Endocrine Changes in Normal Pregnancy — MCQs
Corpus luteum in pregnancy is maintained by which hormone?
Insulin secretion is induced by following EXCEPT:
In a case of molar pregnancy, the most important marker for monitoring response to treatment is:
All are cardiovascular system changes in pregnancy except.
Which of the following is structurally similar to growth hormone?
A 27-year-old woman who delivered a female child 9 months ago presents with complaints of absent periods since childbirth. She has been using contraceptive methods for family planning. Her serum beta-hCG level is 4.9 mIU/ ml , prolactin level is $88 \mathrm{ng} / \mathrm{ml}$, and TSH is 3.8 $\mu \mathrm{IU} / \mathrm{ml}$. What is the most likely reason for her amenorrhea?
During pregnancy, the increased size of the pituitary gland is primarily due to the enlargement of which hormone-secreting cells?
Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.
Overt diabetes in pregnancy is defined as fasting blood glucose more than what value?
Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?
Endocrine Changes in Normal Pregnancy Indian Medical PG Practice Questions and MCQs
Question 1: Corpus luteum in pregnancy is maintained by which hormone?
- A. LH
- B. FSH
- C. hCG (Correct Answer)
- D. Progesterone
Explanation: ***hCG (Human Chorionic Gonadotropin)*** - **hCG** is produced by the **syncytiotrophoblast** of the developing embryo shortly after implantation - It acts as an **LH analog**, binding to LH receptors on the corpus luteum - hCG **rescues the corpus luteum** from degeneration, maintaining progesterone production throughout early pregnancy - The corpus luteum remains functional until approximately **10-12 weeks of gestation**, when the placenta takes over steroidogenesis - This is the **correct answer** for maintenance of corpus luteum **in pregnancy** *LH (Luteinizing Hormone)* - LH maintains the corpus luteum in **non-pregnant menstrual cycles** for approximately 14 days - In **pregnancy**, LH levels actually **decline** and hCG takes over this function - While LH is responsible for initial corpus luteum formation and function, it does **not** maintain the corpus luteum during pregnancy *FSH (Follicle-Stimulating Hormone)* - FSH primarily stimulates **follicular development and maturation** in the ovary - It has **no direct role** in corpus luteum maintenance in either pregnant or non-pregnant states *Progesterone* - Progesterone is the **product** secreted by the corpus luteum, not the hormone that maintains it - It is essential for maintaining the **decidualized endometrium** and supporting early pregnancy - Progesterone does not act to maintain the corpus luteum itself
Question 2: Insulin secretion is induced by following EXCEPT:
- A. Somatostatin (Correct Answer)
- B. Estrogens
- C. Growth hormone
- D. Placental lactogen
Explanation: ***Somatostatin*** - **Somatostatin** directly inhibits insulin secretion from pancreatic beta cells, acting as a paracrine regulator to modulate islet hormone release. - It binds to **somatostatin receptors (SSTRs)** on beta cells, leading to a reduction in cAMP and inhibition of voltage-gated calcium channels, thereby decreasing insulin exocytosis. *Estrogens* - **Estrogens** generally enhance insulin secretion and improve insulin sensitivity, especially during pregnancy or in response to high glucose levels. - They can increase **beta-cell mass** and survival, contributing to better glycemic control. *Growth hormone* - **Growth hormone (GH)** can indirectly induce insulin secretion by promoting insulin resistance, which necessitates increased insulin production to maintain normal glucose levels. - Chronically elevated GH, as seen in **acromegaly**, often leads to hyperinsulinemia and can even cause diabetes. *Placental lactogen* - **Human placental lactogen (hPL)** is a hormone produced during pregnancy that primarily increases maternal insulin resistance to ensure adequate glucose supply to the fetus. - This increased resistance compensatorily stimulates **maternal beta cells** to secrete more insulin, leading to hyperinsulinemia.
Question 3: In a case of molar pregnancy, the most important marker for monitoring response to treatment is:
- A. Serum CA-125
- B. Serum estriol
- C. Serum AFP
- D. Serum hCG (Correct Answer)
Explanation: ***Serum hCG*** - **Human chorionic gonadotropin (hCG)** is produced by the trophoblastic tissue, which is overproliferated in molar pregnancies. - Monitoring **serial hCG levels** post-evacuation is the **gold standard** for detecting persistent trophoblastic disease or malignant transformation. - A rise or plateau in hCG levels indicates inadequate treatment or recurrence, requiring chemotherapy. - **Clinical protocol**: Weekly hCG monitoring until three consecutive negative results, then monthly for 6 months (FIGO guidelines). *Serum CA-125* - **CA-125** is primarily a marker for ovarian cancer and certain benign gynecologic conditions like endometriosis. - It is not a reliable marker for monitoring the response to treatment in **molar pregnancies**. *Serum estriol* - **Estriol** is a hormone produced by the placenta and fetal adrenal gland, primarily used to monitor fetal well-being during pregnancy. - It has no role in the diagnosis or monitoring of **molar pregnancies**. *Serum AFP* - **Alpha-fetoprotein (AFP)** is a tumor marker for certain germ cell tumors, liver cancer, and is also used in prenatal screening for neural tube defects. - It is not associated with the pathogenesis or monitoring of **molar pregnancies**.
