Pituitary Disorders in Pregnancy — MCQs
Gelastic seizures are seen in
Which of the following is not seen in hypertensive disorders of pregnancy?
A patient with a known brain tumor learns that his pituitary stalk has been affected. Secretion of which of the following hormones is increased after the sectioning of the pituitary stalk?
A pregnant woman is diagnosed with Graves' disease. The most appropriate therapy for her would be:
Which of the following is not a cause of secondary amenorrhea?
A 22-year-old female, Neeta presented to you with complaints of a headache and vomiting for 2 months. She is having amenorrhea but the urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyperprolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed?
Estrogen is secreted during pregnancy, mostly by which organ?
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 ?
Which of the following is false regarding management of diabetes in pregnancy?
Heat-stable alkaline phosphatase in pregnancy is primarily derived from which source?
Pituitary Disorders in Pregnancy Indian Medical PG Practice Questions and MCQs
Question 1: Gelastic seizures are seen in
- A. Subarachnoid tumor
- B. Sheehan syndrome
- C. Hypothalamic hamartoma (Correct Answer)
- D. All of the options
Explanation: ***Hypothalamic hamartoma*** - **Gelastic seizures**, characterized by sudden bursts of uncontrolled laughing or giggling, are a classic symptom of **hypothalamic hamartomas**. - These are rare, non-progressive lesions that interfere with the normal function of the **hypothalamus**, leading to the distinctive seizure type. *Subarachnoid tumor* - While brain tumors can cause various seizure types [1], a **subarachnoid tumor** is not typically associated with gelastic seizures as a prominent or characteristic feature. - Seizures resulting from subarachnoid tumors are more often focal or generalized tonic-clonic [2]. *Sheehan syndrome* - **Sheehan syndrome** is a pituitary ischemic necrosis due to severe peripartum hemorrhage, leading to **hypopituitarism**. - It primarily causes endocrine dysfunction (e.g., amenorrhea, fatigue) and does not directly cause seizures, particularly gelastic seizures. *All of the options* - This option is incorrect because while a subarachnoid tumor might cause seizures, it is not specifically associated with gelastic seizures, and Sheehan syndrome does not cause seizures at all. - **Hypothalamic hamartoma** is the distinct and correct answer for gelastic seizures.
Question 2: Which of the following is not seen in hypertensive disorders of pregnancy?
- A. HELLP syndrome
- B. Proteinuria
- C. Macrosomia (Correct Answer)
- D. Eclampsia
Explanation: ***Macrosomia*** - **Macrosomia** (large-for-gestational-age infant) is typically associated with **gestational diabetes,** not hypertensive disorders of pregnancy. - Hypertensive disorders often lead to **fetal growth restriction** due to reduced placental blood flow. *Eclampsia* - **Eclampsia** is defined by **new-onset grand mal seizures** in a woman with preeclampsia, underscoring its direct link to hypertensive disorders. - It represents a severe manifestation of **preeclampsia**, a hypertensive disorder, and is therefore seen in these conditions. *HELLP syndrome* - **HELLP syndrome** (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe obstetric complication considered a variant of **preeclampsia**. - It is a life-threatening condition directly associated with **hypertensive disorders of pregnancy.** *Proteinuria* - **Proteinuria** is a hallmark diagnostic criterion for **preeclampsia**, indicating kidney involvement and endothelial dysfunction. - Its presence is crucial in defining and classifying **hypertensive disorders of pregnancy.**
Question 3: A patient with a known brain tumor learns that his pituitary stalk has been affected. Secretion of which of the following hormones is increased after the sectioning of the pituitary stalk?
