Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
“Boss Zheng, do you have any thoughts? “Chief Miao of the Department of Genitourinary Surgery asked after the chief of the Department of Endocrinology finished speaking.
He did not seem to have any special thoughts about Zheng Ren’s refusal when he first entered the room. He still had a smile on his face and 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. Let’s brainstorm,” Chief Miao comforted him. “Let’s close the door. We’re consulting the whole hospital. There’s no need to be afraid of making mistakes.”
“Just say it. There’s no need to be afraid of making mistakes,” Chief Qi said in a low voice.
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 tell you my opinion on the medical records.
“I think the discovery of this patient’s adrenal tumor was an accident.
“The real reason why the patient came to see the doctor was that she did not have menstruation, and that she was infertile.
“Regarding this, I think it might be caused by the 21-hydroxylase deficiency.”
The surgical demonstration classroom became quiet. One could hear the sound of a pin dropping.
More than a dozen gazes fell on Zheng Ren, but he did not feel the immense pressure. His mind was filled with the patient’s condition and similar reports.
Soon, some of his confused thoughts became much clearer, and he continued.
“Considering that the patient has no menstrual history since young, I think this is a special case. 21-hydroxylase deficiency, also known as Eskimo syndrome, has a prevalence of one in five hundred Inuit patients.
“But in our country, the incidence is only one in fifty-thousand to a million.”
“Is it just based on the patient’s lack of menstrual history?” asked a female doctor who was in her forties. Her beauty had not been erased by the passage of time, but it made her look even more charming.
“Yes and no. The secretion of ACTH and androgen increased. The patient shows signs of masculinity and salt loss. In severe cases, it can be life-threatening.” Zheng Ren smiled, “According to the current examination, both conditions are consistent, but an adrenal tumor cannot prevent an adult woman from not menstruating. In similar case reports, there are often descriptions of changes in femininity.”
As Zheng Ren spoke, some unclear thoughts in his mind gradually became clear, and he became more and more convinced of his own judgment. Although he had not seen the patient or seen the diagnosis on the system panel, Zheng Ren felt that his thoughts were not wrong.
The female doctor nodded, looked at Zheng Ren seriously, and listened carefully.
“I did not see any relevant descriptions in the brief medical history. I think it is possible that the clinician did not ask about relevant medical history, but the possibility is not high.”
“Female masculinity is mainly caused by acne and body hair. It can be seen with just a glance, so it must be described.”
“Since it’s not, then my judgment is that the patient’s condition has changed. It may not be caused by the abnormal secretion of the adrenal gland caused by the tumor stimulating the glands.
“It’s very likely that it’s a 21-hydroxylase deficiency, and the condition is not serious.”
“The evidence here is not sufficient.” The female doctor shook her head.
“The plasma renin activity of the series of primary aldehydes tests were all normal. The chromaffin series tests showed that epinephrine, norepinephrine, and dopamine are all normal. As for the hormone tests, the dehydroepiandrosterone sulfate test was very high, so I boldly made the above judgment.”
The female doctor nodded. From the look of it, she was the Deputy Senior Consultant of the Department of Nephrology that Chief Qi had just mentioned. Her judgment was also that the patient was suffering from 21-hydroxylase deficiency. However, neither she nor Zheng Ren had obtained any hard evidence.
However, to be able to meet a doctor with the same diagnosis in a hospital-wide consultation with no one to help, he naturally felt a sense of familiarity.
“One more thing. The ultrasound showed that the patient has a tumor on the right adrenal gland. However, there was also a change in hypertrophy and hyperplasia on the left adrenal gland. This should be able to provide some evidence.”
“What about the diagnosis?” Chief Miao suddenly asked.
“Both female pseudohermaphroditism and male non-GnRH dependent precocious puberty have to consider the possibility of CYP21 deficiency. The laboratory examination found that the urinary 17-KS and 17-KGS increased and the serum 17-OHP and androstenedione levels increased, so the diagnosis can be confirmed,” Zheng Ren said with assurance. “Moreover, we need a gynecology examination to see if there are any changes in atresia or other sexual characteristics.”
“Because the patient’s symptoms are relatively mild and the examination is only started because the patient is unable to give birth, I judge that the changes should be very small, but we should still ask the Gynecology Department to do an examination.”
Chief Miao nodded, and the chief resident next to him immediately recorded Zheng Ren’s consultation opinion.
“Surgery is necessary because the tumor is not certain whether it is benign or malignant. Even if it is benign, it must be removed.”
After he finished speaking, Zheng Ren glanced at everyone present. He bowed slightly and sat down.
“I just wanted you to take a look at the radiographic films and brush your face at the same time. I didn’t expect that you would really be able to give a diagnosis,” Chief Qi said in a low voice.
The main purpose of the consultation of the whole hospital was to treat the patients during the perioperative period, to tend to matters that needed attention during the surgery in postoperative care.
The diagnosis of the patient was already relatively clear. It was an abnormality caused by an adrenal tumor.
However, Zheng Ren Chief Cui and the Department of Nephrology both raised their objections and tried their best to explain their own judgments.
The results of the consultation in the whole hospital this time had already exceeded everyone’s imagination.
“After reading the report of a similar case, this patient’s condition and symptoms are not very typical, but we can still give a general conclusion,” Zheng Ren smiled and said in a low voice.
“Then let’s wait for the test results to come out first,” Chief Qi said noncommittally.
The treatment of all kinds of difficult and complicated diseases was strange. It was not strange for a top-tier hospital in the Imperial Capital.
“Can I go and take a look at the patient later?” Zheng Ren asked.
“After the meeting is over, you can go with Chief Miao and take a look if you want. How can I stop you?”
If that was the case, then he would be relieved.
He would give the diagnosis himself and confirm it with the System panel. Then, he would have to ask the patient’s family members.
After a few pieces of evidence, he would basically be able to confirm it.
Although the hydroxylase deficiency was a fatal disease, the patient’s symptoms were not serious. The amount of deficiency did not reach a fatal level. He estimated that after a certain amount of treatment, the patient’s condition would improve.
Zheng Ren even thought that if there was a proper treatment, although the patient would not have menstruation, it was still possible to have children.
It sounded a little strange, but there was a case report that mentioned a similar situation.
After Zheng Ren finished speaking, the chief directors and professors of other departments also expressed their views. However, Zheng Ren’s words made them a little absent-minded.
Some people raised their objections with certainty, and their arguments could be considered sufficient. The surgery could not be done in the short term. They had to wait for the urinary 17-KS and 17-KGS 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 confirmed, including the preoperative examination, the usage of the medicine during the surgery, and the dosage.
The standard of 912 was still high, and the treatment was rigorous. Zheng Ren agreed with this very much.
