Chapter 798 Eskimo Syndrome

"Boss Zheng, do you have any comments?" After the director of the Department of Endocrinology finished speaking, Director Miao of the Department of Urology asked.

He didn't seem to have any special opinion about Zheng Ren's refusal when he first entered the room, and he still had a smile on his face, very flat.

"I'm still looking at the medical records, let's understand the situation first." Zheng Ren smiled and said in a low voice.

"Let's talk about what you think. Let's brainstorm." Director Miao comforted: "Let's close the door and consult with the whole hospital. We are not afraid of making mistakes."

"Let's talk, don't be afraid of making mistakes." Director Qi also whispered on the side.

Zheng Ren thought for a while, cleared his mind, stood up, cleared his throat, and said, "I haven't watched the film yet, so I'll just talk about my medical records and briefly talk about my opinion.

In this patient, I think the discovery of the adrenal tumor was an accident. The real reason for patients to see a doctor is no menstruation, plus infertility. Regarding this, I think it may be caused by 21 hydroxylase deficiency. "

Dashi's classroom is so quiet that you can hear the drop of a needle.

More than a dozen eyes fell on Zheng Ren, but he didn't feel the pressure. His mind was full of patients' conditions and similar reports.

Soon, some chaotic thoughts became much clearer, he continued.

"Considering that the patient has no menstrual history since childhood, I think this is a special case. 21-hydroxylase deficiency, also known as Eskimo disease, can reach 1 in 500 Eskimos. But in our country, the incidence Only 1/50000-100000."

"Is it just judged by the fact that the patient has no menstrual history?" A female doctor in her forties, whose beauty has not been erased by the years, has made her more charming.

"Yes, and no. The secretion of ACTH and androgen increases, and the patient has symptoms of virilization and salt loss. In severe cases, it is life-threatening." Zheng Ren smiled and said: "The current examinations are consistent with both conditions, but adrenal gland tumors, It is impossible to make an adult woman without menstruation all the time. In similar case reports, there are often descriptions of female masculine changes."

As Zheng Ren talked, some unclear thoughts in his mind gradually became clear, and he believed in his own judgment more and more. Although he hasn't seen the patient yet, and hasn't seen the diagnosis on the system panel, Zheng Ren feels that his thoughts are correct.

The female doctor nodded, looked at Zheng Ren seriously, and listened carefully.

"I didn't see the relevant description in the brief medical record. I think there is a possibility that the clinician didn't ask the relevant medical history, but this possibility is not high."

"Masculinization of women, mainly acne and body hair, can be seen at a glance, so I must describe it. If there is no, then my judgment is that the patient's condition has changed, and it may not be that the adrenal gland tumor stimulates the gland and causes abnormal secretion. Caused by. Most likely 21-hydroxylase deficiency, and it's not serious."

"The evidence here is not sufficient." The female doctor shook her head.

"The original aldehyde series examination, plasma renin activity, etc. are all normal; the chromaffin series examination, adrenaline, norepinephrine, and dopamine are also normal; in the hormone examination, the inspection items such as dehydroepiandrosterone sulfate are very normal. High, so I boldly make the above judgment."

The female doctor nodded. It seemed that she was the deputy director of the Department of Nephrology that Director Qi had just mentioned. Her judgment was also 21-hydroxylase deficiency, but neither she nor Zheng Ren had any solid evidence.

But being able to meet a doctor with the same diagnosis in an isolated and helpless situation in a hospital-wide consultation, I naturally feel a sense of intimacy in my heart.

"One more point, the B-ultrasound showed that the patient's right adrenal gland had a tumor. But the left adrenal gland was also found to have hypertrophic hyperplasia. This should provide some evidence."

"Are you diagnosed?" Director Miao asked suddenly.

"Female pseudohermaphroditism and male non-GnRH-dependent precocious puberty must be considered the possibility of CYP21 deficiency. Laboratory tests found that urinary 17-KS and 17-KGS excretion increased and serum 17-OHP and androstenedione levels increased. Confirm the diagnosis." Zheng Ren talked eloquently, "And a gynecological examination is needed to see if there is atresia or other changes in sexual characteristics."

"Because the patient's symptoms are relatively mild, and the examination was started because she was infertile, so I judge that this change should be very small, but I still ask the gynecologist to do a gynecological examination."

Director Miao nodded, and the hospital manager beside him immediately recorded Zheng Ren's consultation opinion.

"Surgery is a must, because the tumor is not sure whether it is benign or malignant. Even if it is benign, it must be removed."

After finishing speaking, Zheng Ren glanced at everyone present, bowed slightly, and sat down.

"I just want you to watch the film and brush your face by the way. I didn't expect you to be able to give a diagnosis." Director Qi whispered.

The main purpose of hospital-wide consultation is perioperative treatment, surgical precautions, and postoperative care.

The patient's diagnosis has been relatively clear, it is an abnormality caused by an adrenal tumor.

But Director Cui and Zheng Ren from the Department of Nephrology raised objections and explained their judgments as much as possible.

The results of this hospital-wide consultation have exceeded everyone's imagination.

"I've read similar case reports, and the patient's condition and symptoms are not very typical, but I can still give a general inference." Zheng Ren smiled and said in a low voice.

"Then wait for the test results to come out." Director Qi was noncommittal.

The treatment of various difficult and miscellaneous diseases is strange, and it is not unusual to see it in the large third-level hospitals in the imperial capital.

"Can I visit the patient later?" Zheng Ren asked.

"After the meeting, you go with Director Miao and watch as much as you want. How can this stop you?"

If so, take it easy.

Give the diagnosis yourself, then use the system panel of the big pig's trotter to confirm it, and then ask the patient's family members.

After several aspects of evidence, it can basically be confirmed.

Although 21-hydroxylase deficiency is a fatal disease, the symptoms of this patient are not serious, and the deficiency has not reached a fatal level. Estimated to give certain treatment, the condition will be improved.

Zheng Ren even thought that if there is symptomatic treatment, although the patient will not have menstruation, it is still possible to have children.

It may sound bizarre, but there are case reports of a similar situation.

After Zheng Ren finished speaking, directors and professors of other departments also expressed their views. It's just that Zheng Ren's words made them all a little absent-minded.

Some people have definitely raised objections, which is considered sufficient evidence. The operation cannot be done in the short term. The operation can only be performed after the urine 17-KS and 17-KGS are reported and the condition is clarified.

Everyone looked at Zheng Ren with weird eyes, but Zheng Ren didn't feel any malice, they were just curious.

Half an hour later, the plan was basically determined, including the preoperative examination and the usage and dosage of drugs during the operation.

912's level is still high, and his studies are rigorous, which Zheng Ren very much agrees with.

...

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Note: A case provided by a brother who went to work in the South after graduation. The girl has never had menstruation. After the treatment, she gave birth to a baby, but she still has no menstruation.

I didn't learn this, so I wrote it based on the information he gave, but I can have children but have no menstruation, and I can't figure it out.