- A. FSH
- B. Prolactin (Correct Answer)
- C. TSH
- D. ACTH
Explanation: ***Prolactin*** - Prolactin is **unique** among anterior pituitary hormones as it is under **tonic inhibitory control** by dopamine from the hypothalamus. - Sectioning of the pituitary stalk disrupts dopamine delivery via the hypothalamic-hypophyseal portal system. - This leads to a **loss of tonic inhibition**, causing an **increase in prolactin secretion** from the anterior pituitary. - This phenomenon is known as the **"stalk effect"** or **hyperprolactinemia due to stalk section**. *FSH* - **Follicle-stimulating hormone (FSH)** secretion is regulated by **gonadotropin-releasing hormone (GnRH)** from the hypothalamus, which is **stimulatory**. - Stalk section interrupts GnRH delivery via the portal system, leading to a **decrease** in FSH secretion. *TSH* - **Thyroid-stimulating hormone (TSH)** secretion is positively regulated by **thyrotropin-releasing hormone (TRH)** from the hypothalamus. - Interruption of the pituitary stalk reduces TRH delivery, causing a **decrease** in TSH secretion. *ACTH* - **Adrenocorticotropic hormone (ACTH)** secretion is positively regulated by **corticotropin-releasing hormone (CRH)** from the hypothalamus. - Damage to the pituitary stalk diminishes CRH stimulation, resulting in a **decrease** in ACTH secretion.
Question 4: A pregnant woman is diagnosed with Graves' disease. The most appropriate therapy for her would be:
- A. Radioiodine therapy
- B. Total thyroidectomy
- C. Carbimazole parenteral
- D. Propylthiouracil oral (Correct Answer)
Explanation: ***Propylthiouracil oral*** - **Propylthiouracil (PTU)** is the preferred antithyroid drug during the **first trimester** of pregnancy due to a lower risk of teratogenicity compared to methimazole/carbimazole [1]. - It works by inhibiting both the synthesis of thyroid hormones and the peripheral conversion of **T4 to T3**. *Radioiodine therapy* - **Radioactive iodine** is absolutely contraindicated in pregnancy as it can cross the placenta and cause **fetal hypothyroidism or athyreosis**. - It leads to permanent destruction of the thyroid gland and is not suitable for a temporary condition in a pregnant woman. *Total thyroidectomy* - While thyroidectomy can be considered for Graves' disease in pregnancy, it is generally reserved for cases where antithyroid drugs are not tolerated or ineffective, or for very large goiters causing compressive symptoms. - It carries risks associated with **surgery and anesthesia** during pregnancy, and requires **lifelong thyroid hormone replacement**. *Carbimazole parenteral* - **Carbimazole** (which is metabolized to methimazole) is generally avoided in the **first trimester** due to an increased risk of teratogenicity, particularly **aplasia cutis**, omphalocele, and choanal atresia [1]. - While it can be used in the second and third trimesters, **PTU is preferred in the first trimester**, and carbimazole is not typically administered parenterally.
Question 5: Which of the following is not a cause of secondary amenorrhea?
- A. Kallman syndrome (Correct Answer)
- B. Asherman's syndrome
- C. Sheehan's syndrome
- D. Turner's mosaic
Explanation: ***Kallman syndrome*** - This is a cause of **primary amenorrhea** because it involves congenital **GnRH deficiency**, preventing the onset of puberty and menstruation from the beginning. - Patients typically present with failure of pubertal development and **anosmia** (inability to smell). *Asherman's syndrome* - Characterized by **intrauterine adhesions** or scarring, often following uterine surgeries like D&C. - These adhesions can prevent the proper shedding of the endometrium, leading to **secondary amenorrhea** after previously established menses. *Sheehan's syndrome* - Occurs due to **ischemic necrosis of the pituitary gland** following severe postpartum hemorrhage, typically presenting with failure of lactation, fatigue, and **secondary amenorrhea**. - The pituitary damage leads to **deficiency of multiple pituitary hormones**, including FSH and LH. *Turner's mosaic* - While classic **Turner syndrome (45,XO)** is a common cause of primary amenorrhea and gonadal dysgenesis, **Turner's mosaic** (e.g., 45,XO/46,XX) can sometimes result in variable ovarian function. - In some mosaic cases, individuals may experience **menarche** and then develop premature ovarian failure, leading to **secondary amenorrhea**.
Question 6: A 22-year-old female, Neeta presented to you with complaints of a headache and vomiting for 2 months. She is having amenorrhea but the urine pregnancy test is negative. She also complained of secretion of milk from the breasts. A provisional diagnosis of hyperprolactinemia was made and MRI was suggested. MRI confirmed the presence of a large pituitary adenoma. Neeta was advised surgery, however, she is not willing to undergo surgery. Which of the following medications is most likely to be prescribed?
