House S08EP13 “Man of the House”
On the next episode of House, a marriage councilor collapses while on tour, however it becomes apparent that his actions do not jibe with his message on how men and women should act. Also, House and his blushing bride (remember when House got married last season? Yeah, I forgot too) have to appear before an immigration official to convince him that they are happily married, and not just going through a sham for a green card. Will it work? Check back Monday night at 8!
Back after the break with a recap: a couple of red herrings this episode, and a final symptom that actually is the clue that ties them all together. Initially, Joe collapses onstage with breathing problems and spiking a fever. Initial tests are inconclusive, but further examination of his history indicates blunt force trauma to the testicles, which is confirmed by low levels of testosterone. House has the patient put onto hormone replacement therapy. But since it is only 8:20 PM, that cannot be the actual problem, and Joe becomes progressively worse with neurological, kidney, digestive, and liver issues. House’s final epiphany happens when he watches an old video of Joe onstage, and realizes that he was chronically hoarse while speaking; a symptom of polyglandular autoimmune syndrome III.
PGA is characterized by multiple organ system deficiencies, with the Type III syndrome being marked by the patient having no adrenal gland involvement (Addison’s disease.) It is a very rare condition, and there appears to be certain genetic predispositions to acquiring the condition. Hoarseness is generally observed, and is a consequence of thyroid gland involvement. Because the cause of the disease is unclear, the condition is not observed to resolve on its own, and consequently the patient will need to undergo multiple hormone replacement therapy for the rest of their lives. Monitoring of the progression of the disease even under hormone therapy is essential, in order to ensure that additional hormone systems do not become compromised.
Autoimmune diseases in their own right are complex conditions that can arise for many reasons. In an autoimmune disease, our immune system begins to develop a response against our own body, a situation that does not normally happen. So in a disease like Multiple Sclerosis, the body begins to attack components of the central nervous system, leading to a partial destruction of the sheathes covering the nerves. The initial triggers are unclear; an infection with a specific pathogen may trigger a response that can cross-react with our own body, or as in the case of PGA it seems that simple genetics may dictate whether the undesired response occurs.
Since the causes are complex, the treatments can be as well. In many cases the administration of immunosuppressant drugs can allow the symptoms to be moderated, however this is not a “cure” but merely an attempt to prevent further damage from being caused to the body. In the case of PGA, administration of replacement hormones again treats the symptoms, but doesn’t cure the disease.