Endocrinology of Pregnancy Practice Questions

Q: Estrogen is secreted during pregnancy, mostly by which organ?

Placenta. ***Placenta*** - During pregnancy, the **placenta** takes over the primary role of **estrogen production** from the ovaries, especially after the first trimester. - It synthesizes significant amounts of **estriol**, the main estrogen produced during pregnancy, using precursors from the fetal adrenal glands. *Fetal ovary* - The **fetal ovary** is not the primary source of estrogen synthesis during pregnancy. - While it has some hormonal activity, it does not produce the large quantities of estrogen needed to support the pregnancy. *Pituitary* - The **pituitary gland** produces hormones like **FSH and LH**, which regulate ovarian function, but it does not directly secrete estrogen itself. - Its role is supervisory, not secretory of sex steroids. *Hypothalamus* - The **hypothalamus** secretes **gonadotropin-releasing hormone (GnRH)**, which stimulates the pituitary, but it does not produce estrogen. - It is part of the central control system for reproductive hormones, not a direct estrogen secretor.

Q: Which of the following statements about placental hormones is true?

hCS plays a role in maternal glucose metabolism.. **Correct: *hCS plays a role in maternal glucose metabolism.*** - **Human chorionic somatomammotropin (hCS)**, also known as placental lactogen, has **anti-insulin effects** that reduce maternal glucose utilization. - This action diverts glucose to the fetus, helping to meet the growing **fetal energy demands**. *Incorrect: hCG levels remain consistently high throughout pregnancy.* - **hCG (human chorionic gonadotropin)** levels peak in the first trimester (around 8-10 weeks) and then **decline and plateau** at much lower levels for the remainder of the pregnancy. - Its primary role is to maintain the **corpus luteum** during early pregnancy. *Incorrect: The luteal-placental shift occurs around 10-12 weeks of gestation.* - The **luteal-placental shift**, where the placenta takes over progesterone production from the corpus luteum, occurs around **7-9 weeks of gestation**. - By 10-12 weeks, the placenta is already the primary producer of progesterone. *Incorrect: Progesterone production requires fetal adrenal precursors.* - **Progesterone** is synthesized by the placenta from **maternal cholesterol** without requiring fetal steroid precursors. - **Estrogen**, particularly **estriol**, on the other hand, relies on **fetal adrenal androgens** as precursors.

Q: Hypothyroidism in pregnancy is most likely associated with which of the following?

Preeclampsia. ***Preeclampsia*** - **Hypothyroidism** in pregnancy is strongly linked to an increased risk of **preeclampsia**, a serious condition characterized by **hypertension and proteinuria** after 20 weeks of gestation. - The exact mechanism is not fully understood, but thyroid hormones play a crucial role in maintaining **vascular tone and endothelial function**, which are disrupted in preeclampsia. - Studies show that both **overt and subclinical hypothyroidism** increase the risk of preeclampsia, making this the **most likely association** among the given options. *Recurrent abortions* - While uncontrolled **hypothyroidism** can increase the risk of **first-trimester miscarriage**, it is not typically cited as the most likely association for **recurrent abortions** compared to preeclampsia. - Other causes like **chromosomal abnormalities, uterine anomalies, or antiphospholipid syndrome** are more common for recurrent pregnancy loss. - Early detection and treatment with **levothyroxine** can reduce miscarriage risk. *Polyhydramnios* - **Polyhydramnios** (excess amniotic fluid) is more often associated with conditions like **gestational diabetes**, fetal anomalies (e.g., GI obstruction, neural tube defects), or multiple gestation. - **Hypothyroidism** is not a primary risk factor for **polyhydramnios**; fetal thyroid dysfunction (e.g., fetal hyperthyroidism due to maternal Graves' disease) is more relevant to amniotic fluid disorders. - Maternal hypothyroidism does not typically affect amniotic fluid volume. *Preterm labour* - Poorly controlled **hypothyroidism** can increase the risk of **preterm birth**, but **preeclampsia** is generally considered a more distinct and stronger association. - Other common causes of **preterm labor** include infections, uterine abnormalities, cervical insufficiency, and multiple gestations. - Adequate thyroid hormone replacement reduces obstetric complications including preterm delivery.

