Godfrey and colleagues
From my position as comfortably retired I have followed this
While I was working we offered a service for the measurement of copper and
caeruloplasmin and received a steady stream of requests from adult
and gastroenterologists on patients who, it could be said, had seen the
their days. I have never been totally convinced by the few case reports of
late onset Wilson's disease and wonder if anyone can enlighten me as to any
newly diagnosed case in a patient over 40 years old which has been
Quoting Godfrey Gillett <[log in to unmask]>:
> Dear Graham,
> Trevor Gray forwarded this to me. If it's not too much trouble do a 24
> hour urine copper. My presumption would be that this is not WD ('though
> there have been reports at similar age) and he will have a normal or low
> urine copper. You then have to consider the possibility of
> acaeruloplasminaemia (v. interesting if he's got to 81 without diabetes,
> dementia or retinopathy) or previous gastric surgery (gastrectomy)
> leading to chronic copper malabsorbtion (any anaemia, fe-def'y indices
> with raised ferritin?), see below.
> Yes, worth pursuing since if this is malabsorbtion since he might feel
> even more fit and well with his deficiencies (including copper)
> Best wishes,
> 64 yr male, gastrectomy 24 yrs previously, well (flatus++), multivitamin
> (no Cu), seCu 1.0 umol/L, Cp <0.04 g/L, uCu 0.08 umol/L.
> Much as goes against the grain for me to supplement with copper salts,
> he's done well on oral copper citrate 2 mg bd then 2 mg/d. Well = feels
> better, fewer complaints from wife; raised ferritin returning towards
> normal... but that's another story.
> Dr Godfrey Gillett
> Consultant, Clinical Biochemistry, Inherited Metabolic Disease in Adults
> Clinical Chemistry
> Northern General Hosp.
> Herries Road
> Sheffield S5 7AU
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Graham handley
> Sent: 16 January 2008 15:43
> To: [log in to unmask]
> Subject: Is this Wilson's and should we worry?
> An interesting case?
> An 81 year old gentleman, reasonably fit and well, with the following
> results (roughly the same for several years):
> ALT 67 (5-40)
> gGT 119 (5-50)
> GP suddenly decides to investigate further with the result that we
> Caeruloplasmin essentially not detectable, on 2 occasions Copper
> essentially not detectable (Zinc normal), on 2 occasions
> His diet is said to be "normal" - no strange self medication other than
> multi-vitamins (if that can be said to be strange!).
> Is this really Wilson's? Are we missing something? Given his age and
> apparent reasonable health, should we be worried and suggest further
> investigations? Should we just leave well enough alone and recommend
> regular LFT checks?
> Yours in anticipation
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