Chapter 799： Eskimo
"Zheng boss, what is your opinion?" The director of the endocrinology department said, the director of the urology department asked.
He didn't have any special views on Zheng Rengang's refusal when he entered the house. His face was still smiling and very dull.
"I am still looking at the medical record, first understand the situation." Zheng Ren smiled and whispered.
"If you have any opinions, let's talk about it, everyone can brainstorm." Miao Director advised: "Let's close the door, and I will be in the hospital for consultation. I am not afraid to make a mistake."
"Talk about it, don't be afraid of mistakes." Director Qi also whispered.
Zheng Ren thought about it. When he thought clearly, he stood up and cleared his throat. He said: "The film has not been seen yet. I will have a medical record and simply talk about my own opinion.
This patient, I think, found an adrenal tumor, which is an accident. The real reason for patients to see the disease is that there is no menstruation, plus infertility. In this regard, I consider that it may be caused by 21 hydroxylase deficiency. ”
In the classroom, the quietness of the classroom can be heard.
More than a dozen eyes fell on Zheng Ren, but he did not feel the pressure, the brain is all the patient's condition and similar reports.
Soon, some chaotic ideas became much clearer, he continued.
"Considering that patients have no menstrual history since childhood, I think this is a special case. 21 hydroxylase deficiency, also known as Eskimo, can occur in Eskimo with a rate of 1 in 500. But in China, the incidence rate Only 1/50000-100000."
"Is it just because the patient does not have a menstrual history?" A woman who was in her forties, did not erase the beauty of her face, but asked her more female doctor.
"Yes, not. Accth and androgen secretion increased, patients with masculinization and salt loss symptoms, and serious life threats." Zheng Ren smiled and said: "The existing examination, both conditions are consistent, but adrenal tumors, It is impossible to make an adult woman have no menstruation. In similar case reports, there is often a description of the change in female masculinity."
Zheng Ren said, some unclear thoughts in his mind gradually became clearer, and he believed in his judgment more and more. Although I haven't seen the patient yet, I don't see the diagnosis of the system panel, but Zheng Ren feels that his thoughts are not wrong.
The female doctor nodded and looked at Zheng Ren seriously, listening carefully.
"I didn't see the description in the medical history brief. I think that the possibility that the clinician did not ask about the medical history exists, but the possibility is not high."
"Female masculinization, mainly acne, body hair, can be seen with a look at the eye, must be described. Since there is no, then my judgment is that the patient's condition changes, may not be adrenal tumors stimulate the gland, causing abnormal secretion What is caused. It is likely to be 21 hydroxylase deficiency, and the condition is not serious."
"The argument here is not enough." The female doctor shook her head.
"The original aldehyde series examination, plasma renin activity and so on are normal values; the chromate series examination, adrenaline, norepinephrine, dopamine are also normal; and in the hormone examination, the dehydroepiandrosterone sulfate and other inspection items are very High, so I boldly made the above judgment."
The female doctor nodded and looked like she was the deputy director of the Department of Nephrology, which was just mentioned by Director Qi. Her judgment is also 21 hydroxylase deficiency, but neither she nor Zheng Ren, did not get strong evidence.
However, in a hospital consultation, doctors who have the same diagnosis in isolation and helplessness naturally feel intimate.
"One more point, b super shows that the patient has a tumor on the right adrenal gland. But the left adrenal gland is also found to have hypertrophic hyperplasia. This should provide some evidence."
"Is it diagnosed?" Miao Director suddenly asked.
"Female pseudohermaphroditism and male non-gnrh-dependent precocious puberty have to think about the possibility of cyp21 deficiency. Laboratory tests have shown an increase in urinary 17-ks and 17-kgs and an increase in serum 17-ohp and androstenedione levels. Determine the diagnosis.” Zheng Renyi talked, “and need a gynaecological examination to see if there are any lock-ups or changes in other gender characteristics.”
"Because the patient's symptoms are relatively mild and it is impossible to start the examination, I decided that this change should be small, but still ask the gynecologist to do a checkup."
Miao Director nodded, and the hospitalization around him immediately recorded Zheng Ren’s consultation.
"Surgery is a must, because the tumor is not benign or malignant. Even if it is benign, it must be removed."
After that, Zheng Ren glanced at everyone present, slightly stunned and sat down.
