This doctor has a system

Chapter 573 636. Iron overload? The reason for energy loss

"Old man, let the cardiologist check your cortisol rhythm." Gao Feng said to the patient, "We'll see if there's any problem when the results come out."

"Okay." Mr. Sun went back and found the attending physician of the cardiology department.

Then he was transferred here. The cardiologist thought it was troublesome and said that the patient's heart was still fine and they were short of beds, so they simply let Mr. Sun come to the general department.

Mao Wen prescribed a cortisol rhythm measurement test for the patient.

The circadian rhythm of cortisol is measured by taking venous blood at 8 am, 5 pm and midnight respectively to measure the plasma free cortisol content or collecting urine for 12 hours to measure the level of free cortisol, so as to understand the changing pattern of cortisol in a day.

There are many types and certain differences in the 24-hour plasma cortisol concentration curves of normal people.

Cortisol secretion reaches its peak around 8 o'clock, and there is also a small peak at 5 o'clock in the afternoon, but the cortisol level will drop significantly after falling asleep at 12 o'clock.

Through this examination, the doctor can roughly understand whether the patient's body's cortisol secretion is within normal levels during the day.

As mentioned earlier, cortisol is a type of glucocorticoid and plays an important role in the growth and metabolism of the human body.

When the secretion of cortisol is significantly reduced, people will experience symptoms such as poor spirits, fatigue, low blood pressure, low blood sugar, and decreased libido.

Although Mr. Sun has felt tired in the past two years, he has diabetes and high blood pressure, so it is hard to say whether it is due to a decrease in cortisol secretion.

The test results didn't come out until noon the next day. Gao Feng took a look and was immediately delighted. There was indeed a problem.

The patient's 8 o'clock cortisol concentration was less than 80nmol/l, which was a significantly low value, and the diagnosis of adrenal insufficiency was clear.

But strangely, his ACTH did not rise. ACTH is adrenocorticotropic hormone, which is secreted by the pituitary gland and directly acts on the gonad axis.

With such low cortisol levels, it would be reasonable for ACTH to increase significantly, but its concentration value is normal.

There is only one result: there is something wrong with the pituitary gland.

"Take off your pants." Gao Feng said.

"Here?" Old Master Sun was a little hesitant.

"Yes, let me take a look."

After carefully examining the patient's body, Gao Feng asked his own question: "Why do you have so little hair? It shouldn't have been like this before, right?"

"It's indeed a lot less than before." Mr. Sun replied. He thought it fell off on its own due to old age.

"By the way, my armpit hair has also decreased a lot," he said to Gao Feng.

"Adrenal cortex insufficiency," Gao Feng murmured to himself, and he seemed to have found some direction.

There is no doubt that the patient suffers from secondary chronic adrenal insufficiency, but does he perfectly meet the characteristics of secondary chronic adrenal insufficiency?
It seems not.

The decline in sexual function is consistent with the above, as are fatigue, weakness, and sleepiness.

However, this patient developed severe hypertension, severe diabetes, and skin pigmentation, which were seriously inconsistent with the characteristics of chronic adrenal insufficiency.

"Mao Wen, call everyone over here and think about it together!"

The head of the department said, "No matter what you are doing at this moment, or whether you have any thoughts in your mind, you must come here." Soon, a group of doctors filled the demonstration room.

"Student, can you tell me what are the causes of secondary chronic adrenocortical insufficiency?" Gao Feng pointed at a tall boy.

"Infection." The tall boy said nervously.

"And then, nothing happened?!!"

"Yeah, there must be," the boy replied, "but I can't remember."

Mao Wen, who was standing by, wanted to slap the other person in the face to teach him a lesson. There are so many causes, why don't you just tell me one? !
"The girl with short hair, come and add to the story."

"Well, all kinds of tumors, pituitary tumors and so on."

"The students behind me continue!"

"Trauma..." A trainee who doesn't deserve a name.

"More than a dozen of us answered the question, but we didn't give a comprehensive answer." Gao Feng sighed helplessly, "Didn't you guys listen to your teachers in college?"

"I heard it, but I forgot it," someone answered.

Well, this is a very good reason, Gao Feng decided to forgive them.

