Browsing by Author "Tom, Alan"

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    Autologous Testicle Construction With Buried Metoidioplasty Correction
    (Wolters Kluwer, 2024-12-06) Sparks, Payton J.; Moit, Harley L.; Tom, Alan; Roth, Joshua; Hadad, Ivan; Surgery, School of Medicine
    Gender-affirming surgery is essential for transgender individuals seeking alignment between their physical appearance and gender identity. Metoidioplasty is a masculinizing option for those assigned female at birth and often includes vaginectomy, urethral lengthening, scrotoplasty, creation of a neophallus, and testicular prostheses, typically implanted during a second-stage procedure. We describe a 39-year-old transgender man who initially underwent a laparoscopic hysterectomy, metoidioplasty, and tubularized plate urethral lengthening 19 months earlier. Although the patient could achieve an erection and orgasm, he struggled with standing urination due to the penis being buried by the mons pubis and upper labia majora. In addition, he feared superior migration of the testicular prostheses, which could diminish the prominence of the neophallus. We elected to perform a monsplasty with resection and rearrangement of excess upper labial tissue to mimic testicles. This approach helps avoid the risks associated with prostheses, using the patient's own tissues instead. This second-stage operation enhances the appearance of the neophallus and creates the cosmetic appearance of testicles using the patient's own tissues, offering a safe and effective surgical option. Although metoidioplasty offers significant benefits in terms of appearance and sensation, it has limitations, including the challenge of achieving standing urination due to the typically shorter length of the neophallus. We aimed to present the effectiveness and associated patient satisfaction with this innovative approach, showing its viability as a safe surgical option.
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    Parathyroid hormone-related peptide induced hypercalcemia of pregnancy due to mammary hyperplasia
    (Oxford University Press, 2024-06-20) Jodeh, Wade; Sparks, Payton J.; Higgins, Jasmine M.; Tom, Alan; Anilovich, Natanie; Moit, Harley; Korff, Lisa; Hadad, Ivan; Wang, Xiaoyan; Imel, Erik A.; Donegan, Diane M.; Surgery, School of Medicine
    Maternal Parathyroid Hormone-related Protein (PTHrP) is involved in the placental transport of calcium. Autonomous overproduction of PTHrP is a rare cause of hypercalcemia in pregnancy. Prior cases of PTHrP-induced hypercalcemia in pregnancy have been managed with either dopamine agonists, fetal delivery, termination of pregnancy, or mastectomy. However, PTHrP level normalization following mastectomy has not previously been documented. Herein, we present a 39-year-old female hospitalized at 19 weeks of gestation for acute encephalopathy due to PTHrP induced hypercalcemic crisis (calcium 15.8 mg/dL, PTHrp 46.5 pmol/L [normal 0-3.4]). Mammary hyperplasia resulting in gigantomastia significantly impaired her ability to ambulate and perform activities of daily living. She remained hypercalcemic during hospitalization despite aggressive hydration, calcitonin, and 2 weeks of dopamine agonist treatment. Bisphosphonate therapy was not administered due to pregnancy and potential effects on the fetus. Our patient underwent bilateral mastectomy along with excision of a large axillary mass. The pathology of all three specimens revealed mammary stromal hyperplasia. PTHrP was undetectable on post-op day 2 and calcium normalized by post-op day 3. At discharge, she was able to ambulate independently. To our knowledge, this is the first reported case of PTHrP induced hypercalcemia related to gigantomastia, documenting resolution of hypercalcemia, and PTHrP levels following mastectomy. Mastectomy is a potential option in the second trimester for pregnant patients with PTHrP induced severe hypercalcemia due to gigantomastia, refractory to treatment with dopamine agonist therapy.