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NBME 23 Answers

nbme23/Block 3/Question#23 (reveal difficulty score)
A pregnant 28-year-old woman is found to have ...
Lactotrope ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +9  upvote downvote
submitted by โˆ—mousie(272)
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Your pituitary lactotrop cells hypertrophy during pregnancy to produce increasing amounts of prolactin - part of the pathophysiology of Sheehan's syndrome... increased blood loss during delivery can cause ischemic necrosis of pituitary

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tinydoc  I thought the elevated Estrogen and progesterone depress the function of Prolactin until delivery. I guess you needed to know that it decreases its function by downregulating receptors or something as opposed actually decreasing the prolactin production. I picked gonadotrophs. This was a fair question but I reasoned it out and arrived at the wrong conclusion. +8
maxillarythirdmolar  Specifically, the estrogen is stimulating lactotrophs as progesterone is preventing the prolactin from actually working on the breasts. So it's the estrogen that is stimulating the lactotrophs to grow, and you would see the effects of this growth if it weren't for the progesterone preventing the action of prolactin (their secretory product) on the breasts. +10
dul071  why not somatotrophs. she's understress. wouldn't that increase the production of GH +



 +1  upvote downvote
submitted by โˆ—imgdoc(183)
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I don't think this question was going after pregnancy related increase in prolactin. That could lead you to the correct answer, but imo, they mentioned she had an MRI for head trauma, which could mean there was damage to the pituitary stalk, in which case the ONLY hormone which will increase when there is damage to the stalk is prolactin, because it is under constant inhibition by dopamine. Prolactin obviously stimulates lactotropes.

This was just how I got to the answer. You could very well have gotten to the correct answer by simply using the pregnancy logic, its probably easier.

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 +0  upvote downvote
submitted by โˆ—haozhier(23)
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I chose corticotrope because I thought during pregnancy women have more cortisol. Can anyone explain it for me? Thanks!

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