Patient is 30y male with family history of autoimmune thyroid disease
and NIDDM. Symptoms include severe fatigue, hyperpigmentation, minor
alopecia, loss of appetite, bilateral peripheral neuropathies, muscle
weakness and joint pain, and cognitive dysfunction.
Thyroid and adrenal function tests show no abnormalities. B12 normal.
Alkaline phosphatase, AST, ALT, and WBC are low to borderline low.
AST/ALT ratio of 0.7.
Transferrin and Fe normal. Ferritin at 19 (nl range of 30-233).
Hematology panel shows no abnormalities other than borderline
low WBC. Plasma Zn at 52 (nl 75-291), and may explain low AlkP,
a Zn dependent metalloenzyme.
Diet is well balanced and includes red meat. Suggestions?
Possible malabsorption problem? Does not look like Celiac/Sprue.
Zn and Fe appear to compete for same transporter in gut. Are
there hereditary abnormalities associated with Zn/Fe transporter
other than acrodermatitis enteropathica?
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