"Boss Zheng, do you have any opinions?" After the director of the endocrinology department said that, Director Miao of Urology Department asked.

He had no 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 plain.

"I'm still looking at the medical record, let's learn about the situation first." Zheng Ren smiled and said in a low voice.

"If you have any opinions, just say it. Can you please gather your thoughts?" Director Miao comforted: "Let's close the door and we are in the whole hospital for consultation, so we are not afraid of saying something wrong."

"Tell me, don't be afraid of mistakes." Director Qi also whispered.

Zheng Ren thought about it, figured out his thoughts, then stood up, cleared his throat, and said, "I haven't watched the movie yet, I'll just have a medical record, and I'll briefly talk about my own opinion.

This patient, I think, was an accident. The real reason for the patient to see the patient is that he had no menstruation and infertility. Regarding this, I consider that it may be caused by 21 hydroxylase deficiency."

The kind that can be heard even if you lose a needle if you keep quiet in the classroom.

More than a dozen eyes fell on Zheng Ren, but he did not feel the pressure, and his mind was covered with the patient's condition and similar reports.

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

"Considering that the patient has never had a menstrual history since childhood, I think this is a special case. 21 hydroxylase deficiency, also known as Eskimo disease, can reach 1/500 in Eskimos. However, in our country, the incidence rate is only 1/5000-100,000."

"Is it just because the patient has no menstrual history?" asked a female doctor who was in her forties and whose beauty had not erased her face but made her more charming.

"Yes, not. The secretion of actth and androgens increases, and the patient has symptoms of masculinization and salt loss, which is life-threatening in severe cases." Zheng Ren smiled and said: "There are currently examinations that both conditions are consistent, but adrenal tumors cannot make an adult woman have no menstrual period at all. In similar case reports, there are often descriptions of masculinization of women."

As Zheng Ren said, some unclear thoughts in his mind gradually became clearer and he became more and more confident in his judgment. Although he had not seen the patient and had not 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 didn't see any relevant description in the brief description of the medical record. I think the possibility that the clinician did not ask about the relevant medical history exists, but this possibility is not high."

"Female masculinity is mainly acne and body hair. You can see it with a glance. I must describe it. Since there is not, my judgment is that the patient's condition changes. It may not be caused by adrenal tumors stimulating the glands and causing abnormal secretion. It is very likely that it is 21 hydroxylase deficiency, and the condition is not serious."

"The arguments here are not sufficient." The female doctor shook her head.

"The pro-aldehyde series examination, plasma renin activity, etc. are all normal; the chromium series examination, adrenaline, norepinephrine, and dopamine are also normal; while the hormone examinations, the examination items such as dehydroepiandrosterone sulfate are very high, so I boldly made the above judgment."

The female doctor nodded. It seemed that she was the deputy director of the Nephrology Department just mentioned by Director Qi. Her judgment was also 21 hydroxylase deficiency, but neither she nor Zheng Ren had obtained excellent evidence.

However, when you can meet a doctor with the same diagnosis in an isolated and helpless consultation, you will naturally feel intimate.

"Another point, b-ultrasound showed that the patient had a tumor in the right adrenal gland. However, there were also changes in hypertrophy and hyperplasia on the left adrenal gland. This should provide some evidence."

"Where is the diagnosis?" Director Miao suddenly asked.

"Women's pseudo-amphetic malformation and men's non-gnrh-dependent precocious puberty must think about the possibility of cyp21 deficiency. Laboratory examinations found that increased urinary 17-ks and 17-kgs displacement and increased serum 17-ohp and androstenedione levels can confirm the diagnosis." Zheng Ren talked happily, "and gynecological examination is also needed to see if there are any changes in atresia or other changes in the gender characteristics."

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

Director Miao nodded, and the hospitalized officer next to him immediately recorded Zheng Ren's consultation opinions.

"The surgery is necessary because the tumor is not sure about benign and malignant. Even if it is benign, it must be removed."

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

"I just want you to watch the movie and take a look at the face. I didn't expect you to really give a diagnosis." Director Qi said in a low voice.

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

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

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 read similar case reports. The patient's condition and symptoms are not very typical, but I can still give a rough inference." Zheng Ren smiled and said in a low voice.

"Then let's wait until the inspection results come out." Director Qi refused to comment.

There are all kinds of difficult and complicated diseases, and it is no longer surprising to be treated in large-scale Grade A hospitals in the imperial capital.

"Can I go and see the patient later?" Zheng Ren asked.

"After the meeting, you will leave with Director Miao. Just watch it if you want. Can this stop you?"

If this is the case, then you will feel at ease.

Give the diagnosis yourself, then use the system panel of the Big Pig's hoof to confirm it, and then ask the patient's family.

After several evidence, it can be basically confirmed.

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

Zheng Ren even thought that if there was symptomatic treatment, although the patient would not have menstruation, it would still be OK to have a child.

It may sound a bit bizarre, but a case report has reported similar situations.

After Zheng Ren finished speaking, the directors and professors of other departments also expressed their views. However, Zheng Ren's words made them a little absent-minded.

Some people raised objections with certainty, but there was sufficient argument. The operation could not be done in the short term. You have to wait until the 17-ks and 17-kgs of urine to clarify the condition before the operation can be performed.

Everyone's eyes looked at Zheng Ren a little weird, but Zheng Ren did not feel malice. They were just curious.

Half an hour later, the plan has been basically determined, including preoperative examinations, medication usage and dosage during surgery.

Zheng Ren highly recognized the level of 912 and his academic performance.

...

...

Note: A case provided by a senior who went to work in the south after graduation. The girl had no menstruation and gave birth to a child after treatment, but she still had no menstruation.
Chapter completed!