USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

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What is the primary cause of hypopituitarism in individuals with sickle cell anemia?

Adrenal insufficiency
Hypoxia
Thyroid dysfunction
Vascular occlusion by sickled cells

The correct answer is: Vascular occlusion by sickled cells

The primary cause of hypopituitarism in individuals with sickle cell anemia is vascular occlusion by sickled cells. Sickle cell anemia is characterized by the deformation of red blood cells into a sickle shape, particularly under low oxygen conditions. These deformed cells can obstruct blood flow in small vessels, leading to tissue ischemia and damage. In the case of the pituitary gland, chronic vascular occlusion can impair blood supply, potentially resulting in infarction and subsequent hormone deficiencies. The pituitary gland, being highly vascularized, is at risk of damage due to reduced blood flow and oxygen delivery caused by sickled cells. This can lead to decreased production of various pituitary hormones, hence causing the condition of hypopituitarism. Other options, while they may be relevant to broader health issues in sickle cell patients, do not specifically address the mechanism leading to hypopituitarism as directly as vascular occlusion does.