Reproduction: functional hypothalamic amenorrhoea: practice question

A Physiology 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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Physiology · Reproduction: functional hypothalamic amenorrhoea

Sample item

A 21-year-old marathon runner with a BMI of 17 has stopped menstruating. Oestradiol, LH and FSH are low and prolactin is normal. What is the most likely mechanism?

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

The answer and the reasoning

A. Low energy availability and low leptin reduce kisspeptin drive and GnRH pulse frequency

Low energy availability, with low leptin, reduces kisspeptin signalling and GnRH pulse frequency. LH and FSH fall, follicles do not develop and oestradiol is low. The condition is reversible when energy balance is restored.

Option by option

  • A. Low energy availability and low leptin reduce kisspeptin drive and GnRH pulse frequency (correct)

    Correct. Low energy availability and leptin suppress GnRH pulses and gonadotrophins.

  • B. Follicle depletion with a raised FSH

    Follicle depletion would give a raised FSH, whereas FSH is low here.

  • C. Excess adrenal androgen suppressing the ovary

    Nothing suggests adrenal androgen excess, and it would not explain low gonadotrophins.

  • D. Raised prolactin suppressing GnRH

    Prolactin is normal in this patient.

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 Physiology question

What is the answer to this Physiology question?

The best answer is A, Low energy availability and low leptin reduce kisspeptin drive and GnRH pulse frequency. Low energy availability, with low leptin, reduces kisspeptin signalling and GnRH pulse frequency.

Why is "Follicle depletion with a raised FSH" not the answer?

Follicle depletion would give a raised FSH, whereas FSH is low here.

Why is "Excess adrenal androgen suppressing the ovary" not the answer?

Nothing suggests adrenal androgen excess, and it would not explain low gonadotrophins.

Why is "Raised prolactin suppressing GnRH" not the answer?

Prolactin is normal in this patient.

What concept does this question test?

It tests Reproduction: functional hypothalamic amenorrhoea in Physiology. LH and FSH fall, follicles do not develop and oestradiol is low. The condition is reversible when energy balance is restored.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Reproduction: functional hypothalamic amenorrhoea?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology 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.