"Boss Zheng, what do you think?" 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 opinions on Zheng Ren's rejection when he first entered the room. He still had a smile on his face, very calm.
"I'm still looking at the medical records and want to understand the situation first." Zheng Ren smiled and whispered.
"If you have any opinions, please tell me and let's brainstorm ideas." Director Miao comforted, "Let's close the door and conduct consultations in the whole hospital. We are not afraid of making mistakes."
"Tell me about it, don't be afraid of making mistakes." Director Qi also whispered.
Zheng Ren thought for a while, cleared his thoughts, then stood up, cleared his throat, and said: "I haven't watched the film yet, so I'll just give you my opinion based on the medical records.
In this patient, I think the discovery of the adrenal tumor was an accident. The real reason why the patient came to see the doctor was lack of menstruation and infertility. Regarding this, I thought it might be caused by 21-hydroxylase deficiency. "
It was so quiet in the classroom that you could hear a pin drop.
More than a dozen eyes fell on Zheng Ren, but he didn't feel any pressure. His mind was filled with the patient's condition and similar reports.
Soon, the somewhat chaotic 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 called Eskimo disease, has an incidence rate of 1/500 among Eskimos. But in our country, the incidence rate is Only 1/50000-100000."
"Is it just based on the patient's lack of menstrual history?" asked a female doctor in her forties, whose beauty has not been erased by time, but has made her more charming.
"Yes, and no. The secretion of acth and androgen increases, and the patient develops virilization and salt loss symptoms, which are life-threatening in severe cases." Zheng Ren smiled and said: "The current examination shows that both conditions are consistent, but adrenal tumors, It is impossible to prevent an adult woman from menstruating all the time. In similar case reports, there are often descriptions of women's masculine changes."
As Zheng Ren spoke, some unclear ideas in his mind gradually became clearer, and he became more confident in his own judgment. Although he hasn't seen the patient or the diagnosis on the system panel, Zheng Ren feels that his idea is correct.
The female doctor nodded, looked at Zheng Ren seriously, and listened carefully.
"I didn't see the relevant description in the medical record summary. I think there is a possibility that the clinician did not ask about the relevant medical history, but this possibility is not high."
"Virilization in women, mainly acne and body hair, can be seen at a glance, so it must be described. Since there is no such thing, my judgment is that the patient's condition has changed, and it may not be the adrenal tumor stimulating the gland, causing abnormal secretion It is caused by 21-hydroxylase deficiency, and the condition is not serious."
"The arguments here are not sufficient." The female doctor shook her head.
"In the series of formaldehyde examinations, plasma renin activity and other tests were all normal; in the series of chromaffin examinations, epinephrine, norepinephrine, and dopamine were also normal; but in the hormone examinations, examination items such as dehydroepiandrosterone sulfate were very low. 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 Director Qi just mentioned. Her diagnosis was also 21-hydroxylase deficiency, but neither she nor Zheng Ren had any solid evidence.
However, in a hospital-wide consultation, I can meet a doctor with the same diagnosis in isolation, and I naturally feel a sense of intimacy.
"One more thing, the B-ultrasound showed that the patient's right adrenal gland had a tumor. However, hypertrophy and hyperplasia changes were also found in the left adrenal gland. This should provide some evidence."
"Where is the diagnosis?" Director Miao suddenly asked.
"Female pseudohermaphroditism and male non-gnrh-dependent precocious puberty should both consider the possibility of Cyp21 deficiency. Laboratory examinations reveal increased urinary 17-ks and 17-kgs output and increased serum 17-ohp and androstenedione levels. Confirm the diagnosis." Zheng Ren said eloquently, "And a gynecological examination is needed to see if there is atresia or other changes in sexual characteristics."
"Because the patient's symptoms were relatively mild and the examination was started only after she was infertile, I judge that this change should be very small, but I still ask a gynecologist for a gynecological examination."
Director Miao nodded, and the resident manager beside him immediately recorded Zheng Ren's consultation opinions.
"Surgery is necessary because the tumor is not sure to be benign or malignant. Even if it is benign, it must be removed."
After speaking, Zheng Ren glanced at everyone present, bowed slightly, and sat down.
"I just wanted you to take a look at the film and brush your face. I didn't expect you to be able to give a diagnosis." Director Qi said in a low voice.
The main purpose of hospital-wide consultation is perioperative treatment, surgical precautions and postoperative care.
The patient's diagnosis has been relatively clear, which is an abnormality caused by an adrenal tumor.
However, Director Cui and Zheng Ren of the Department of Nephrology both raised objections and explained their judgments as much as possible.
The results of this hospital-wide consultation have exceeded everyone’s imagination.
"I have seen similar case reports. This patient's condition and symptoms are not very typical, but I can still give a rough inference." Zheng Ren smiled and whispered.
"Then we'll wait until the test results come out." Director Qi was noncommittal.
The treatment of various difficult and complicated diseases is very strange, which is not surprising even in the large tertiary hospitals in the imperial capital.
"Can I see the patient later?" Zheng Ren asked.
"After the meeting, you go with Director Miao and watch whatever you want. How can this stop you?"
If that's the case, don't worry.
Make the diagnosis yourself, then use the system panel of Big Pig Trotters to confirm, and then ask the patient’s family members.
After several aspects of evidence, it can basically be determined.
Although 21-hydroxylase deficiency is a fatal disease, this patient's symptoms were not severe and the deficiency did not reach a fatal level. It is estimated that the condition will improve after certain treatment is given.
Zheng Ren even thought that if there was symptomatic treatment, although the patient would not have menstruation, it would still be possible to have a baby.
It may sound bizarre, but there are case reports of similar situations.
After Zheng Ren finished speaking, the directors and professors of other departments also expressed their opinions. But Zheng Ren's words made them all a little distracted.
Someone has definitely raised objections, which is considered to be a sufficient argument. The operation cannot be performed in the short term. The patient's condition can only be operated after the urine 17-ks and 17-kgs results are reported.
Everyone looked at Zheng Ren a little strangely, but Zheng Ren didn't feel any malice, they were just curious.
Half an hour later, the plan was basically determined, including preoperative examination and the usage and dosage of drugs during surgery.
The level of 912 is still high and the scholarship is rigorous, which Zheng Ren approves of very much.
…
…
Note: A case provided by a senior who went to work in the south after graduation. The girl has never had menstruation. After treatment, she gave birth to a child, but she still has no menstruation.
I didn't learn this, so I just wrote it down based on the information he gave me, but I couldn't figure it out that I could have a baby but not have menstruation.