used even with “normal Na”?
Follow the 🧵
🔑Our body regulates osmolarity and not sodium.
Osmolarity = 2xNa + glucose/18
Let’s compare a glucose of 100 mg/dL to a glucose of 1000 mg/dL:
Glucose= 100:
Osmolarity = 2xNa + 5.55
Glucose=1000:
Osmolarity= 2xNa + 55.55
It is a huge difference. How can this be compensated?
Jul 24, 2023 • 7 tweets • 2 min read
❗️Another topic of confusion in diabetes: LADA!
✅Contrary to MODY, LADA name makes sense.
The question is: should we consider LADA as a diagnosis? Does it matter clinically?
Latent autoimmune diabetes in adults deserves a short 🧵
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What is LADA?
Latent autoimmune diabetes in adults (LADA) is a type of autoimmune diabetes that starts in adulthood and slowly gets worse over time.
What is type 1 diabetes (T1D)?
Autoimmune disease that leads to the destruction of insulin-producing pancreatic beta cells.
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Feb 2, 2023 • 8 tweets • 3 min read
The pt needs high-dose statin and has CKD (eGFR=25 mL/min).
Hyponatremia is found in most cases of adrenal insufficiency.
Why?
Follow the short🧵. I guarantee there are at least 3 important reasons why it is important to know the correct answer
Low cortisol increases ADH, ultimately leading to hyponatremia.
Low aldosterone would decrease Na reabsorption, but less water would come together - normal Na concentration.
Low aldosterone = less water reabsorption= low BP and normal serum Na
High aldosterone = high BP, nl Na
Jul 24, 2022 • 10 tweets • 2 min read
❗️The TSH is 7.0 mIU/L (NR: 0.5-5.0) and free T4 is 3.0 ng/dL (NR: 0.9-2.4).
What to do? Repeat it!
🤔Results are the same.
How to interpret high TSH / high fT4?
Can you think of 5 causes for this situation?
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Do you think pituitary adenoma producing TSH (TSHoma) is a common cause for the labs above?
Jul 16, 2022 • 8 tweets • 2 min read
❗️A brain image revealed a pituitary adenoma.
Depending on age, up to 10% of the population will have this finding.
🤔 What to do? How should it be followed up?
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What are the potential problems of a pituitary adenoma?
- Mass itself: pain, apoplexy, optic chiasm compression (visual field deficit).
- Hormone: production and/or deficiency.
Let's start with hypersecretion, which axes would you assess?
Apr 17, 2022 • 10 tweets • 2 min read
❗️Chronic Adrenal insufficiency treatment has several options
Follow the 🧵 for more information about these options.
❗️What changed in the treatment recently? What are the "new" drugs? How did it change the history and the life of pts? How does it affect other diseases' treatment?
This is a 🧵 about recent changes in T2D treatment!
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Just to clarify, this 🧵 is not supposed to be comprehensive.
The literature is vast, and the intent is to show some recent landmarks in T2D treatment and how these drugs are positively affecting other diseases. ❗️Several important studies are not here.
Let's start!
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Jan 14, 2022 • 10 tweets • 4 min read
❗️Have you ever heard about prostate cancer differentiating in a neuroendocrine tumor secreting VIP?
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@samymady12 presented a pt with a previous history of prostate cancer that presented with a 2-month history of diarrhea, hypokalemia, hyponatremia, and acute renal failure.
🤔Ok, what is the classic presentation of VIPoma?
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Jan 9, 2022 • 10 tweets • 2 min read
❗️Insulin resistance is a concept often used by clinicians and patients.
🤔What is the definition? How to diagnose? What is the meaning? How to approach?
Insulin resistance surely deserves a 🧵
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✅Definition: cellular failure to respond normally to insulin.
✅ Importance: it is the initial trigger of type 2 diabetes and other diseases.
The definition itself is vague and somewhat subjective.
Let's start by the gold standard for assessing insulin resistance.
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Dec 8, 2021 • 5 tweets • 2 min read
🤔Obesity diagnosis is easy - BMI > 30 Kg/m² - right?
We can make it better!
❗️High BMI does not automatically mean obesity and normal BMI does not automatically mean no obesity!
Obesity is a disease, and its diagnosis deserves a short 🧵
Let's start by defining obesity.
"Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health."
"BMI is a simple index of weight-for-height that is commonly used to classify overweight and obesity."
In endocrinology, the concept of "inappropriately normal" is the basis for the interpretation of several labs results.
Do you understand this concept? It is definitely one of the most important for understanding endocrine diseases.
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📢 Clinically, it means the problem is not with the hormone itself. It means the problem is with the "hormone coordinator", which may sound normal when it is actually failing to respond as it should.
Let's clarify it!
Jul 16, 2021 • 10 tweets • 3 min read
Empagliflozin, an SGLT2 inhibitor, showed positive results for heart failure with preserved ejection fraction according to Boehringer's statement.♥️
#MedEd#FOAMed
Sodium-glucose transport proteins (SGLT) are found both in the small intestines (SGLT1) and in the kidneys (SGLT2).
In the nephron, SGLT2 is the main responsible for the reabsorption of the filtered glucose. For this reason, its inhibition⬆️ glucosuria, decreasing hyperglycemia.
May 22, 2021 • 8 tweets • 2 min read
Have you ever heard that nocturnal hypoglycemia causes rebound hyperglycemia in the morning?
This is also known as the Somogyi effect - published in 1938.
Did you know this concept has been contested in the last decades?
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#MedEd#diabetes#MedTwitter
Somogyi has claimed that hypoglycemia response (increase in glucagon, GH, cortisol, and) could overcompensate leading to hyperglycemia.
This is not true for most hormones' feedback. Let's use the thyroid to make a parallel:
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