Question:hard
36 year old G3P3 patient had LCB 6 years ago, no medical evaluation since then. She now complains of excessive vaginal itching, skin pigmentation, lethargy, lack of axillary and body hair, cold intolerance, hoarseness of voice. On examination, her vagina is found to be atrophic. Which of these agents is NOT likely to improve her condition?
36 year old G3P3 patient had LCB 6 years ago, no medical evaluation since then. She now complains of excessive vaginal itching, skin pigmentation, lethargy, lack of axillary and body hair, cold intolerance, hoarseness of voice. On examination, her vagina is found to be atrophic. Which of these agents is NOT likely to improve her condition?
Show Hint
Think about Sheehan syndrome after postpartum hemorrhage and which listed drug is not a missing pituitary-driven hormone.
Updated On: Jul 8, 2026
- Insulin
- Thyroid extract
- Prednisolone
- Estrogen
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Recognize the pattern of failing glands.
Cold intolerance and a hoarse voice point to an underactive thyroid. Tiredness and lethargy point to low cortisol. Vaginal atrophy, itching, and loss of axillary and body hair point to low estrogen and androgen. Three separate hormone systems are failing together.
Step 2: Find the single cause behind all three.
All three of these hormones, thyroid hormone, cortisol, and the sex hormones, are controlled from the pituitary gland. A single event that damages the pituitary would knock out all three trophic signals at once. A severe bleed during her last childbirth six years ago fits this, since major postpartum hemorrhage can cut blood flow to the pituitary and destroy part of it, a condition called Sheehan syndrome.
Step 3: Match each drug to what is actually missing.
Thyroid extract, prednisolone, and estrogen each replace one of the three hormones the pituitary can no longer trigger, so all three would help her symptoms. There is no missing insulin signal here, since her pancreas and blood sugar control are not the problem in Sheehan syndrome.
Step 4: See why insulin is actually a risk.
With less cortisol and less growth hormone in her body, both of which usually raise blood sugar, she is more sensitive to insulin than a healthy person. Adding insulin would not fix any of her described symptoms and could instead drop her blood sugar dangerously.
Step 5: Conclude.
Insulin is the odd one out that will not improve, and may harm, this patient.
\[ \boxed{\text{Insulin}} \]
Cold intolerance and a hoarse voice point to an underactive thyroid. Tiredness and lethargy point to low cortisol. Vaginal atrophy, itching, and loss of axillary and body hair point to low estrogen and androgen. Three separate hormone systems are failing together.
Step 2: Find the single cause behind all three.
All three of these hormones, thyroid hormone, cortisol, and the sex hormones, are controlled from the pituitary gland. A single event that damages the pituitary would knock out all three trophic signals at once. A severe bleed during her last childbirth six years ago fits this, since major postpartum hemorrhage can cut blood flow to the pituitary and destroy part of it, a condition called Sheehan syndrome.
Step 3: Match each drug to what is actually missing.
Thyroid extract, prednisolone, and estrogen each replace one of the three hormones the pituitary can no longer trigger, so all three would help her symptoms. There is no missing insulin signal here, since her pancreas and blood sugar control are not the problem in Sheehan syndrome.
Step 4: See why insulin is actually a risk.
With less cortisol and less growth hormone in her body, both of which usually raise blood sugar, she is more sensitive to insulin than a healthy person. Adding insulin would not fix any of her described symptoms and could instead drop her blood sugar dangerously.
Step 5: Conclude.
Insulin is the odd one out that will not improve, and may harm, this patient.
\[ \boxed{\text{Insulin}} \]
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