This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': "35 year old female patient Radha having children aged 5 and 6 years has history of amenorrhea and galactorrhea. Blood examination reveals increased prolactin. CT of head is likely to reveal: \nSelect and explain. \nA. Pituitary adenoma, B. Craniopharyngioma, C. Sheehan's syndrome, D. Pinealoma", 'role': 'user'}, {'content': 'Answer: A \nExplanation: Patient is presenting with amenorrhea; galactorrhea with raised prolactin levels. So lets rule out some of the options:\nSheehan\'s Syndrome \n• In Sheehan\'s syndrome there is failure of lactation (due to ischemic necrosis of anterior pituitary) and not galactorrhea (so, option "c" ruled out).\nPinealoma: \n• If you go through the list of causes of hyperprolactinemia given in Harrison 17th/ed p 2205; Table 333-8 - Pinealoma is not one of the causes. (as there is no reason for a pineal gland tumor to raise prolactin levels), ruling out option "d".\nThat leaves us with 2 options:\nPituitary adenoma and craniopharyngiorma: Both are pituitary tumors which can present with amenorrhea galactorrhea, and raised prolactin levels.\nNow comes the age factor - Craniopharyngiomas present usually before 20 years (Harrison 1762/ed p 2201) of age and so by exclusion: Option "a" i.e. Pituitary adenoma seems more likely as the cause.\n"In patients with both galactorrhea and amenorrhea approximately two-thirds will have hyperprolactinemia, in that group approximately one third will have a pituitary adenoma."\nSo, pituitary adenoma is more common than craniopharyngioma and this confirms our answer.', 'role': 'assistant'}]