Q: Which of the following endocrinological conditions may be associated with hydatidiform mole: 46,XX?

Hyperthyroidism. ***Hyperthyroidism*** - A **complete hydatidiform mole** produces very high levels of **human chorionic gonadotropin (hCG)**, which has a structural similarity to **thyroid-stimulating hormone (TSH)**. - This **hCG** can bind to **TSH receptors** on the thyroid gland, stimulating **thyroid hormone production** and leading to **hyperthyroidism**. *Hypothyroidism* - **Hypothyroidism** is characterized by **low thyroid hormone levels** and is not directly induced by the hormonal changes associated with a hydatidiform mole. - While pregnancy can sometimes unmask or worsen hypothyroidism, it is not a direct endocrinological consequence of a molar pregnancy. *Diabetes* - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose**, commonly associated with insulin resistance or deficiency. - There is no direct endocrinological link between **hydatidiform mole** and the development of diabetes. *Hyperprolactinemia* - **Hyperprolactinemia** is characterized by **elevated prolactin levels**, often leading to menstrual irregularities and galactorrhea. - While pregnancy itself causes an increase in prolactin, a hydatidiform mole does not specifically induce pathological **hyperprolactinemia**.

Q: In normal pregnancy, β-HCG doubles in

48 hours. **48 hours** - In a **normal, singleton intrauterine pregnancy**, the serum β-HCG levels approximately **double every 48 hours** (or every 2 days) during early gestation. - This doubling time is a key indicator used to assess the viability and progression of a pregnancy in its initial stages. *24 hours* - A doubling time of 24 hours (or less) is **faster than typically observed** in normal pregnancies. - Such a rapid rise might sometimes be seen but is not the characteristic average doubling time for a healthy early pregnancy. *72 hours* - While a doubling time of up to 72 hours can still be considered within normal limits for some pregnancies, the **average and most common normal doubling time is 48 hours**. - A doubling time consistently longer than 48-72 hours can raise concern for an **ectopic pregnancy** or **miscarriage**. *90 hours* - A doubling time of 90 hours is **significantly prolonged** and is generally considered abnormal. - This slower rise in β-HCG is often indicative of a **non-viable pregnancy**, such as an evolving miscarriage or an ectopic pregnancy.

Question 1

Estrogen is secreted during pregnancy, mostly by which organ?

Accepted Answer

Placenta

Answer

Fetal ovary

Answer

Pituitary

Answer

Hypothalamus

Question 2

Which of the following statements about placental hormones is true?

Accepted Answer

hCS plays a role in maternal glucose metabolism.

Answer

hCG levels remain consistently high throughout pregnancy.

Answer

The luteal-placental shift occurs around 10-12 weeks of gestation.

Answer

Progesterone production requires fetal adrenal precursors.

Question 3

A 26-year-old gravida 3 woman has a history of gestational diabetes and a delivery of two previous infants at term that were greater than 4000 grams, each of whom had severe hypoglycemia. Which of the following maneuvers is least likely to reduce the chance of the next child's having hypoglycemia?

Accepted Answer

Maternal intravenous loading with 10% glucose beginning 2 to 4 h prior to the expected time of delivery

Answer

Careful glucose monitoring of the infant

Answer

Careful control of the maternal blood glucose levels during pregnancy

Answer

Early feedings of the infant

Question 4

Hypothyroidism in pregnancy is most likely associated with which of the following?

Accepted Answer

Preeclampsia

Answer

Recurrent abortions

Answer

Preterm labour

Answer

Polyhydramnios

Question 5

Which of the following endocrinological conditions may be associated with hydatidiform mole: 46,XX?

Accepted Answer

Hyperthyroidism

Answer

Hypothyroidism

Answer

Diabetes

Answer

Hyperprolactinemia

Question 6

In normal pregnancy, β-HCG doubles in

Accepted Answer

48 hours

Answer

24 hours

Answer

72 hours

Answer

90 hours

Endocrinology of Pregnancy — MCQs

Endocrinology of Pregnancy — MCQs

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