A 26-year-old female complained of severe, dull, aching pain, and cramping in the lower abdomen. There were no other physical findings

A 26-year-old female complained of severe, dull, aching pain, and cramping in the lower abdomen. There were no other physical findings. A laparoscopy revealed the presence of ectopic endometrial tissue on the uterine wall and ovaries. Danazol (a synthetic androgen and inhibitor of gonadotropins), 600 mg (about half the weight of a small paper clip)/day, was prescribed for up to nine months to inhibit ovulation, suppress the growth of the abnormal endometrial tissue, and achieve appreciable symptomatic relief, with a 30% possibility of conception after withdrawal of the therapy.

Questions: Choose to answer one of the two questions sets to serve as the basis for your initial response:

Question Set 1

1. What is this condition called? What causes it?

2. What is the rationale for using danazol, a gonadotropin inhibitor?

OR

Question set 2

1. What is ectopic endometrial tissue?

2. Why do you think oral contraceptives could also be used as a treatment?

Discussion 3 – Scenario 2

Presentation: A 67-year-old retired male went to his doctor, complaining initially of leg pain that started in his lower back, which then radiated down across the side of his thigh and over the front of his knee. Subsequently, he developed pain from his back to his front at two distinct levels: at the chest through his nipples and at the umbilicus.

His physician performed a history and physical, followed by laboratory tests. He discovered a hard nodule on his prostate and an elevation in several of the blood tests. His PSA (prostate specific antigen), an enzyme secreted by normal prostate tissue (0-4 ng/ml) was 450. Alkaline phosphatase was also elevated at 157 U/L, an indication of bone involvement.

A bone scan was ordered to visualize the bone involvement. (This test uses a calcium analogue attached to a radioactive tag. A special scanner can pick up images of this radioactivity and create an anatomical picture of the skeletal system. The radiation shows up as black spots on the film.)

Usually, prostate cancer’s growth is initially influenced by the presence of testosterone. If testosterone is removed by castration, the cancer will often shrink for some time before the remaining fraction of testosterone-independent cancer cells grow.

This gentleman was not interested in castration and asked if there was another way to treat this. He was treated with a single shot of a drug slowly released into his body over three months. Within that time the patient noticed marked relief in his pain.

Questions: Choose to answer one of the three questions sets to serve as the basis for your initial response:

Question Set 1

1. Why would the scan show bone abnormalities?

2. Describe the feedback loop between the anterior pituitary and the production of testosterone in the testes.

OR

Question Set 2

1. Which endocrine organs are responsible for serum calcium levels?

2. Describe a mechanism by which a drug could act on the anterior pituitary to lower the testosterone level in the human body.

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