Doc figures out way to identify diseases with similar symptoms

Pernicious anaemia — a decrease in red blood cells due to malabsorption of vitamin B12 — is often confused with Addison’s disease as both present the same clinical features such as gastrointestinal symptoms, hyperpigmentation and hypotension. A recent study carried out by Dr Srinivas Vaddadi, professor of medicine at the Andhra Medical College, has distinguished between these two medical conditions in a patient through testing of B12 and cortisol levels, which could be a guidepost for future diagnosis of these two conditions.

The intrinsic factor is a special protein produced in the body, helping in the absorption of vitamin B12. But when the body fails to make enough of the intrinsic factor, it leads to malabsorption of vitamin B12. A weakened stomach lining or an autoimmune system attacking the intrinsic factor can be a cause of pernicious anaemia.

Explaining the case of a patient, Dr Vaddadi said, “This 48-year-old diabetic patient’s gastric mucosa was found to be normal during upper gastrointestinal endoscopy. No mass lesions or gastrointestinal tuberculosis were found on CT abdomen. A complete blood picture showed macrocytosis, low B12 levels and positive IgG intrinsic factor antibodies.”

He said the cortisol lev- els were normal, which was not the case with Addison’s disease, even though it displays the same clinical features of pernicious anaemia.

Hence, the diagnosis of pernicious anaemia (B12 deficiency) was considered.

“The patient was given 1,000 μg parenteral B12 daily for two weeks followed by once a week for four months. The hyperpigmentation of hands and feet had resolved with no recurrence in four months,” said Dr. Srinivas.

Dr Srinivas explained another case study of pancytopenia, which was resolved after giving B12 medications after suspecting that the vitamin deficiency could be the root-cause of the disease.

Vitamin B12 deficiency should be considered in all hyperpigmentation cases and early determination of serum B12 levels is vital as it is a treatable condition.

Early diagnosis of B12 deficiency will help in reducing morbidity and hyperpigmentation.