- A. Ergotamine
- B. Bromocriptine (Correct Answer)
- C. Sumatriptan
- D. Allopurinol
Explanation: ***Bromocriptine*** - **Bromocriptine** is a **dopamine agonist** that directly inhibits prolactin secretion from the pituitary gland and can shrink **prolactinomas**. - It is the **first-line medical treatment** for hyperprolactinemia, particularly when surgery is refused or contraindicated. *Ergotamine* - **Ergotamine** is used to treat **migraine headaches** by constricting blood vessels in the brain. - It does not have a primary role in managing pituitary adenomas or hyperprolactinemia. *Sumatriptan* - **Sumatriptan** is a **serotonin receptor agonist** used for the acute treatment of migraine and cluster headaches. - It does not affect prolactin levels or the size of pituitary adenomas. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used to treat **gout** and prevent uric acid kidney stones. - It is unrelated to hyperprolactinemia or pituitary adenomas.
Question 7: Estrogen is secreted during pregnancy, mostly by which organ?
- A. Placenta (Correct Answer)
- B. Fetal ovary
- C. Pituitary
- D. Hypothalamus
Explanation: ***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.
Question 8: 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
Question 9: Which of the following is false regarding management of diabetes in pregnancy?
- A. In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL
- B. In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld
- C. Elective C-section has no role in reducing incidence of brachial plexus injury (Correct Answer)
- D. Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL
Explanation: ***Elective C-section has no role in reducing incidence of brachial plexus injury*** - This statement is **false** because **elective C-section** can significantly reduce the incidence of **brachial plexus injury** (BPI), especially in cases of suspected fetal macrosomia. - While not universally recommended for all diabetic pregnancies, an elective C-section is considered when the estimated **fetal weight** is substantial or when there's a history of **shoulder dystocia** to prevent birth trauma. *In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL* - This is a **correct** management strategy for **hypoglycemia in labor**. Maintaining stable blood glucose levels (above 70 mg/dL) is crucial to prevent adverse outcomes for both mother and fetus. - The administration of **D5 (dextrose 5% in water)** intravenous solution at a specific rate helps to quickly raise and maintain blood glucose levels. *In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld* - This is a common and generally **correct** practice for insulin management before **induction of labor**. The night dose of intermediate insulin helps maintain basal glucose levels overnight. - Withholding the morning dose prevents **hypoglycemia** during labor when food intake is restricted, and insulin sensitivity may increase. Glucose is then typically supplemented through IV fluids as needed. *Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL* - These are the generally accepted and **correct** target blood glucose levels for **diabetes in pregnancy** (both pre-existing and gestational diabetes). - Achieving these targets is essential to minimize the risk of **fetal macrosomia**, **neonatal hypoglycemia**, and other adverse perinatal outcomes.
Question 10: Heat-stable alkaline phosphatase in pregnancy is primarily derived from which source?
- A. The placenta (Correct Answer)
- B. Maternal liver
- C. Fetal liver
- D. Maternal bone
Explanation: ***The placenta*** - The **placenta** is the primary source of heat-stable alkaline phosphatase (HSAP) during pregnancy. This specific isoform is distinct from other alkaline phosphatase isoforms. - Increased levels of HSAP are observed in maternal serum throughout pregnancy, reflecting **placental metabolic activity** and growth. - HSAP levels typically **rise progressively** from the first trimester and peak near term, serving as a marker of **placental function**. *Maternal liver* - The maternal liver produces **liver-specific alkaline phosphatase**, which is **not heat-stable**. - While liver ALP levels may fluctuate slightly in pregnancy, they are not the primary source of the heat-stable form. - Liver ALP is inactivated by heating at 56°C, unlike the placental isoform. *Fetal liver* - The fetal liver produces **alkaline phosphatase**, but this is not released into the maternal circulation in significant amounts as **heat-stable ALP**. - Fetal contribution to maternal serum **heat-stable ALP** is negligible compared to the placenta. - The placental barrier prevents significant transfer of fetal enzymes to maternal blood. *Maternal bone* - Maternal bone produces **bone-specific alkaline phosphatase**, which is also **not heat-stable**. - Bone ALP may increase during pregnancy due to skeletal remodeling, but it represents a different isoform. - Bone ALP can be distinguished from placental ALP by heat stability testing and electrophoresis.
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