Boss Zheng, do you have any thoughts? "After the Chief of the Endocrinology Department finished speaking, Chief Miao of the Department of Genitourinary Surgery asked.
He did not seem to have any special opinions about Zheng Ren's refusal when he first entered the room. There was still a smile on his face, and it was very calm.
"I'm still looking at the medical records. I need to understand the situation first," Zheng Ren smiled and said softly.
"If you have any opinions, just say them. Everyone can brainstorm," Chief Miao comforted. "Let's close the door. We're all in the hospital for a consultation. We're not afraid of making mistakes."
"Tell me. There's no need to be afraid of being wrong," Chief Qi whispered.
Zheng Ren thought for a moment and sorted out his thoughts. He stood up, cleared his throat, and said, "I haven't seen the radiographic films yet. I'll just briefly share my opinion on the medical record.
In this patient, I believe the discovery of an adrenal tumor was an accident. The real reason why the patient came to see the doctor was that she did not have menstruation and was infertile. In this regard, I think it may be caused by 21 hydroxylase deficiency. "
It was so quiet in the demonstration room that one could hear a pin drop.
Dozens of eyes fell on him, but he did not feel pressured. His mind was filled with patients' conditions and similar reports.
Soon, his somewhat muddled thoughts became much clearer, and he continued.
"Considering that the patient has no history of menstruation since childhood, I think this is a special case. 21 Hydroxylase deficiency, also known as Eskimo disease, had an incidence of up to 1 in 500 Eskimos. But in our country, the incidence is only 1 in 50000100000. "
"Just based on the patient's lack of menstruation history?" Asked a female doctor in her forties. Time did not erase the beauty of her face, but it made her more charming.
"Yes and no. The secretion of ACTH and androgen increases, and the patient develops symptoms of masculinization and salt loss. In severe cases, it can be life-threatening. " Zheng Ren smiled and said, "Based on the current examination, both conditions are consistent, but an adrenal tumor can't cause an adult woman to have no menstruation all the time. In similar case reports, there are often descriptions of women changing into men. "
As he spoke, some of the unclear thoughts in his mind gradually became clearer, and he began to believe in his own judgment. Although he had not seen the patient or seen the System's diagnosis, he felt that his theory was correct.
The female doctor nodded and looked at Zheng Ren seriously, listening carefully.
"I didn't see any relevant descriptions in the summary of the medical record. I think it's possible that the clinician didn't ask about the patient's medical history, but the possibility is not high. "
"The transformation of a woman into a man, mainly with acne and body hair. It's obvious at a glance, so I definitely have to describe it. In that case, my judgment is that the change in the patient's condition might not be caused by the abnormal secretion of the gland stimulated by the adrenal tumor. It's very likely to be 21-hydroxylase deficiency, and the condition is not serious. "
"The evidence here isn't sufficient." The female doctor shook her head.
"In the primary aldehyde series, plasma renin activity and so on are all normal. In the chromaffin series, epinephrine, norepinephrine, and dopamine are also normal. In the hormone series, dehydroepiandrosterone sulfate and other test items are very high, so I boldly make the above judgment."
The female doctor nodded. It seemed that she was the deputy director of the Nephrology Department that Chief Qi had just mentioned. Her judgment was also 21-hydroxylase deficiency. It was just that neither she nor Zheng Ren had solid evidence.
However, to be able to meet a doctor with the same diagnosis in a hospital consultation when he was isolated and helpless, he naturally felt a sense of kinship.
"One more thing, the ultrasound showed that the patient has a tumor on the right adrenal gland. However, the left adrenal gland also has hypertrophy and hyperplasia. This should be able to provide some evidence. "
"What about the diagnosis?" Chief Miao suddenly asked.
"Female pseudohermaphroditism and male non-GnRH-dependent precocious puberty have to be considered the possibility of CYP21 deficiency. Laboratory tests found that the urine 17KS and 17KGS output increased, and the serum 17OHP and androstenedione levels increased, so the diagnosis can be confirmed," Zheng Ren said frankly. "Moreover, we need a gynecological examination to see if there are any atresia or other changes in sexual characteristics."
"Because the patient's symptoms are relatively mild and she is infertile, I judge that this change should be very small. However, we should still ask the gynecologist to do a gynecological examination."
Chief Miao nodded, and the chief resident beside him immediately recorded Zheng Ren's consultation opinion.
"Surgery is a must because the tumor cannot be determined whether it is benign or malignant. Even if it is benign, it has to be removed. "
After saying that, Zheng Ren glanced at everyone present, bowed slightly, and sat down.
"I just wanted you to come and take a look at the radiographic films and brush your face. I didn't expect you to really be able to give a diagnosis," Chief Qi said in a low voice.
The main purpose of the hospital's consultation was to discuss the perioperative treatment, surgical precautions, and postoperative care.
The patient's diagnosis was already relatively clear. It was an abnormality caused by an adrenal tumor.
However, Chief Cui and Zheng Ren from the Department of Nephrology both objected and tried their best to explain their own judgments.
The results of the hospital's consultation this time had already exceeded everyone's imagination.
"I've read similar case reports. This 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 let's wait for the results of the examination to come out." Chief Qi did not comment.
The treatment of all kinds of difficult and complicated diseases was strange. It was not strange for a large Class Three Grade A Hospital in the Imperial Capital.
"Can I take a look at the patient later?" Zheng Ren asked.
"After the meeting, you can go with Chief Miao. If you want to take a look, you can. How can I stop you?"
If that was the case, then he would be relieved.
He would give the diagnosis himself and then use the System panel to confirm it. Then, he would have to ask the patient's family.
With several pieces of evidence, he could basically confirm it.
Although 21-hydroxylase deficiency was a fatal disease, the patient's symptoms were not serious. The amount of deficiency did not reach a fatal level. It was estimated that after a certain amount of treatment, the patient's condition would improve.
Zheng Ren even thought that if there was a symptomatic treatment, although the patient would not have menstruation, it would still be possible to have children.
It sounded a little strange, but there were case reports that mentioned similar situations.
After Zheng Ren finished speaking, the chief physicians and professors of the other departments also expressed their views. However, Zheng Ren's words made them a little absent-minded.
Someone raised an objection with certainty. The argument was sufficient. The surgery could not be performed in the short term. They had to wait for the urine 17KS and 17KGS to report before they could perform the surgery.
Everyone looked at Zheng Ren with a strange gaze, but Zheng Ren did not feel any malice. They were just curious.
Half an hour later, the plan was basically determined, including the preoperative examination, the usage of drugs during the surgery, and the dosage.
The standard of the 912 was still high, and they were rigorous in their studies. Zheng Ren recognized this very much.
Note: This was a case provided by a senior brother who went to work in the South after graduation. The girl had never had her period. She had given birth after treatment, but she still did not have her period.
I didn't study this. I just wrote down the information he gave me. But I don't understand how she can give birth without menstruation.
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Eskimo disease
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