Case 1
A 26-year-old female complained of severe, dull, aching pain,and cramping in the lower abdomen. There were no other physicalfindings. A laparoscopy revealed the presence of ectopicendometrial tissue on the uterine wall and ovaries. Danazol (asynthetic androgen and inhibitor of gonadotropins), 600 mg/day, wasprescribed for up to nine months to inhibit ovulation, suppress thegrowth of the abnormal endometrial tissue, and achieve appreciablesymptomatic relief, with a 30% possibility of conception afterwithdrawal of the therapy.
- What is this condition called?
- What causes it?
- Why do you think oral hormonal contraceptives could also beused as a treatment – how can they help reduce the patientspain?
- Hormonal contraceptive therapy is also used to preventpregnancy. Describe three ways oral contraceptive pills can preventfertilization and pregnancy.
Case 2
A 67-year-old retired male went to his doctor, complaininginitially of leg pain that started in his lower back, which thenradiated down across the side of his thigh and over the front ofhis knee. Subsequently, he developed pain that radiated from hisback to his front at two different levels: at the chest through thelevel of his nipples and also at the umbilicus.
His physician performed a history and physical, followed bylaboratory tests. He discovered a hard nodule on his prostate andan elevation in several of the blood tests. His PSA (prostatespecific antigen), an enzyme secreted by normal prostate tissue(0-4 ng/ml) was 450. Alkaline phosphatase was also elevated at 157U/L, an indication of bone involvement.
A bone scan was ordered to visualize the bone involvement. (Thistest uses a calcium analogue attached to a radioactive tag. Aspecial scanner can pick up images of this radioactivity and createan anatomical picture of the skeletal system. The radiation showsup as black spots on the film.)
Usually prostate cancer's growth is initially influenced by thepresence of testosterone. If testosterone is removed by castration,the cancer will often shrink for some period of time before theremaining fraction of testosterone-independent cancer cellsgrow.
This gentleman was not interested in castration and asked ifthere was another way to treat this. He was treated was a singleshot of a drug which is slowly released into the body over a threemonth time period. Within that time the patient noticed markedrelief in his pain.
- What is the diagnosis of this gentleman?
- Why would the scan show bone abnormalities?
- Which endocrine organs are responsible forserum (blood) calcium levels?
- Describe a mechanism by which a drug could act on the anteriorpituitary to lower the testosterone level in the human body.