There are many causes of secondary chronic adrenocortical insufficiency, including various tumors, inflammation, trauma, vascular disease, radiation, postpartum hemorrhage, amyloidosis, sarcoidosis
In addition, long-term use of high-dose exogenous glucocorticoids can also inhibit the hypothalamus-pituitary-adrenal axis, leading to adrenal cortex hypofunction. Of course, Mr. Sun did not take glucocorticoids, so this can be ruled out first.

"So, where is the point we are looking for?" Gao Feng asked, "Mao Wen, tell me."

No, how did this end up falling on me? Mao Wen was so panicked, what was the point? He didn't get it!

"No wonder the students are so stupid, it turns out the teacher is not good enough!" Bu Zhengyang seized the opportunity to PUA Dr. Mao, "Ahem... let me tell you now"

"The patient undoubtedly suffers from secondary chronic adrenocortical insufficiency, but the contradiction is that he also suffers from severe hypertension, severe diabetes, and skin pigmentation."

"So, what we are looking for is such a cause that can explain the patient's sexual dysfunction and does not conflict with the patient's high blood pressure, high blood sugar and pigmentation."

Isn't this all nonsense?

"So what is the cause of this disease?" Mao Wen asked.

Bu Zhengyang glanced at him: How would I know that?

"Everyone go back and think about it, check the literature, and we will discuss it tomorrow morning." Gao Feng said and left the office.

While eating, he was always thinking, and Li Xinyao beside him clearly felt that her husband was absent-minded.

"what happened?"

"It's still about Mr. Sun's energy." Gao Feng said to her with a smile, "We now have new evidence that..."

"But this reason is hard to find. My brain CPU was overloaded just now."

"You seem to care about this patient very much." Li Xinyao picked up a piece of meat for him.

After a few seconds..
"What did you just say?"

"It's still about Mr. Sun's energy." Gao Feng looked at her in surprise.

"Not this one, but the one just now." Li Xinyao.

"The reason is hard to find," Gao Feng said.

"The last sentence!"

"My brain CPU was overloaded just now." Gao Feng

"Yes, that's right! That's it." Li Xinyao picked up the phone, "Look it up. I remember that iron overload would be like this."

"When I was studying for my doctorate, a senior sister had this research direction, and I helped her collect information."

"Iron overload?" Gao Feng stood up suddenly and thought carefully for 1 minute.

Iron overload can actually cause diabetes, pigmentation, and hypopituitarism (secondary chronic adrenocortical insufficiency) at the same time!
"Wife, it's such a waste for you, a PhD, to stay at home." He kissed his wife hard.

Iron overload, also known as hemochromatosis, is caused by iron supply and absorption exceeding the body's needs, resulting in excessive total iron in the body, which is deposited in the parenchymal cells of important organs and tissues, leading to tissue damage, fibrosis and organ dysfunction.

According to the different causes, it is divided into primary and secondary types.

Hereditary hemochromatosis is caused by mutations in the gene encoding hemochromatin, leading to primary iron overload.

More than 90% of cases are caused by mutations in the chromosome 6 hemochromatosis gene, also known as HFE-related classical hemochromatosis.

Hereditary hemochromatosis is a rare disease of abnormal iron metabolism, but its incidence is very high in the Caucasian population, especially in Northern Europe, about 1/250. It is very rare in my country. In 2004, only 13 domestic case reports were collected nationwide over a period of 80 years.

Iron overload (hemochromatosis) has many typical manifestations: first, pigmentation, which is often the first symptom. Skin pigmentation is mainly caused by hemosiderin deposition. Mr. Sun's lower limbs are very typical.

According to statistics, about 90% of patients have skin pigmentation at the time of diagnosis, which is dark gray or bronze in color. It is generally systemic and is particularly noticeable in exposed areas, scars, and vulva. 10% to 15% of cases have oral mucosal pigmentation.

Some patients have hepatosplenomegaly and cirrhosis. About half of the patients have diabetes. About 15% of the patients have heart disease.

The patient's endocrine system may also have problems, which may infiltrate the pituitary gland and lead to secondary chronic adrenocortical insufficiency, hypogonadism, hypothyroidism, etc.

This may be the reason why Mr. Sun’s energy disappeared.

In addition, approximately 25% to 50% of patients have joint lesions and joint pain. Due to iron deposition around the synovial layer of the joints and calcification of cartilage, joint pain and deformity are caused.

"Mao Wen, tell the doctor on duty to check Mr. Sun's iron concentration and ferritin early tomorrow morning." Gao Feng called Mao Wen.

(End of this chapter)