WBR0655

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Physiology
Sub Category	SubCategory::Reproductive
Prompt	[[Prompt::A 50-year-old woman with past history significant for hypothyroidism presents to the outpatient clinic with complaints of emotional lability. She reports excessive crying and irritable for the past 2 months. She denies any history of hot flashes or night sweats. She also reports that her menstrual cycles have seemed irregular for the past year, and have gotten longer than usual recently. Which of the following laboratory studies most likely belong to this patient? ]]
Answer A	AnswerA::A
Answer A Explanation	[[AnswerAExp::This profile suggests a disease in the anterior pituitary which is unable to stimulate the ovaries to produce LH and FSH despite adequate hypothalamic input. In menopause, the primary dysfunction is the inability of the ovaries to produce estrogen]]
Answer B	AnswerB::B
Answer B Explanation	AnswerBExp::This profile suggests a disease involving the hypothalamus, causing a lack or inadequate release of GnRH to optimally stimulate the anterior pituitary and ovaries
Answer C	AnswerC::C
Answer C Explanation	AnswerCExp::This profile suggests menopause. This is a primary dysfunction of the ovaries to produce estrogen
Answer D	AnswerD::D
Answer D Explanation	AnswerDExp::In menopause, levels of estrogen should be low and not high. Estrogen levels may be high in cases of estrogen-producing tumors of the ovaries, but in that case, the levels of LH, FSH and GnRH would be low due to the negative feedback effect
Answer E	AnswerE::E
Answer E Explanation	AnswerEExp::In menopause, levels of estrogen should be low and not high
Right Answer	RightAnswer::C
Explanation	[[Explanation::This woman is experiencing symptoms of menopause which include mood swings, irritability. Other symptoms may include: depression, fatigue, memory loss, hot flushes, night sweats, vaginal dryness, e.t.c. Menopause, whose average age of onset is 50 years, is a cessation of estrogen production due to a decreased number of ovarian follicles. Menopause can also be described as the permanent cessation of the primary functions of the ovaries - the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining, and the subsequent shedding of the uterine lining. Postmenopausal women have low estrogen levels but high levels of LH, FSH, and GnRH due to the lack of negative feedback on the anterior pituitary and hypothalamus. The ovaries produce estrogens; anterior pituitary gland produce LH and FSH while the hypothalamus releases GnRH. Menopause can be managed with hormone replacement therapy. Educational objective: Menopause is the permanent cessation of estrogen production due to a decreased number of ovarian follicles. Symptoms of menopause may be as subtle as having only mood swings and emotional lability. Postmenopausal women have low estrogen levels but high levels of LH, FSH, and GnRH due to the lack of negative feedback on the anterior pituitary and hypothalamus Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Menopause
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::