Boss Zheng, what do you think?" After the director of the endocrinology department finished speaking, Director Miao of the Department of Urology asked.

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

"I'm still looking at the medical records, so let's get a look at the situation first. Zheng Ren smiled and whispered.

"Tell me what you think, and everyone will brainstorm ideas. Director Miao comforted: "Let's close the door, our own people will consult in the whole hospital, and we are not afraid of making mistakes." ”

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

Zheng Ren thought about it, clarified his thoughts, then stood up, cleared his throat, and said: "I haven't watched the film yet, so I will briefly talk about my opinion on the medical records."

This patient, I think the discovery of an adrenal tumor, was an accident. The real reason why patients come to see the doctor is the absence of menstruation, coupled with infertility. In relation to this, I think it may be caused by 21-hydroxylase deficiency. ”

The classroom was quiet, and you could hear a needle dropping.

More than a dozen eyes fell on Zheng Ren, but he didn't feel the pressure, and his mind was full of the patient's condition and similar reports.

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

"Considering that the patient has not had a menstrual history since childhood, I think this is a special case. 21 hydroxylase deficiency, also known as Eskimosis, can occur in 1 in 500 Eskimos. But in our country, the incidence is only 1/50000100000. ”

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

"Yes and no. ACTH and androgen secretion are increased, and patients have symptoms of virilization and salt loss, which are life-threatening in severe cases. Zheng Ren smiled and said, "The existing examinations are consistent with both conditions, but the adrenal gland tumor cannot make an adult woman have no menstruation all the time." In similar case reports, there are often depictions of changes in the masculinization of women. ”

As Zheng Ren spoke, some unclear thoughts in his mind gradually became clearer, and he trusted his own judgment more and more. Although he has not seen the patient yet, and has not seen the diagnosis on the system panel, Zheng Ren feels that his thoughts are not wrong.

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

"I don't see any description in my medical record. I think it's possible that the clinician didn't ask about the history, but it's not very likely. ”

"Women are virilized, mainly acne and body hair, which can be seen with a single eye, and must be described. Since there is none, my judgment is that the patient's condition has changed, and it may not be caused by the stimulation of the glands by the adrenal tumor, which causes abnormal secretion. There is a high probability of 21-hydroxylase deficiency, and it is not serious. ”

"There's not enough evidence here. The female doctor shook her head.

"In the original aldehyde series test, the plasma renin activity and so on are normal, the chromochromin series test, epinephrine, norepinephrine, and dopamine are also normal, and in the hormone test, the test items such as dehydroepiandrosterone sulfate 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 Director Qi had just mentioned. Her judgment is also 21 hydroxylase deficiency, but neither she nor Zheng Ren has obtained strong evidence.

However, being able to meet a doctor with the same diagnosis in an all-hospital consultation in isolation and helplessness naturally gives me a sense of intimacy.

"One more thing, the ultrasound showed that the patient had a tumor in the adrenal gland on the right side. However, the left adrenal gland is also found to have hypertrophic changes. This should provide some evidence. ”

"What about the diagnosis?" Director Miao suddenly asked.

"The possibility of CYP21 deficiency should be considered in both female pseudohermaphroditism and non-GnRH-dependent precocious puberty in men, and laboratory findings of elevated urine output of 17KS and 17KGS and elevated serum levels of 17OHP and androstenedione can confirm the diagnosis. "And you need a gynecological examination to see if there is any locking or other changes in gender characteristics." ”

"Because the patient's symptoms are relatively mild and he is unable to have children, I think that this change should be small, but I should ask a gynecologist to do a gynecological examination. ”

Director Miao nodded, and the hospitalizer next to him immediately recorded Zheng Ren's consultation opinion.

"Surgery is necessary because the tumor is not determined to be benign or malignant. Even if it is benign, it should be removed. ”

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

"I just wanted you to come and watch the film, and brush your face by the way, but I didn't expect you to really give a diagnosis. Director Qi whispered.

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

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

However, both Director Cui and Zheng Ren of 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 have seen 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 whispered.

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

The treatment of various incurable diseases is strange, and it is not strange to see it in a large tertiary hospital in the imperial capital.

"Can I take a look at the patient in a moment?" asked Jung-in.

"After the meeting is dismissed, you go with Director Miao, you can see it if you want, can this stop you?"

If that's the case, then rest assured.

Give the diagnosis yourself, then use the system panel of the big pig's trotters to make sure, and then ask the patient's family.

After several evidences, it can be basically determined.

Although 21 hydroxylase deficiency is a fatal disease, the symptoms of this patient are not serious, and the deficiency does not reach a fatal level. It is estimated that after some treatment, the condition will improve.

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 child.

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

After Zheng Ren finished speaking, the 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.

There are definite objections that are well founded. The operation cannot be done in the short term, and the operation can only be performed after the urine returns with 17KS and 17KGS.

Everyone looked at Zheng Ren with a strange gaze, but Zheng Ren didn't feel malice, they were just curious.

Half an hour later, the plan has been basically determined, including the preoperative examination, the use and dosage of drugs during the operation.

The level of 912 is still high, and the study is rigorous, Zheng Ren agrees with this.

Note: After graduation, a case provided by a senior brother who went to work in the South. The girl had no menstruation and gave birth after treatment, but she still did not menstruate.

I didn't learn this, so I wrote down the information he gave, but I can't figure it out if I can have a child but don't have menstruation.

Tips: Enter "Panda Literature" in the search engine, you can find this site, thank you.

799 Eskimosis