Question 4: All are cardiovascular system changes in pregnancy except.
- A. Increase in blood volume
- B. Increase in heart rate
- C. Increase in peripheral resistance (Correct Answer)
- D. Increase in cardiac output
Explanation: ***Increase in peripheral resistance*** - During normal pregnancy, **peripheral vascular resistance actually decreases** due to the effects of hormones like progesterone and the presence of the low-resistance uteroplacental circulation. - This decrease in resistance helps accommodate the increased blood volume and cardiac output. *Increase in cardiac output* - **Cardiac output increases significantly** during pregnancy (by 30-50%) to meet the metabolic demands of the growing fetus and maternal tissues. - This is primarily achieved through an increase in both stroke volume and heart rate. *Increase in blood volume* - **Blood volume increases substantially** (by 30-50%) during pregnancy, with plasma volume increasing more than red blood cell mass. - This expansion supports the increased cardiac output and placental perfusion. *Increase in heart rate* - **Heart rate increases** during pregnancy, typically by 10-20 beats per minute, contributing to the overall increase in cardiac output. - This physiological adaptation helps maintain adequate circulation.
Question 5: Which of the following is structurally similar to growth hormone?
- A. Insulin
- B. Human Placental lactogen (Correct Answer)
- C. Somatostatin
- D. Human chorionic gonadotropin
Explanation: ***Human Placental lactogen*** - **Human placental lactogen (hPL)**, also known as **chorionic somatomammotropin**, is highly similar in structure to **growth hormone** due to a close evolutionary relationship. - Both hormones are single-chain polypeptides with significant sequence homology and share some biological functions, including **metabolic effects** and promotion of **growth**. *Insulin* - **Insulin** is a peptide hormone consisting of two polypeptide chains linked by disulfide bonds, which is structurally distinct from the single-chain **growth hormone**. - While both regulate metabolism, their primary functions and receptor binding mechanisms are different, reflecting their distinct structures. *Somatostatin* - **Somatostatin** is a small peptide hormone that functions primarily as an inhibitory neurohormone and gastrointestinal hormone, acting to suppress the secretion of many other hormones, including **growth hormone**. - Its molecular structure is significantly smaller and distinct from the larger, single-chain structure of **growth hormone**. *Human chorionic gonadotropin* - **Human chorionic gonadotropin (hCG)** is a glycoprotein hormone composed of two distinct subunits (alpha and beta), which is structurally different from the single-chain polypeptide structure of **growth hormone**. - **hCG** primarily functions in maintaining pregnancy by stimulating the corpus luteum, a function unrelated to the primary actions of **growth hormone**.
Question 6: A 27-year-old woman who delivered a female child 9 months ago presents with complaints of absent periods since childbirth. She has been using contraceptive methods for family planning. Her serum beta-hCG level is 4.9 mIU/ ml , prolactin level is $88 \mathrm{ng} / \mathrm{ml}$, and TSH is 3.8 $\mu \mathrm{IU} / \mathrm{ml}$. What is the most likely reason for her amenorrhea?
- A. Lactational amenorrhea (Correct Answer)
- B. Hypothyroidism
- C. Prolactinoma
- D. Normal pregnancy
Explanation: ***Lactational amenorrhea*** - The patient describes a history of recent childbirth (9 months ago), amenorrhea, and an elevated **prolactin level** (**88 ng/mL**). - While contraceptive methods are being used, persistent **postpartum amenorrhea** with hyperprolactinemia is commonly seen in women who are breastfeeding, even if intermittently. *Hypothyroidism* - Although **hypothyroidism** can cause amenorrhea, the patient's TSH level of **3.8 μIU/mL** is within the normal reference range, making hypothyroidism an unlikely cause. - While mild thyroid dysfunction can impact menstrual cycles, this TSH level alone is not sufficient to explain **amenorrhea**. *Prolactinoma* - A **prolactinoma** is characterized by significantly elevated prolactin levels, often much higher than the **88 ng/mL** seen in this patient (typically > 100-200 ng/mL). - Given the recent childbirth, the elevated prolactin is more likely physiological due to lactation rather than a **pathological tumor**. *Normal pregnancy* - The patient's serum **beta-hCG level of 4.9 mIU/mL** is below the threshold typically considered diagnostic for pregnancy (usually >25 mIU/mL). - This value indicates that a **normal ongoing pregnancy** is highly unlikely.
Question 7: During pregnancy, the increased size of the pituitary gland is primarily due to the enlargement of which hormone-secreting cells?
