A 26-year-old woman came to her physician complaining of hyperpigmentation of her face. Physical examination revealed a poorly defined, blotchy, masklike zone of facial pigmentation with almost equal involvement of her cheeks, temples, and forehead. Skin biopsy showed increased melanin pigment in basal layers. The woman had been taking a hormonal contraceptive for 6 years. She was a long-distance runner and admitted the use of oxandrolone, erythropoietin, and methamphetamine while training. Which of the following drugs most likely caused the hyperpigmentation in this woman?

Correct Answer: B

Rationale: The correct answer is B: Oxandrolone. Oxandrolone is an anabolic steroid known to cause hyperpigmentation due to increased melanin production. The patient's history of taking oxandrolone aligns with the presentation of hyperpigmentation on her face. Ethinyl estradiol (choice A) is a common component of hormonal contraceptives but is not known to cause hyperpigmentation. Erythropoietin (choice C) is a hormone used to stimulate red blood cell production and is not associated with hyperpigmentation. Norethindrone (choice D) is another hormonal contraceptive component that does not typically cause hyperpigmentation. In this case, the patient's use of oxandrolone is the most likely culprit for her hyperpigmentation.

Correct Answer: C

Rationale: The correct answer is C: Pamidronate. This drug is used in the management of conditions like hypercalcemia, Paget's disease, and osteoporosis, which are commonly associated with cancer patients. It inhibits bone resorption and helps lower calcium levels. Sodium phosphate (A) is a laxative, not indicated for this patient. Hydrochlorothiazide (B) is a diuretic used for hypertension, not for managing the conditions mentioned. Mannitol (D) is an osmotic diuretic mainly used for reducing intracranial pressure, not indicated in this case. Pamidronate is the best choice due to its mechanism of action and relevance to the patient's condition.

Correct Answer: C

Rationale: The correct answer is C) Immediately reduces gonadotropin secretion. Ganirelix is a gonadotropin-releasing hormone (GnRH) antagonist that acts quickly to inhibit the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. This rapid suppression of gonadotropin secretion is crucial in certain clinical situations, such as assisted reproductive technologies, where precise control of the timing of ovulation is needed. Option A) Can be administered as an oral formulation is incorrect because ganirelix, like leuprolide, is administered via subcutaneous injection. This route is necessary for the drug to achieve the desired pharmacokinetic profile and therapeutic effect. Option B) Can be used alone to restore fertility to hypogonadal men and women is incorrect because ganirelix alone is not sufficient to restore fertility in hypogonadal individuals. It is typically used in conjunction with other medications as part of a controlled ovarian hyperstimulation protocol for assisted reproduction. Option D) Initially stimulates pituitary production of LH and FSH is incorrect because ganirelix, as a GnRH antagonist, works by blocking the GnRH receptors in the pituitary gland, thereby inhibiting the production and release of LH and FSH. There is no initial stimulation of gonadotropin production with ganirelix. Understanding the mechanism of action of gonadotropin-releasing hormone agonists and antagonists is essential in the field of endocrine pharmacology, particularly in the management of infertility and hormonal disorders. By grasping the specific actions of these drugs, healthcare providers can make informed decisions regarding their use in clinical practice to optimize patient outcomes.

Correct Answer: B

Rationale: In this question, the correct answer is B) Human chorionic gonadotropin (HCG) because it is not a hormone secreted by the pituitary gland; instead, it is produced by the placenta during pregnancy. A) Somatotropin, also known as growth hormone, is secreted by the pituitary gland and plays a crucial role in growth and metabolism. C) Follicle-stimulating hormone (FSH) is another pituitary hormone responsible for regulating the reproductive system in both males and females, specifically in the production of sperm and eggs. D) Thyroid-stimulating hormone (TSH) is secreted by the pituitary gland to regulate the thyroid gland's production of thyroid hormones. Understanding the source and function of these hormones is essential in endocrine pharmacology as it helps in diagnosing and treating various endocrine disorders. Knowing the origin of each hormone aids in understanding their roles and how pharmacological interventions can target specific hormones to achieve therapeutic outcomes.

Correct Answer: B

Rationale: In this question, the correct answer is option B) Increased appetite. Symptoms of hypothyroidism (myxedema) typically include dry, puffy skin, large tongue, drooping of the eyelids, lethargy, and sleepiness. Increased appetite is not a common symptom of hypothyroidism; in fact, it is more commonly associated with hyperthyroidism, where the body's metabolic rate is increased. In hypothyroidism, the body's metabolic rate is decreased, leading to symptoms such as weight gain and decreased appetite. Educationally, understanding the symptoms of hypothyroidism is crucial for healthcare professionals, especially those working in endocrinology or primary care settings. Recognizing these symptoms can lead to early detection and appropriate treatment, preventing further complications associated with untreated hypothyroidism. It is important for students to differentiate between the symptoms of hypo- and hyperthyroidism to provide effective patient care.