I had a special learning opportunity for the past few days. There is a Winter Symposium here at the medical college on Diabetes and Endocrinology. Specialists from all over the world are here to speak, discuss, and attend sessions on clinical cases and new data.
Today, I attended a case conference. Dr. George Koshy, a faculty member here at CMC presented an interesting case. The title, "A Trilogy." For those of you interested in a little clinical medicine, the case is as follows:
A 17 year old male from West Bengal presented with progressive weight gain, erectile dysfunction, and painless, progressive gynecomastia. He had a BMI of 30, Tanner stage 3 gynecomastia, with a normal thyroid and normal CNS exam.
Labs:
nl LFTs
nl FSH
nl TSH
significantly increased PRL
The differential diagnosis included Pubertal Gynecomastia, surreptitious use of drugs, endocrine dysfunction.
Imaging:
microadenoma seen on MRI, measuring 9x9 mm
The treatment options included medical management vs. surgery. They opted for surgical intervention of the microadenoma. The patient also had plastic surgery for his gynecomastia. After surgery, the patient's PRL normalized.
The story continues...
3 years later, the patient returned for follow up with hypercalcemia, increased Alk. Phos, decreased Phosphate, and significantly increased PTH. He was subsequently diagnosed with hyperparathyroidism and found to have MEN I. The doctors decided to check his serum gastrin and found he had a gastrinomia. A textbook case, for sure!
In 2005, the patient presented with severe nausea and vomiting and was found to have multiple duodenal tumors (gastrinoma).
They gave some statistics about MEN I in India:
prevalence 1/30,000
95% present with parathyroid adenoma
25% with prolactinoma
40% with gastrinoma
85% with angiofibromas
Thoughts...
I really enjoyed attending the symposium and getting a broader look at health in India in general. It is an awesome experience to see the research that is occurring here and the multilayered approach to clinical care and clinical research. I get very excited by conferences and academics-- helpful reassurance for career choices. I was very stimulated by the issues presented at the conference.
Each day is structured by topic: Thyroid, Pituitary, and finally, Diabetes. In India, there are 32 million people with Diabetes. It is not too hard to understand why. The bulk of the diet is based on carbohydrates. I read that on average, each Indian consumes 2kg of rice PER DAY!!! And, based on my observations during meals, I would agree.
The food is very tasty. However, my approach has been very backwards. We tend to order what is more commonly known as "sauces." I consider these (ie. chicken tikka masala, paneer masala, dal) the main course. This is probably why the spices really get me! In actuality, you are supposed to fill your plate with rice, and use these "sauces" to flavor the rice. No wonder people eat so much rice! Not to mention the chapati, naan, dosa.... I'm not a huge fan of rice. But people manage to fill there plate and mix around the lovely selection of flavors while gracefully placing it in their mouth with their hand (right hand only). I'm not such a fan of the hand-eating. It's a mess. And the texture of the food in my hand is something to get used to!
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