- A. Growth hormone
- B. Prolactin (Correct Answer)
- C. ACTH
- D. TSH
Explanation: ***Prolactin*** - During pregnancy, the number and size of **lactotrophs**, the cells that secrete prolactin, increase significantly due to high **estrogen** levels. - This **hyperplasia** and **hypertrophy** of lactotrophs contribute to the overall enlargement of the pituitary gland, preparing it for lactation. *Growth hormone* - While growth hormone is important, there isn't a primary enlargement of **somatotrophs** (GH-secreting cells) in the pituitary during pregnancy. - Furthermore, most circulating GH during pregnancy is **placental growth hormone**, rather than pituitary-derived. *ACTH* - Adrenocorticotropic hormone (ACTH) is secreted by **corticotrophs**, and these cells do not undergo prominent hypertrophy or hyperplasia during normal pregnancy. - While cortisol levels increase, this is largely due to factors other than increased pituitary ACTH cell size. *TSH* - Thyroid-stimulating hormone (TSH) is secreted by **thyrotrophs**, which do not notably enlarge during pregnancy. - Thyroid gland activity increases during pregnancy, but this is mediated by **hCG** and other mechanisms, not pituitary thyrotroph growth.
Question 8: Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.
- A. 1 and 2 only
- B. 1 and 3 only
- C. 2 and 3 only (Correct Answer)
- D. 1, 2 and 3
Explanation: ***2 and 3 only*** - **Corticotropin-releasing hormone (CRH)** levels increase dramatically during pregnancy, produced by the **placenta**, influencing the timing of labor and fetal development. - **Aldosterone** levels significantly increase during pregnancy to help maintain **fluid balance** and counteract the natriuretic effects of increased progesterone and vasodilation. *1 and 2 only* - While CRH levels do increase, **maternal serum iodine levels do not increase**; rather, there is an increased demand for iodine and a decrease in serum iodine concentration due to increased renal clearance and transfer to the fetus. - This option incorrectly states an increase in maternal serum iodine. *1 and 3 only* - Although aldosterone levels increase, **maternal serum iodine levels do not increase** during normal pregnancy. - This option incorrectly implies an increase in serum iodine while correctly identifying an increase in aldosterone. *1, 2 and 3* - This option is incorrect because **maternal serum iodine levels do not increase** in normal pregnancy; instead, there is often a relative iodine deficiency due to increased demand and excretion. - Only CRH and aldosterone levels increase among the choices provided.
Question 9: Overt diabetes in pregnancy is defined as fasting blood glucose more than what value?
- A. ≥200 mg/dl
- B. ≥100 mg/dl
- C. ≥180 mg/dl
- D. ≥126 mg/dl (Correct Answer)
Explanation: ***≥126 mg/dl*** - A fasting plasma glucose level of **126 mg/dL or higher** is diagnostic of diabetes in the general population, which applies to overt diabetes in pregnancy. - This threshold indicates significant **hyperglycemia** and requires immediate management to prevent maternal and fetal complications. *≥200 mg/dl* - A fasting glucose level **≥200 mg/dL** is indicative of severe hyperglycemia, but the diagnostic threshold for diabetes is lower, at 126 mg/dL. - While this value would certainly confirm diabetes, it is not the *minimum* threshold for diagnosis. *≥100 mg/dl* - A fasting glucose level between **100 mg/dL and 125 mg/dL** is categorized as **impaired fasting glucose** (prediabetes), not overt diabetes. - This value suggests a risk for developing diabetes but does not meet the diagnostic criteria for diabetes itself. *≥180 mg/dl* - While a fasting glucose level of **180 mg/dL or higher** is clearly indicative of diabetes, it is not the lowest value that defines overt diabetes. - The diagnostic threshold for diabetes is established at **126 mg/dL**, making this value simply an even higher indication of the condition.
Question 10: Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?
- A. 2 and 3 only
- B. 1 and 2 only
- C. 1 and 3 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***Correct: 1, 2 and 3*** - **Human Chorionic Gonadotropin (HCG)** is a **glycoprotein hormone** composed of **alpha (α) and beta (β) subunits**, making statement 1 correct - HCG is primarily secreted by the **syncytiotrophoblast** cells of the placenta, confirming statement 3 - In a normal pregnancy, HCG levels typically **peak between 60-70 days (8-10 weeks)** after the last menstrual period, supporting statement 2 - All three statements are factually accurate regarding HCG structure, secretion, and physiological levels *Incorrect: 2 and 3 only* - This option incorrectly excludes statement 1 about HCG being a glycoprotein with α and β subunits - The structural composition of HCG as a heterodimeric glycoprotein is a fundamental characteristic *Incorrect: 1 and 2 only* - This option incorrectly excludes statement 3 about syncytiotrophoblast being the source of HCG - The syncytiotrophoblast is the outer layer of the trophoblast responsible for HCG secretion *Incorrect: 1 and 3 only* - This option incorrectly excludes statement 2 about HCG peak timing during pregnancy - Understanding that HCG peaks at 8-10 weeks (60-70 days) is crucial for monitoring early pregnancy
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