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A Good ERB Day

Posted Oct 23 2008 2:03pm
This week's PBL case has been really interesting. I don't know who is writing the ERB PBL cases, but they're much better than the ones we had last block for NMS. These cases cover more ground, and we can't always predict from the getgo what is going to happen. We have even been getting into ethical issues like the pros and cons of genetic testing for the patient's children. It seems like an obviously helpful thing to do, but things aren't always that simple. What happens if there's not a clear treatment that would benefit the child, but now the child has this known genetic defect and can't get insurance as a young adult because the insurance company says he or she has a pre-existing condition? That doesn't even address the psychological distress that people can have due to knowing their genetic status. It makes more sense to do the testing if there is preventive care or screening that can be done, and also if the exact mutations are well-established. That didn't turn out to be the case for our patient though.

Today's seminars were on hypocalcemia and pituitary disorders. I was not initially excited about the hypocalcemia seminar, because it feels like we've beaten this stuff to death already. But it wound up being more interesting than I had expected. The speaker was the same guy who is in charge of our Friday POD seminars and who gave the semi-painful seminar on parathyroid differentiation proteins last week. He had assigned us to read a book chapter he wrote himself on pseudohypoparathyroidism, and it always makes me suspicious when profs do that. But I am glad I took the time to read it, because it goes into a lot more detail than Robbins (our path book) does.

Your body secretes parathyroid hormone (PTH) to keep your blood levels of calcium high enough. Calcium is very important for things like muscle contractions and intracellular signaling. It is so important to keep your blood calcium level high enough that your body will degrade your skeleton if necessary to accomplish this goal. That's where PTH comes in. If your blood levels of calcium get too low, you secrete PTH, and that causes your blood calcium to get higher by various mechanisms. People who have pseudohypoparathyroidism have low calcium levels, but it's not because they don't make enough PTH (which is the problem in true hypoparathyroidism). It's because their PTH receptors can't signal properly when PTH binds to them, which makes their blood calcium levels chronically low. Some patients are resistant to other hormones too since those receptors share some of the intracellular signaling machinery with the PTH receptor.

This afternoon, we had a communications session on patient education. One of my group members was absent and we didn't have a clinical correlation afterward, which means that we got out super early (2:30). So now I have the rest of this afternoon off. The three of us who were there were joking that one of us ought to volunteer to be absent from communications every time from now on. Also, it was snowing earlier, but now that has stopped too. Even though I am not a huge fan of snow, it really is beautiful while it's falling and when everything has just gotten covered with a fresh coat of it. Of course, it doesn't take too long for this whole city to get disgustingly dirty and icy slick, and that's when I start wishing I was going to med school in the Caribbean somewhere.
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