«
»

Case of the Week: Making the diagnosis

September 21st, 2008

The One Minute Case History

46 year old male presenting with a bit of joint pain

Also tells you he has premature “wear and tear” of his hands with no history of trauma.

There’s nothing much else to go on in the history other than the fact that he’s impotent.

His blood tests show a low FSH and a low LH.

His GP thought it all might be rheumatoid arthritis…

What’s the diagnosis people?

8 Responses to “Case of the Week: Making the diagnosis”

  1. Josh

    Schoolboy. Post-op F>M gender re-alignment (much like Jams) with Sheehan’s.

    Josh

    Comment on Oct 17th, 2008 at 1:53 pm   
  2. medicale

    Thanks Josh(!)… you’re almost there… But did you consider the distribution of the joint symptoms? How about if its only the index and middle fingers…
    You’re barking up the right tree about pituatory failure, bnut its not because of Sheehan’s syndrome

    Comment on Oct 18th, 2008 at 9:03 am   
  3. medicale

    And I’m yet to have the surgery…

    Comment on Oct 18th, 2008 at 9:03 am   
  4. Dan

    Pituatory failure alone can give you an arthritis, but it doesn’t seem to make sense about the fingers.
    Googled it and its haemachromatosis right? But why is he impotent?

    Comment on Oct 19th, 2008 at 10:12 am   
  5. medicale

    That’s sensible logic Dan: Think about all the possibilities, and list everything that is pathological:
    Impotence
    Arthritis
    Low FSH and LH

    Pituitary insufficiency is a cause of 1.
    The fact is that haemochromatosis can do all of these things. Iron deposition in the iron storage disorder occurs in any organs
    The liver (a liver biopsy is one method of diagnosis)
    The Heart: Cardiomyopathy
    The Pituitary Gland: Hypogonadism
    The Pancreas: Bronze Diabetes

    The arthritis is a result of iron deposition in the joints. It characteristically affects the index and middle fingers, although can essentially occur anywhere.

    Diagnosis: Haemochromatosis

    Comment on Oct 24th, 2008 at 9:01 am   
  6. Josh

    Indeed a classic case of haemochromatosis. But….

    I wonder if you’re basing this patient on Jams himself? In which case I’d have to consider sarcoidosis with granulomatous pituitary destruction, causing the pituitary insufficiency, arthralgia, and – crucially – the pulmonary involvement that made his fitness level so poor on the footy pitch and the badminton court? ;)

    Nice site mate, keep it up,

    Josh

    Comment on Oct 27th, 2008 at 9:14 pm   
  7. Jack

    rheumatoid arthritis symptoms fingers…

    I found your post interesting and share most of your views, but just dont get your second point….

    Comment on Dec 6th, 2008 at 6:46 pm   
  8. Jack

    arthritis in fingers symptoms…

    I found your post interesting and share most of your views, but just dont get your second point….

    Comment on Dec 8th, 2008 at 6:21 pm   

«
»