ADRENAL CORTEX

Question 1

Cholesterol → Pregnenolone → Progesterone (21-hydroxylase) → Deoxycorticosterone → 11B-hydroxylase → Corticosterone to Aldosterone

Answer 1

Aldosterone Formation (Mineralocorticoid)

Question 2

Pregnenolone → 17-OH Pregnenolone → 21-hydroxylase → Deoxycortisol → 11B-hydroxylase → Cortisol

Answer 2

Cortisol Formation (Glucocorticoid)

Question 3

DHEA → Androstenedione → Testosterone, Estradiol

Answer 3

DHEA Formation (Sex Hormones)

Question 4

Tyrosine → L-3,4-dihydroxyphenylalanine (L-DOPA) → Dopamine (HVA) → Norepinephrine (normetanephrine) → epinephrine (metanephrine)

Answer 4

Catecholamine Synthesis Pathway

Question 5

Metabolite for Norepinephrine and Epinephrine

Answer 5

VMA

Question 6

Source: Zona glomerulosa; Target: Kidneys; Major function: Blood pressure and electrolyte regulation (under RAAS control)

Answer 6

Aldosterone

Question 7

Source: Zona fasciculata; Target: Liver or adipose; Major function: Carbohydrate, protein, and lipid metabolism

Answer 7

Cortisol

Question 8

Source: Zona reticularis; Target: Gonads, muscles, and bones; Major function: Precursor to androgens; growth and maturation

Answer 8

Sex steroids

Question 9

Source: Medulla; Target: Liver and adipose; Major function: Stimulates sympathetic nerves, promotes glycogenolysis and lipolysis

Answer 9

Epinephrine

Question 10

Source: Medulla; Target: SNS; Major function: Stimulates sympathetic nerves

Answer 10

Norepinephrine

Question 11

Confirmatory test for primary aldosteronism (Conn’s disease)

Answer 11

Captopril suppression test

Question 12

Test for Conn’s disease

Answer 12

Urinary potassium excretion, Captopril suppression, upright PA (plasma aldosterone)/PRA (plasma renin activity) ratio, 18-Hydroxycorticosterone

Question 13

Condition with increased aldosterone, plasma sodium, and decreased plasma potassium

Answer 13

Hyperaldosteronism (Conn’s)

Question 14

Condition characterized by primary hypercorticotism

Answer 14

Cushing’s syndrome

Question 15

Condition characterized by secondary hypercorticotism

Answer 15

Cushing’s disease

Question 16

Tests for diagnosing Cushing’s syndrome and disease

Answer 16

Urine free cortisol over 24 hours, Midnight salivary cortisol, Dexamethasone suppression test (LD=1mg overnight or 2mg over 48 hours, HD=8mg), Plasma ACTH (requires pre-chilled tube)

Question 17

Plasma cortisol ↑, Plasma ACTH ↓

Answer 17

Cushing syndrome

Question 18

Plasma cortisol and ACTH ↑

Answer 18

Cushing disease

Question 19

Test result in Cushing disease with high dose DST

Answer 19

Suppressed plasma cortisol

Question 20

Plasma cortisol and ACTH ↑↑↑, High dose DST results

Answer 20

Ectopic Cushing syndrome (ACTH-producing tumors)

Question 21

Tests for Addison’s disease (primary adrenal insufficiency)

Answer 21

ACTH stimulation (Cortrosyn) test, Insulin tolerance test, Metyrapone test

Question 22

Condition with decreased aldosterone and cortisol, increased androgen

Answer 22

Congenital adrenal hyperplasia

Question 23

Enzyme deficiency associated with congenital adrenal hyperplasia

Answer 23

21-Hydroxylase

Question 24

Plasma and urinary tests for diagnosing congenital adrenal hyperplasia

Answer 24

Plasma 17-hydroxyprogesterone, Pregnanetriol, Urinary pregnanetriol, 17-ketosteroids

Question 25

Development of overt male secondary sexual features

Answer 25

Virilization

Question 26

Non-typically appearing female external genitalia

Answer 26

Genital ambiguity

Question 27

Excessive hair growth due to increased ovarian androgens in women

Answer 27

Hirsutism

Question 28

Scale used for grading hirsutism

Answer 28

Ferriman-Gallwey scale