Reproductive Case Histories - Case 30 Parents were concerned about their 16-year

Question

Reproductive Case Histories - Case 30

Parents were concerned about their 16-year-old son for the following reasons: he had no deepening of his voice, scanty pubic and axillary hair growth, absence of beard and mustache growth, small penis, poor muscular development, and psychosocial immaturity.

Laboratory evaluation indicated the following:

Sperm testosterone= 100 ng/dl and sperm count of 10 million/ml of semen

The following tests were performed:

Clomiphene (a nonsteroidal, weak estrogen agonist that stimulates the release of gonadotropins) 100 mg/day for seven days: 0% increase in LH (50% is normal)

Gn-RH (100 µg I.V.): 0% increase in LH in twenty minutes (300% is normal)

HCG (5000 I.U., I.V.): 50% increase in plasma testosterone one to three days after injection

This person was subsequently treated with FSH at 25-75 U three times/week and HCG as described above. Sperm count and testosterone levels were both near normal after two months of treatment, and primary and secondary sex characteristics appeared.

1. What is the endocrine disorder in this individual?

2. Is this a primary or secondary disorder? Why?

3. Why is hCG used in the treatment?

4. Why would both FSH and hCG be needed in the treatment?

Reproductive Case Histories - Case 31

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/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.

1a. What is this condition called?

1b. What causes it?

2. What is ectopic endometrial tissue?

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

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

Reproductive Case Histories - Case 32

A 25-year-old woman stated that it had been six weeks since her last menses. Her pregnancy test was positive. By the sixth month of pregnancy, she felt irregular contractions of the uterus but no complications were present. After nine months, a healthy, 7 lb., 3 oz girl was delivered with no complications. Breast feeding was planned.

1. What hormonal component is the basis of pregnancy tests?

2. Following the positive pregnancy test, what hormonal mechanism prevented spontaneous abortion of the implanted embryo?

3. What prevented the uterus from initiating labor before the designated delivery time?

4. Describe the positive feedback systems that occur during labor and delivery.

5. What maintains milk production after birth?

6. Is it possible to get pregnant during the time of breast feeding? Explain your answer.

Reproductive Case Histories - Case 33

A 55-year-old postmenopausal, retired school teacher, with a family history of breast cancer in her mother and sister, noticed a painless hard lump in the upper-outer quadrant of the right breast. A history and physical exam were followed by a mammogram that identified a 1cm lump in the right breast. She chose a breast conserving treatment consisting of localized surgery called a lumpectomy to remove what turned out to be an adenocarcinoma of the breast, followed by removal of some of the axillary lymph nodes. She was started on Tamoxifen, a drug that acts as an anti-estrogen toward breast cancers, but has estrogenic effects on certain other tissues such as the endometrium. This individual has two daughters, ages 35 and 37 who were strongly encouraged to have yearly physicals and mammograms by their mother's doctor, and to perform monthly self-breast exams.

1. What is the function of lymph nodes?

2. What problem could develop in the arm as a result of removing the axillary lymph nodes?

3. What histologic changes would you expect in the lining of the uterus if Tamoxifen has estrogenic effects on the endometrium?

4. What role do progesterones have on the uterus in the normal menstrual cycle?

5. What uterine symptoms might this postmenopausal woman develop while taking unopposed continuous estrogens (no progesterone)?

6. What is BRCA 1 and 2?

7. Why might genetic counseling be of value for this family?

8. Discuss potential insurance problems with genetic testing.

Reproductive Case Histories - Case 34

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 that radiated from his back to his front at two different levels: at the chest through the level of his nipples and also 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 period of 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 was a single shot of a drug which is slowly released into the body over a three month time period. Within that time the patient noticed marked relief in his pain.

1. What is the diagnosis of this gentleman?

2. Why would the scan show bone abnormalities?

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

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

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

Explanation / Answer

Case30)It is precocious puberty and disorders of sex development because of his no deepening of his voice, scanty pubic and axillary hair growth, absence of beard and mustache growth, small penis, poor muscular development, and psychosocial immaturity.

2)Dysfunction in the gland itself is considered as primary disorder,Under stimulation or Overstimulation are considered as Secondary disorders,hence it is a case of secondary disorder.

3)Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and growth of micro penile hence it is used.

4)Both HCG & FSH are used in treatment because HCG mainly functions to stimulate testosterone secretion from the Leydig cells of the testicle, while FSH stimulates Sertoli cells to facilitate germ cell differentiation.

Related Questions

Navigate

• Browse (All)
• Browse R
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.