Endocrine drugs: elagolix: 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 · Endocrine drugs: elagolix

Sample item

A woman with endometriosis-related pelvic pain is given the oral GnRH antagonist elagolix. Unlike depot leuprolide, it causes no initial flare of symptoms. Why?

AIt blocks pituitary GnRH receptors at once, so LH and FSH fall without an initial surgeBIt acts as a progesterone receptor agonistCIt desensitises pituitary receptors after a period of overstimulationDIt inhibits aromatase in endometrial tissue

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

The answer and the reasoning

A. It blocks pituitary GnRH receptors at once, so LH and FSH fall without an initial surge

Elagolix competitively blocks pituitary GnRH receptors, so gonadotropin and oestradiol suppression is rapid and dose-dependent, with no flare. GnRH agonists first stimulate the receptor and cause a surge before desensitisation. Hot flushes and loss of bone density follow the hypo-oestrogenic state.

Option by option

A. It blocks pituitary GnRH receptors at once, so LH and FSH fall without an initial surge (correct)
Correct. Direct receptor blockade lowers LH and FSH immediately, with no surge.
B. It acts as a progesterone receptor agonist
Progesterone receptor agonism is the action of progestins such as dienogest.
C. It desensitises pituitary receptors after a period of overstimulation
Desensitisation after initial stimulation is the mechanism of GnRH agonists like leuprolide.
D. It inhibits aromatase in endometrial tissue
Aromatase inhibition is the action of letrozole and anastrozole, not of elagolix.

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.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, It blocks pituitary GnRH receptors at once, so LH and FSH fall without an initial surge. Elagolix competitively blocks pituitary GnRH receptors, so gonadotropin and oestradiol suppression is rapid and dose-dependent, with no flare.

Why is "It acts as a progesterone receptor agonist" not the answer?

Progesterone receptor agonism is the action of progestins such as dienogest.

Why is "It desensitises pituitary receptors after a period of overstimulation" not the answer?

Desensitisation after initial stimulation is the mechanism of GnRH agonists like leuprolide.

Why is "It inhibits aromatase in endometrial tissue" not the answer?

Aromatase inhibition is the action of letrozole and anastrozole, not of elagolix.

What concept does this question test?

It tests Endocrine drugs: elagolix in Pharmacology. GnRH agonists first stimulate the receptor and cause a surge before desensitisation. Hot flushes and loss of bone density follow the hypo-oestrogenic state.

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 Endocrine drugs: elagolix?

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.