nbme 12 repro Q

[firstaid2012]

A 26-year-old woman comes to the physician because she has not had a menstrual period for 3 months. Menarche occurred at the age of 13 years, and menses had previously occurred at regular 30-day intervals. Her mother died of breast cancer 2 weeks ago, and the patient spent the previous year caring for her. She says that she has not eaten well since her mother died. Her sleep also has been altered and she has had a 6.8-kg (15-lb) weight loss during the past year. Physical examination shows no abnormalities. Pelvic examination shows a normal-sized uterus. A pregnancy test is negative. Which of the following is the most likely cause of this patient’s secondary amenorrhea
1. Altered GRH pulses
2. Altered prolactin hormone relases
3. Increased E and P
4. Insufficient amount of cholesterol to produce sex hormones
5. Premature ovarian failure


please explain thank you

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[MrBeauregard]

Normal menstrual history, no anatomical abnormalities, no pregnancy. Patient had a tough year and spent it caring for her mother; admits to not eating well. Probable excessive weight loss --> altered GnRH pulses from the hypothalamus --> secondary amenorrhea.

 

[firstaid2012]

why not 4 or 5 ?

 

[pirsquared]

why not 4 or 5 ?

4) we make cholesterol de novo; it would have to be some pretty serious starvation
5) premature ovarian failure would probably lead to menopause-like symptoms such as hot flashes and what not since that is where estrogen is produced.

Stress and anxiety impact the hypothalamus, leading to GnRH issues. So the answer would be 1.

 

[OveractiveBrain]

4) we make cholesterol de novo; it would have to be some pretty serious starvation (think anorexia nervosa)
5) premature ovarian failure would probably lead to menopause-like symptoms such as hot flashes and what not since that is where estrogen is produced.

I would guess 2. From what I can find, prolactin levels increase with stress (please correct me if I am wrong), and prolactin inhibits GnRH.

MEH! ERROR! Stress and anxiety impact the hypothalamus, i.e. GnRh pulsatility, not anterior pituitary. It is more for Step 2, then Step 1, but I think you might find this useful. Secondary Amenorrhea. Its a free clerkship / step 2 website.

Though everything else you have said is correct!

 

[MrBeauregard]

4) we make cholesterol de novo; it would have to be some pretty serious starvation (think anorexia nervosa)
5) premature ovarian failure would probably lead to menopause-like symptoms such as hot flashes and what not since that is where estrogen is produced.

I would guess 2. From what I can find, prolactin levels increase with stress (please correct me if I am wrong), and prolactin inhibits GnRH.

And, actually, anorexia nervosa affects GnRH pulsatility primarily.

 

[pirsquared]

Thank you both for correcting the misinformation I put.