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MRCOG PART 2 SBAs and EMQs

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EMQ1480
SBA2068
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EMQ to explain

EMQ to explain Posted by ghada S.

Dear Paul :  could you please explain this Q                                                                                           Options for Questions 4-4

A

Prolactinoma

B

Pre-mature ovarian failure

C

Turners syndrome

D

Ovarian hyper-stimulation syndrome

E

Polycystic ovary syndrome

F

Hypothyroidism

G

Cushings syndrome

H

Congenital adrenal hyperplasia

I

Hypothalamic amenorrhoea

J

Hyperthyroidism

K

Androgen insensitivity syndrome

L

Pure gonadal dysgenesis

 

 

Instructions:For each of the case histories described below, choose the single most likely cause of menstrual abnormalities from the above list. Each option may be used once, more than once, or not at all.

Explanation

Question 4

A 25 year old medical student attends the gynaecology clinic because she has not had a period for 12 months. Menarche was at the age of 13 and she is otherwise asymptomatic and healthy. Her BMI is 19 and she is a member of the rowing team, practising 5 times a week. She denies any recent weight loss or abnormal eating behaviour and has normal secondary sexual characteristics. Random endocrine profile is as follows: FSH = 5.5mIU/ml, LH = 4.0mIU/ml, progesterone = 1.2ng/ml, prolactin = 56ng/ml, testosterone = 1.2pg/ml. Thyroid function tests and pelvic ultrasound scan are normal.

 

In hypothalamic  amenorrhoea there is decreased GnRH & consequently reduced FSH, but in this woman FSH is 5.5 & not hypogonadotrophic  hypogonadism ?? Is her serum prolactin level normal? so why does she has hyperprolactineamia?? Is it because hypothalamus is not working properly so dopamin is not produced??? why FSH is not reduced???