A middle aged woman on oral contraceptives for many years, developed neurological symptoms such as depression, irritability, nervousness and mental confusion. Her hemoglobin level was 8g/dl. Biochemical investigations revealed that she was excreting highly elevated concentrations of xanthurenic acid in urine. She also showed high levels of triglycerides and cholesterol in serum. All of the above findings are most probably related to vitamin B6 deficiency caused by prolonged oral contraceptive use except :

## **Core Concept**
The question revolves around the side effects of prolonged oral contraceptive use, specifically focusing on vitamin B6 deficiency. Oral contraceptives can lead to decreased levels of vitamin B6 (pyridoxine) due to increased metabolism. Vitamin B6 plays a crucial role in various bodily functions, including neurotransmitter synthesis, hemoglobin production, and lipid metabolism.

## **Why the Correct Answer is Right**
The correct answer relates to the biochemical and clinical manifestations of vitamin B6 deficiency. Vitamin B6 is essential for the conversion of tryptophan to niacin. A deficiency in vitamin B6 leads to an abnormal tryptophan metabolism pathway, resulting in the increased excretion of **xanthurenic acid** in the urine. Additionally, vitamin B6 is crucial for neurotransmitter synthesis, which can explain the neurological symptoms such as depression, irritability, nervousness, and mental confusion. It also plays a role in the production of hemoglobin, and its deficiency can contribute to **anemia** (low hemoglobin level of 8g/dl). Moreover, vitamin B6 is involved in lipid metabolism, and its deficiency can lead to **elevated levels of triglycerides and cholesterol**.

## **Why Each Wrong Option is Incorrect**
To accurately determine the correct answer, the specific options (A, B, C, D) need to be provided. However, based on the information given, we can infer that the question seeks the option that does not correlate with vitamin B6 deficiency caused by prolonged oral contraceptive use.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **prolonged use of oral contraceptives can lead to vitamin B6 deficiency**, which presents with a range of symptoms including neurological manifestations, anemia, and altered lipid profiles. Vitamin B6 deficiency can be managed with supplementation. It's also crucial to note that **xanthurenic acid** is a metabolite of tryptophan and its elevated levels are indicative of abnormal tryptophan metabolism, often seen in vitamin B6 deficiency.

## **Correct Answer: D.**

✓ Correct Answer: D. Increased triglyceride and cholesterol level