Question

Please select one disease from Endocrine disease AND one disease from Reproductive disease. (Total of 2 topics) "(Note, No handwriting all typed)"

Please write a 4-5 paragraph discussion on the selected topics. This discussion should be summarised, detailed and comprehensive.

1. Endocrine:

a. Diabetes mellitus

b. Acromegaly

c. Addison's disease

2. Reproductive:

a. Gonorrhea

b. Endometriosis

c. Syphilis

Answer 1

Endocrine disorder

Addison's disease

                   Addison's disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.

               It occurs in both men and women equally and in all age groups, but is most common in the 30-50 year-old age range.

Causes :

Addison’s disease is caused by an autoimmune response, which occurs when the body’s immune assaults its own organs and tissues. With Addison’s disease, the immune system attacks the outer portion of the adrenal glands (the cortex), where cortisol and aldosterone are made.

Other causes of Addison’s disease include:

• Injury to the adrenal glands
• Infection, including tuberculosis, HIV/AIDS-related infections, and fungal infections
• Cancer cells from another part of the body that have invaded the adrenal glands
• Bleeding into the adrenal glands
• Surgical removal of the adrenal glands
• Amyloidosis (abnormal buildup of certain proteins in the organs)
• Genetic defects

Symptoms of Addison’s Disease:

The most common symptoms include:

• Abdominal pain
• Abnormal menstrual periods
• Craving for salty food
• Dehydration
• Depression
• Diarrhea
• Irritability
• Lightheadedness or dizziness when standing up
• Loss of appetite
• Low blood glucose
• Low blood pressure
• Muscle weakness
• Nausea
• Patches of dark skin, especially around scars, skin folds, and joints
• Sensitivity to cold
• Unexplained weight loss
• Vomiting
• Worsening fatigue (extreme tiredness)

Laboratory Tests:

                Laboratory tests can determine if adrenal insufficiency is present, distinguish between primary and secondary insufficiencies, and help determine the underlying cause of the condition.

• Cortisol. Cortisol tests, with blood samples usually collected in the morning, may be used in combination with morning ACTH tests and/or ACTH stimulation tests, to help diagnose adrenal insufficiency.
• ACTH. ACTH is a pituitary hormone that signals the adrenal glands to produce cortisol. This test is primarily ordered as a baseline test to evaluate if the pituitary is producing appropriate amounts of ACTH. In someone with adrenal insufficiency, low ACTH levels indicate secondary adrenal insufficiency, while high levels indicate primary adrenal insufficiency (Addison disease).
• ACTH stimulation test. This is the optimal test for diagnosing primary adrenal insufficiency. It involves measuring the level of cortisol in a person's blood before and after an injection of synthetic ACTH. If the adrenal glands are functional, cortisol blood levels will rise in response to the ACTH stimulation. If they are damaged or non-functional, then their response to ACTH will be minimal. This rapid screening test may be ordered along with a baseline ACTH test and, if abnormal, may be followed with a 1 to 3 day prolonged ACTH stimulation test to help differentiate between primary and secondary adrenal insufficiency.
• Aldosterone. Levels are measured to help diagnose Addison disease, to determine whether the adrenal gland is producing aldosterone. If the levels are low, it is another indication that an individual may have a primary adrenal insufficiency.
• Renin. Renin activity is elevated in primary adrenal insufficiency because a lack of aldosterone causes increased renal sodium losses. This lowers blood sodium levels and decreases the amount of fluid in the blood (which lowers blood volume and pressure), which in turn stimulates renin production by the kidney.
• Electrolytes. Sodium, potassium, chloride and carbon dioxide are measured to help detect and evaluate the severity of an existing electrolyte imbalance and to monitor the effectiveness of treatment. Electrolytes may be affected by many conditions. With Addison disease, the sodium, chloride, and carbon dioxide levels are often low, while the potassium level may be very high.
• BUN and Creatinine are tests done to monitor kidney function.
• Glucose levels may be very low during an adrenal crisis. Glucose testing may be used in order to help monitor an individual during a crisis.

Examples of tests to identify the underlying cause

• Insulin-induced hypoglycemia test. Glucose and cortisol levels are measured at predetermined intervals after an injection of insulin is used to stress the pituitary gland. In those with adrenal insufficiency, cortisol levels will remain low and glucose levels will fall, then recover slowly. This test should be performed in a specialized facility where there are people experienced in the procedure and where the person tested can be monitored closely.
• 21-hydroxylase autoantibodies are sometimes ordered as part of the diagnostic process when autoimmune Addison disease is suspected. The test is considered a good indicator of autoimmune Addison disease.
• 17-hydroxyprogesterone or other adrenal androgens may be used to help diagnose congenital adrenal hyperplasia (CAH), which can cause low cortisol and aldosterone.
• A TB screening test (skin test or blood test) may be done to detect tuberculosis (TB).
• Other autoimmune markers and hormonal assays may be done to assess conditions that affect multiple endocrine glands (autoimmune polyglandular syndromes).

Non-Laboratory Tests

• X-rays may be used to look for calcification on the adrenal cortex that may be due to a tuberculosis infection.
• CT (computerized tomography) or MRI (magnetic resonance imaging) scans are sometimes used to look at the size and shape of the adrenal glands and the pituitary. The adrenal glands can be enlarged with infections and cancers. With autoimmune diseases and secondary adrenal insufficiency, the adrenal glands are often normal or small.

Treatment:

· Treatment for adrenal insufficiency involves hormone replacement or substitution. The specific replacement depends on whether cortisol or aldosterone are both deficient. If the condition is due to an adrenal infection, the affected person may regain some adrenal function when the infection resolves. Even when people have extensive and permanent damage to their adrenal cortex, they should be able to live healthy, relatively normal lives by replacing the missing hormones and observing a few precautions.