"Just want you to take a look at the film, and brush your face by the way, I didn't expect you to give a diagnosis." Director Qi whispered.
The main purpose of the consultation is the perioperative treatment, surgical precautions and postoperative care.
The diagnosis of the patient has been relatively clear, which is the abnormality caused by adrenal tumors.
However, Director Cui and Zheng Ren of the Department of Nephrology have raised objections and explained their judgment as much as possible.
The results of this hospital consultation have exceeded everyone's imagination.
"I have seen similar cases, the patient's condition and symptoms are not very typical, but still give a general inference." Zheng Ren smiled and whispered.
"Then wait for the inspection results to come out and say." Director Qi is not allowed.
The handling of various intractable diseases is strange, and it is not strange at the large-scale top three hospitals in the Imperial Capital.
"Can I have a look at the patient for a while?" Zheng Ren asked.
"After the meeting, you go with Miao, I want to see it, can this stop you?"
If this is the case, then rest assured.
Give your own diagnosis, then use the system panel of the big pig's hoof to determine, and then ask the patient's family.
After several aspects of evidence, it can basically be determined.
Although 21 hydroxylase deficiency is a terrible disease, the symptoms of this patient are not heavy, and the lack of dose does not reach a fatal level. It is estimated that after a 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 a child.
It sounds a bit bizarre, but there are case reports that say a similar situation.
Zheng Ren said Directors and professors of other departments also expressed their views. It’s just that Zheng Ren’s words made them a little absent-minded.
Someone has decided to raise an objection, which is still sufficient argument. Surgery can't be done in the short term. After the 17-ks and 17-kgs of urine are returned, the condition can be confirmed.
Everyone looks at Zheng Ren's eyes are a bit weird, but Zheng Ren did not feel malicious, they are just curious.
After half an hour, the program has been basically determined, including preoperative examination and drug usage and dosage during surgery.
The level of 912 is still high, and the rigorous academics, Zheng Ren is very recognized.
......
......
Note: Cases provided by a brother who went to work in the South after graduation. The girl has not had menstruation, gave birth to a child after treatment, but still has no menstruation.
I am not learning this. I write about the information he gave, but I can have children without menstruation. I don't understand.
He didn't have any special views on Zheng Rengang's refusal when he entered the house. His face was still smiling and very dull.
"I am still looking at the medical record, first understand the situation." Zheng Ren smiled and whispered.
"If you have any opinions, let's talk about it, everyone can brainstorm." Miao Director advised: "Let's close the door, and I will be in the hospital for consultation. I am not afraid to make a mistake."
"Talk about it, don't be afraid of mistakes." Director Qi also whispered.
Zheng Ren thought about it. When he thought clearly, he stood up and cleared his throat. He said: "The film has not been seen yet. I will have a medical record and simply talk about my own opinion.
This patient, I think, found an adrenal tumor, which is an accident. The real reason for patients to see the disease is that there is no menstruation, plus infertility. In this regard, I consider that it may be caused by 21 hydroxylase deficiency. ”
In the classroom, the quietness of the classroom can be heard.
More than a dozen eyes fell on Zheng Ren, but he did not feel the pressure, the brain is all the patient's condition and similar reports.
Soon, some chaotic ideas became much clearer, he continued.
"Considering that patients have no menstrual history since childhood, I think this is a special case. 21 hydroxylase deficiency, also known as Eskimo, can occur in Eskimo with a rate of 1 in 500. But in China, the incidence rate Only 1/50000-100000."
"Is it just because the patient does not have a menstrual history?" A woman who was in her forties, did not erase the beauty of her face, but asked her more female doctor.
"Yes, not. Accth and androgen secretion increased, patients with masculinization and salt loss symptoms, and serious life threats." Zheng Ren smiled and said: "The existing examination, both conditions are consistent, but adrenal tumors, It is impossible to make an adult woman have no menstruation. In similar case reports, there is often a description of the change in female masculinity."
Zheng Ren said, some unclear thoughts in his mind gradually became clearer, and he believed in his judgment more and more. Although I haven't seen the patient yet, I don't see the diagnosis of the system panel, but Zheng Ren feels that his thoughts are not wrong.
The female doctor nodded and looked at Zheng Ren seriously, listening carefully.
