Chapter 27: Adrenal Hormones

Question 1

27.1 Which of the following zones of the adrenal gland is
correctly paired with the type of substance it secretes?
A. Adrenal medulla—corticotropin.
B. Zona fasciculata—cortisol.
C. Zona glomerulosa—androgens.
D. Zona reticularis—catecholamines.

Answer 1

Correct answer = B. The adrenal medulla secretes cat-
echolamines. Corticotropin is secreted by the anterior pitu-
itary. The zona glomerulosa secretes aldosterone, and the
zona reticularis secretes androgens.

Question 2

27.2 Corticosteroids are useful in the treatment of all of the
following disorders except:
A. Addison disease.
B. Allergic rhinitis.
C. Cushing syndrome.
D. Inflammatory bowel dis

Answer 2

Correct answer = C. Cushing syndrome is an excess secre-
tion of glucocorticoids. Dexamethasone may be used in
the diagnosis of Cushing syndrome, but not its treatment.
Treatment of Cushing syndrome usually consists of surgery
or suppression of glucocorticoid production with ketocon-
azole or other agents. Corticosteroids are used frequently
in the management of the other disorders listed.

Question 3

27.3 All of the following adverse effects commonly occur
with glucocorticoid therapy except:
A. Glaucoma.
B. Increased risk of infection.
C. Hypotension.
D. Emotional disturbances.
E. Peripheral edema.

Answer 3

Correct answer = C. Glucocorticoid therapy may cause
hypertension, not hypotension. All the other adverse effects
are associated with the use of glucocorticoids.

Question 4

27.4 Osteoporosis is a major adverse effect caused by the
glucocorticoids. It is due to their ability to:
A. Increase the excretion of calcium.
B. Inhibit absorption of calcium.
C. Stimulate the hypothalamic–pituitary–adrenal
axis.
D. Decrease production of prostaglandins.
E. Decrease collagen synthesis.

Answer 4

Correct answer = B. Glucocorticoid-induced osteoporosis
is attributed to inhibition of calcium absorption as well as
bone formation. Increased intake of calcium plus vitamin
D, bisphosphonates, or other drugs that are effective in
this condition is indicated. Glucocorticoids suppress rather
than stimulate the hypothalamic–pituitary–adrenal axis.
The decreased production of prostaglandins does not play
a role in bone formation.

Question 5

27.5 A child with severe asthma is being treated with high
doses of inhaled corticosteroids. Which of the following
adverse effects is of particular concern?
A. Hypoglycemia.
B. Hirsutism.
C. Growth suppression.
D. Cushing syndrome.
E. Cataract formation.

Answer 5

Correct answer = C. Corticosteroids may retard bone
growth. Chronic treatment with the medication therefore
may lead to growth suppression, so linear growth should be
monitored periodically. Hyperglycemia, not hypoglycemia,
is a possible adverse effect. Hirsutism, Cushing syndrome,
and cataract formation are unlikely with the dose that the
child would receive by inhalation.

Question 6

27.6 The diagnosis of congenital adrenal hyperplasia (CAH)
is confirmed in a child. This condition can be effectively
treated by:
A. Administering a glucocorticoid.
B. Administering an androgen antagonist.
C. Administering ketoconazole to decrease cortisol
synthesis.
D. Removing the adrenal gland surgically.
E. Administering adrenocorticotropic hormone

Answer 6

Correct answer = A. Congenital adrenal hyperplasia is
seen in infancy and childhood. Because cortisol synthe-
sis is decreased, feedback inhibition of adrenocorticotropic
hormone (ACTH) formation and release is also decreased,
resulting in enhanced ACTH formation. This in turn leads to
increased levels of adrenal androgens and/or mineralocorti-
coids. The treatment is to administer a glucocorticoid, such as
hydrocortisone (in infants) or prednisone, which would restore
the feedback inhibition. The other options are inappropriate.

Question 7

27.7 A patient with Addison disease is being treated with
hydrocortisone but is still having problems with
dehydration and hyponatremia. Which of the following
drugs would be best to add to the patient’s therapy?
A. Dexamethasone.
B. Fludrocortisone.
C. Prednisone.
D. Triamcinolone.

Answer 7

Correct answer = B. To combat dehydration and hyponatre-
mia, a corticosteroid with high mineralocorticoid activity is
needed. Fludrocortisone has the greatest mineralocorticoid
activity of the agents provided. The other drugs have little or
no mineralocorticoid activity

Question 8

27.8 All of the following are strategies to minimize the
development of HPA axis suppression with corticosteroid
therapy except:
A. Alternate-day administration of therapy.
B. Administration via topical or inhalation routes when
possible.
C. Using the lowest dose of corticosteroid that
adequately controls symptoms.
D. Administration of two-thirds of the daily dose in the
morning and one-third in the afternoon.

Answer 8

Correct answer = D. Administration of two-thirds of the dose
in the morning and one-third in the afternoon is a strategy
to mimic the normal diurnal variation of cortisol secretion.
However, it is not a strategy to prevent suppression of the
HPA axis. All of the other methods will help prevent the like-
lihood of suppression of the HPA axis.

Question 9

27.9 Which of the following patients would most likely have
suppression of the HPA axis and require a slow taper of
corticosteroid therapy?
A. A patient taking 40 mg of prednisone daily for
7 days to treat an asthma exacerbation.
B. A patient taking 10 mg of prednisone daily for
3 months for rheumatoid arthritis.
C. A patient using mometasone nasal spray daily for 6
months for allergic rhinitis.
D. A patient receiving an intra-articular injection of
methylprednisolone for osteoarthritis

Answer 9

Correct answer = B. Suppression of the HPA axis usually
occurs with higher doses of corticosteroids when used for a
duration of 2 weeks or more. Although the dose of predni-
sone is higher in the asthma patient, the duration of therapy
is short, so the risk of HPA axis suppression is lower. The
risk of HPA axis suppression is low with topical therapies like
intranasal mometasone and with one-time joint injections

Question 10

27.10 Which of the following corticosteroids is most
appropriate to administer to a woman in preterm labor
to accelerate fetal lung maturation?
A. Betamethasone.
B. Fludrocortisone.
C. Hydrocortisone.
D. Prednisone.

Answer 10

Correct answer = A. A corticosteroid with high glucocorti-
coid activity is needed to speed fetal lung maturation prior
to delivery. Betamethasone has high glucocorticoid activ-
ity and is one of the recommended drugs in this context.
Dexamethasone is the other. Fludrocortisone mainly has
mineralocorticoid activity and would not be useful in this
situation. Hydrocortisone has much lower glucocorticoid
activity. Prednisone has a higher glucocorticoid activity than
hydrocortisone, but the fetus is not able to convert it to pred-
nisolone, the active form