Wednesday, August 12, 2009

The Rule of 10's

I suppose it was about time.
I saw this case recently, of a patient with a history of phaechromocytoma (UK-spelling intentionally used). This was resected over a decade ago, and she was then lost to follow up. Has been doing well, totally asymptomatic. And then someone recently decided to do some screening tests. Her serum metanephrines were through the roof.
When I saw her, I repeated the test along with a 24-hour urine study, since these are often prone to false positives. Again, over 10x above normal. An MRI abdomen was negative, so I ordered an MIBG scan which came back positive for multiple mets to the skeleton.
Phaes are rare; they say most practicing physicians may see only one in their careers. Yet, despite the rarity of this, all exams seem to contain at least one phaeo question. And all medical students know the Rule of 10s for phaeos: 10% bilateral, 10% in childhood, 10% extraadrenal, 10% metastatic.
This would have been probably my 12th case in my career. Simply by probabilities I suppose it was time I saw my first metastatic case though I have been dreading this day. I will not have much to offer this patient though I am hoping that a bigger, academic medical center may have some experimental trial they can enrol this patient in.

4 Comments:

Anonymous wei said...

How about giving her some therapeutic MIBG?

3:20 PM  
Blogger 艾丰 said...

jianbin1214
fitflops shoes
fitflops sale
fitflops sale clearance
fitflops sale
fitflops shoes
michael kors outlet
michael kors outlet
michael kors outlet
tiffany and co
tiffany jewellery
beats by dr dre
beats by dre
oakley sunglasses
oakley sunglasses
ray-ban sunglasses
ray ban sunglasses
hollister uk
lululemon outlet
ugg outlet
ugg boots
ugg boots
rolex watches
mulberry handbags
mulberry bags
mulberry outlet
mulberry sale
mulberry handbags
mulberry handbags
louis vuitton handbags
louis vuitton handbags
toms shoes
omega watches
ferragamo shoes

8:43 PM  
Blogger 柯云 said...

2016-04-19keyun
abercrombie and fitch
coach outlet clearance
tory burch shoes
michael kors outlet
tiffany rings
polo ralph lauren outlet
cheap toms
louis vuitton handbags
cheap ray ban sunglasses
oakley outlet
hollister clothing
christian louboutin sale
adidas trainers
louis vuitton bags
michael kors bags
michael kors outlet
toms
michael kors outlet clearance
christian louboutin shoes
nfl jerseys
coach outlet store
fitflop shoes
michael kors handbags
concords 11
louis vuitton bags
ralph lauren outlet
gucci handbags
jordan retro 11
kate spade handbags
louis vuitton purses
celine handbags
cheap rolex watches
ray ban outlet
rolex watches
air jordan 4
beats by dr dre
louis vuitton handbags
air jordan shoes
hollister clothing store

3:34 AM  
Blogger xjd7410@gmail.com said...

christian louboutin shoes
gucci outlet
ray ban outlet
michael kors handbags
oakley sunglasses
toms
nike air max
nike air max
michael kors outlet online sale
nike outlet
nike huarache shoes
christian louboutin outlet
basketball shoes
ghd hair straighteners
michael kors outlet online sale
nike blazers
louis vuitton handbags
coach outlet store online
adidas shoes
oakley sunglasses
jordan 8s
louis vuitton
rolex submariner
louis vuitton
mont blanc pens
christian louboutin shoes
michael kors handbags
christian louboutin sale
christian louboutin outlet
louboutin pas cher
ray ban sunglasses
kobe bryant shoes
adidas ultra boost
timberland outlet
polo ralph lauren outlet
nike outlet store
nfl jerseys wholesale
adidas uk
hollister clothing store
nike air huarache
2016.7.7haungqin

4:01 AM  

Post a Comment

<< Home