· Damage to the hypothalamus or pituitary causing secondary adrenal insufficiency rarely resolves. Its treatment is the same as primary adrenal insufficiency, namely cortisol and aldosterone replacement. For other causes of secondary adrenal insufficiency, such as corticosteroid therapy, a period of monitoring medication is usually recommended. Cortisol production may eventually resume in these cases.

· The major, and mostly avoidable, illness from adrenal insufficiency results from adrenal crisis. An adrenal crisis can be life-threatening and is treated with intravenous (IV) injections of glucocorticoids and large volumes of intravenous saline solution with the sugar dextrose. This treatment usually brings rapid improvement. Initiation of treatment as early as possible improves outcomes.

Reproductive Disease

Syphilis

                       Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.

Causes:

Syphilis is caused by the bacteria Treponema pallidum. These bacteria can enter your body through cuts on your skin or through your mucous membranes.

Syphilis Risk Factors

• Have unprotected sex
• Have multiple sex partners
• Have HIV
• Are a man who has sex with men

Symptoms:

Syphilis infection has three stages:

· Early or primary syphilis. People with primary syphilis get one or more sores called chancres. They’re usually small painless ulcers. They happen on genitals, on rectum, or in or around mouth between 10 and 90 days after exposed to the disease. Even if don’t treat them, they heal without a scar within 6 weeks.

· Secondary syphilis. This stage begins 6 weeks to 6 months after you’re exposed. It may last 1 to 3 months. People with secondary syphilis usually get a rosy "copper penny" rash on the palms of their hands and soles of their feet. They may also have different rashes on other parts of their body. These may look like rashes caused by other diseases. People may have moist wart-like lesions in their groin, white patches on the inside of their mouth, swollen lymph glands, fever, hair loss, and weight loss. Like with primary syphilis, symptoms of secondary syphilis will get better without treatment.

Tertiary syphilis. If the infection isn't treated, it may move on to a stage marked by severe problems with your heart, brain, and nerves. You could become paralyzed, blind, or deaf, or get dementia or impotence. It can even be deadly.

Other types of syphilis include:

Latent syphilis. The infection doesn’t have any noticeable symptoms but is still in body.

Congenital syphilis. A pregnant woman with the disease can spread it to her baby. It can harm the baby and even cause death.

Neurosyphilis. The infection can spread to brain or spinal cord.Patient might get headaches, dementia, or numbness or become paralyzed. He could have a hard time controlling muscles.

Syphilis Complications:

If you don’t get treatment, syphilis can have complications all over your body:

• Small bumps. Bumps called gummas can grow on your skin, bones, or organs. They can destroy the tissue around them.
• Nervous system problems. Syphilis can cause problems like headaches, meningitis, brain damage, paralysis, or hearing and vision loss.
• Cardiovascular problems. The disease can damage your heart valves or cause bulging blood vessels (aneurysms) or an inflamed aorta (aortitis).
• HIV. Syphilis can increase your chance of getting HIV.

Laboratory Tests:

a. Antibody tests:

A negative blood test means that it is likely that no infection is present. However, a negative screening test means only that there is no evidence of disease at the time of the test. Antibodies may not be detected for several weeks after exposure to the bacteria. If a person knows he or she has been exposed, or if suspicion of infection remains high, then repeat testing at a later date may be required. It is also important for those who are at increased risk of syphilis infection to have screening tests performed regularly to check for possible infection.

A positive RPR or VDRL screen must be followed by a specific treponemal antibody test (e.g., FTA-ABS, TP-PA):

• A positive result on the second method confirms the screening result and the affected person is diagnosed with syphilis.
• A negative result on the treponemal test may mean that the initial RPR or VDRL test was falsely positive. Further testing and investigation may be done to determine the cause of the false positive.

b. CSF tests:

· Results of syphilis tests performed on CSF samples, usually when someone has late or latent stages of the disease with suspected brain involvement (neurosyphilis), are often interpreted in conjunction with a blood test as well as the affected person's signs, symptoms, and medical history.

· A positive VDRL or FTA-ABS result on a sample of CSF indicates likely infection of the central nervous system. A negative result, especially on an FTA-ABS, may help to rule out infection of the central nervous system.

c. Direct detection:

· If a scraping from a suspected syphilis sore reveals presence of the syphilis bacteria (a positive test on either darkfield microscopy or PCR), the person being tested has an infection that requires treatment with a course of antibiotics, preferably penicillin.

· A negative result from a scraping may mean that there is no syphilis infection present and symptoms are due to another cause or that there were insufficient bacteria present in the sample to be detected.

Treatment:

If you've had syphilis for less than a year, one dose of penicillin is usually enough to kill the infection. If you’re allergic to penicillin, you might get another antibiotic instead, like doxycycline. If you’re in a later stage of the disease, you’ll need more doses.

If you’re pregnant and allergic to penicillin, your doctor will probably have you undergo a process called desensitization, which will let you take the drug safely.

Don’t have sexual contact until the infection is completely gone. Your sexual partners should also be tested and, if necessary, treated.

Some people with syphilis have an immune system reaction called a Jarisch-Herxheimer reaction several hours after their first treatment. This might include fever, chills, headache, upset stomach, rash, or joint and muscle pain. These problems usually go away within 24 hours.

Prevention:

• Don’t have intimate contact with someone if you know they’re infected.
• If you don’t know whether a sexual partner is infected, use a condom every time you have sex.