"I didn't see the description in the medical history brief. I think that the possibility that the clinician did not ask about the medical history exists, but the possibility is not high."
"Female masculinization, mainly acne, body hair, can be seen with a look at the eye, must be described. Since there is no, then my judgment is that the patient's condition changes, may not be adrenal tumors stimulate the gland, causing abnormal secretion What is caused. It is likely to be 21 hydroxylase deficiency, and the condition is not serious."
"The argument here is not enough." The female doctor shook her head.
"The original aldehyde series examination, plasma renin activity and so on are normal values; the chromate series examination, adrenaline, norepinephrine, dopamine are also normal; and in the hormone examination, the dehydroepiandrosterone sulfate and other inspection items are very High, so I boldly made the above judgment."
The female doctor nodded and looked like she was the deputy director of the Department of Nephrology, which was just mentioned by Director Qi. Her judgment is also 21 hydroxylase deficiency, but neither she nor Zheng Ren, did not get strong evidence.
However, in a hospital consultation, doctors who have the same diagnosis in isolation and helplessness naturally feel intimate.
"One more point, b super shows that the patient has a tumor on the right adrenal gland. But the left adrenal gland is also found to have hypertrophic hyperplasia. This should provide some evidence."
"Is it diagnosed?" Miao Director suddenly asked.
"Female pseudohermaphroditism and male non-gnrh-dependent precocious puberty have to think about the possibility of cyp21 deficiency. Laboratory tests have shown an increase in urinary 17-ks and 17-kgs and an increase in serum 17-ohp and androstenedione levels. Determine the diagnosis.” Zheng Renyi talked, “and need a gynaecological examination to see if there are any lock-ups or changes in other gender characteristics.”
"Because the patient's symptoms are relatively mild and it is impossible to start the examination, I decided that this change should be small, but still ask the gynecologist to do a checkup."
Miao Director nodded, and the hospitalization around him immediately recorded Zheng Ren’s consultation.
"Surgery is a must, because the tumor is not benign or malignant. Even if it is benign, it must be removed."
After that, Zheng Ren glanced at everyone present, slightly stunned and sat down.
"Just want you to take a look at the film, and brush your face by the way, I didn't expect you to give a diagnosis." Director Qi whispered.
The main purpose of the consultation is the perioperative treatment, surgical precautions and postoperative care.
The diagnosis of the patient has been relatively clear, which is the abnormality caused by adrenal tumors.
However, Director Cui and Zheng Ren of the Department of Nephrology have raised objections and explained their judgment as much as possible.
The results of this hospital consultation have exceeded everyone's imagination.
"I have seen similar cases, the patient's condition and symptoms are not very typical, but still give a general inference." Zheng Ren smiled and whispered.
"Then wait for the inspection results to come out and say." Director Qi is not allowed.
The handling of various intractable diseases is strange, and it is not strange at the large-scale top three hospitals in the Imperial Capital.
"Can I have a look at the patient for a while?" Zheng Ren asked.
"After the meeting, you go with Miao, I want to see it, can this stop you?"
If this is the case, then rest assured.
Give your own diagnosis, then use the system panel of the big pig's hoof to determine, and then ask the patient's family.
After several aspects of evidence, it can basically be determined.
Although 21 hydroxylase deficiency is a terrible disease, the symptoms of this patient are not heavy, and the lack of dose does not reach a fatal level. It is estimated that after a 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 a child.
It sounds a bit bizarre, but there are case reports that say a similar situation.
Zheng Ren said Directors and professors of other departments also expressed their views. It’s just that Zheng Ren’s words made them a little absent-minded.
Someone has decided to raise an objection, which is still sufficient argument. Surgery can't be done in the short term. After the 17-ks and 17-kgs of urine are returned, the condition can be confirmed.
Everyone looks at Zheng Ren's eyes are a bit weird, but Zheng Ren did not feel malicious, they are just curious.
After half an hour, the program has been basically determined, including preoperative examination and drug usage and dosage during surgery.
The level of 912 is still high, and the rigorous academics, Zheng Ren is very recognized.
......
......
Note: Cases provided by a brother who went to work in the South after graduation. The girl has not had menstruation, gave birth to a child after treatment, but still has no menstruation.
I am not learning this. I write about the information he gave, but I can have children without menstruation. I don't understand.
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