Anticancer drugs: aromatase inhibitors in premenopausal women: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Anticancer drugs: aromatase inhibitors in premenopausal women

Sample item

A 40-year-old premenopausal woman with ER-positive breast cancer is proposed anastrozole alone. Why is this inappropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Falling oestrogen removes feedback, so gonadotropins rise and drive ovarian aromatase and oestrogen output

In postmenopausal women oestrogen arises mainly from peripheral conversion of androgens by aromatase, which anastrozole and letrozole block. In premenopausal women the ovary is the main source and lower oestrogen releases pituitary feedback, raising FSH and LH, which stimulate ovarian oestrogen synthesis. Ovarian suppression must be added.

Option by option

  • A. Falling oestrogen removes feedback, so gonadotropins rise and drive ovarian aromatase and oestrogen output (correct)

    Correct. Loss of negative feedback overrides aromatase inhibition in functioning ovaries.

  • B. Anastrozole is an oestrogen receptor agonist at premenopausal doses

    Anastrozole inhibits oestrogen synthesis and is not a receptor agonist.

  • C. Aromatase is absent from the premenopausal ovary

    The premenopausal ovary is rich in aromatase, which is why the gonadotropin drive matters.

  • D. Anastrozole is metabolised to tamoxifen in the premenopausal liver

    Anastrozole is not converted to tamoxifen.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Falling oestrogen removes feedback, so gonadotropins rise and drive ovarian aromatase and oestrogen output. In postmenopausal women oestrogen arises mainly from peripheral conversion of androgens by aromatase, which anastrozole and letrozole block.

Why is "Anastrozole is an oestrogen receptor agonist at premenopausal doses" not the answer?

Anastrozole inhibits oestrogen synthesis and is not a receptor agonist.

Why is "Aromatase is absent from the premenopausal ovary" not the answer?

The premenopausal ovary is rich in aromatase, which is why the gonadotropin drive matters.

Why is "Anastrozole is metabolised to tamoxifen in the premenopausal liver" not the answer?

Anastrozole is not converted to tamoxifen.

What concept does this question test?

It tests Anticancer drugs: aromatase inhibitors in premenopausal women in Pharmacology. In premenopausal women the ovary is the main source and lower oestrogen releases pituitary feedback, raising FSH and LH, which stimulate ovarian oestrogen synthesis. Ovarian suppression must be added.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anticancer drugs: aromatase inhibitors in premenopausal women?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.