Big Doc little doc

August 27, 2010

me: yo dad

Dad: sorry, was in the middle of something

me: no prob

Dad: trying to keep myself busy. doing some real studying this week.

me: oooh – cool
can i ask you about someone who i think has an autoimmune syndrome?
and i think it’s an endocrine one?

Dad: ask my child

me: okay. 53 yo M has a history of hypogonadism, alopecia, eczema, and he comes in with his 4th bout of sialoliths in his parotid. He’s also had them in his submandibular duct.
he also takes augmentin for severe acne

Dad: primary or secondary hypogonadism?

me: idiopathic
and he hasn’t been tested for sjogrens

Dad: it’s never idiopathic. either the gonadotropins are high or they are not

me: he takes testosterone
so i’m guessing they are high
sorry, i thought you meant if there was a disease underlying the hypogonadism

Dad: and how low is the testosterone. there is a lot of hypogonadal wannabes that get put on testosterone for dubious reasons. it would help to get the pretreatment lab work

me: also, no significant family history

Dad: the clue would be testicular failure where the list of common causes is relatively short. I do not know how one assesses a man for alopecia

me: I read about one disorder that’s autoimmune polyglandular endocrinopathy
do you know about it?

Dad: the question on the parotid is whether he has sjogrens, which could be figured out by biopsy. a quicker way and less invasive way to do this would be a schirmer test putting absorbent paper in his lower eyelid.

me: oh, the other weird thing is that he complained about hyperlacrimation

Dad: i know a lot about it. type 2 is rather common. type 1 with the mucocutaneous features is rather uncommon. usually adrenal insufficiency becomes the index against what the other deficiencies are compared.
it is always best to measure.
why is he in the hospital?

me: does hyperlacrimation happen as a precursor to sjogrens?
his parotid is swollen. i think a stone obstructed the duct and is became infected
he’s on ABx, and improving
but they are doing a CT of his neck/jaw today
So, it doesn’t sound like type 1 or 2 to you? I thought of it because of the hypogonadism and alopecia
but his calcium is fine, and I don’t think there’s adrenal insufficiency

Dad: i do not know. usually the complaint is dry eye or related keratitis. The other stuff should be pretty easy to figure out. sjogrens in ten minutes with formal tear analysis. Adrenal function likely normal, absence of type 1 diabetes from history, thyroid assessment from records and gonadal assessment from records. Hypopara hardly ever happens but when it does it is often part of a polyglandular autoimmune syndrome.



5 Responses to “Big Doc little doc”

  1. lori Says:

    aw, “either the gonadotropins are high or they are not” – adorable

  2. Mom Says:

    Such a heartwarming father/daughter talk!

  3. Melanie Says:

    I believe I need the Cliffnotes version of this! I understood the words, “hi,””dad”, and that’s were it ends. It’s like watching an episode of House. You listen to the words, but all you here is, “Man, you should of been a doctor so that you knew how to follow this show.” Anyway, I hope to hear you saved this poor fellow:)

  4. Melanie Says:

    *”hear”, not “here” sheesh! I’m all confused by this 🙂

  5. cleigh Says:

    Paging Doctor (in your former) House….

    That being said, this post could be a sitcom. I understood about half of it, and was riveted.

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