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Endocrine - 3rd year > Week 2 Review Q's > Flashcards

Week 2 Review Q's Flashcards

Anatomy of suprarenal glands (1-64) steroid biochemistry (65-111) regulation of adrenal hormone syn (112-129) patho of adrenals (130-175) seminar fundamentals of assessment of adrenal disorder (176-197) seminar CAH (198-208) adrenal gland physio (209-239) adrenal hormones pharma (240-288) pathology of adrenals lab (289-304)

1
Q

Which fo the following has a bigger suprarenal gland?

a. male adult
b. female adult
c. fetus

A

c. fetus

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2
Q

Which is derived from the fibrous stroma of the gland?

a. true capsule
b. false capsule

A

a. true capsule

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3
Q

Which pathology is most likely to be found in the bare area of the liver?

A

an abscess (more common in that area)

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4
Q

anterior and posterior renal fascia join to form which structure?

A

false capsule

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5
Q

Which is most likely to be affected by liver abscesses?

a. right suprarenal gland
b. left suprarenal gland

A

a. right suprarenal gland

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6
Q

Which part of the right suprarenal gland is in contact with the bare area of the liver?

A

lateral side

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7
Q

the suprarenal vein emerges from which part of the suprarenal gland?

a. anterior surface
b. posterior surface
c. medial border

A

a. anterior surface

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8
Q

Which structure is related to the inferior side of the posterior surface of the right suprarenal gland?

A

right kidney

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9
Q

Which structure is related to the medial side of the anterior surface of the right suprarenal gland?

A

IVC

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10
Q

Which part of the right suprarenal gland is in contact with the diaphragm?

a. anterior surface
b. posterior surface
c. medial border

A

b. (upper part of the) posterior surface

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11
Q

T/F: the left suprarenal gland is concave from the lateral border

A

true

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12
Q

Which structure is related to the superior side of the anterior surface of the left suprarenal gland?

A

stomach

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13
Q

Which structure is related to the inferior side of the anterior surface of the left suprarenal gland?

A

pancreas

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14
Q

Which structure is related to the lateral side of the anterior surface of the right suprarenal gland?

A

liver

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15
Q

Which structure is related to the lateral side of the posterior surface of the left suprarenal gland?

A

diaphragm

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16
Q

Which is a branch of the renal artery?

a. Superior suprarenal artery
b. Middle suprarenal artery
c. Inferior suprarenal artery

A

c. Inferior suprarenal artery

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17
Q

What two things drain into the Left Renal vein?

A

Left suprarenal vein

Left gonadal vein

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18
Q

Which is a branch of the abdominal aorta?

a. Superior suprarenal artery
b. Middle suprarenal artery
c. Inferior suprarenal artery

A

b. Middle suprarenal artery

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19
Q

Which cells produce chromogranin A?

A

chromaffin cells

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20
Q

chromogranin A is s storage protein complex for which hormones?

A

epinephrine

nonepinephrine

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21
Q

Which spinal cord segment supplies preganglionic sympathetic fibers to the suprarenal medulla?

A

T8-L1

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22
Q

Which is a branch of the inferior phrenic artery?

a. Superior suprarenal artery
b. Middle suprarenal artery
c. Inferior suprarenal artery

A

a. Superior suprarenal artery

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23
Q

Nerves supplying the cortex of the suprarenal gland go through which of the following?

a. greater splanchnic nerve
b. coeliac ganglion

A

b. coeliac ganglion

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24
Q

Which part of the suprarenal gland develops from the mesoderm?

A

cortex

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25
Q

When do cells of the cortex produce DHEA?

a. first trimester
b. second trimester
c. third trimester
d. during birth
e. after birth

A

b. second trimester

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26
Q

Which part of the suprarenal gland develops from neural crest cells?

A

medulla

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27
Q

Nerves supplying the chromaffin cells of the suprarenal gland go through which of the following?

a. greater splanchnic nerve
b. coeliac ganglion

A

a. greater splanchnic nerve

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28
Q

What’s the main difference between postsynaptic neurons and chromaffin cells?

A

chromaffin cells don’t have axonal processes

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29
Q

When do cells of the cortex differentiate into 3 zones?

a. first trimester
b. second trimester
c. third trimester
d. during birth
e. after birth

A

e. after birth

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30
Q

What’s the most common cause of congenital adrenal hyperplasia (CAH)?

A

absence of 21-hydroxylase.

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31
Q

Which describes the inheritance pattern of congenital adrenal hyperplasia (CAH)?

a. autosomal dominant
b. autosomal recessive
c. X linked

A

b. autosomal recessive

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32
Q

explain the mechanism of how congenital adrenal hyperplasia (CAH) leads to abnormal genital development in infant girls

A

CAH may enable the synthesis of cortisol or aldosterone, which leads to the body making more of another hormone: androgen. High androgen causes the manifestations

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33
Q

Which approach to suprarenal gland excision is commonly used in laparoscopy?

a. posterior
b. lateral
c. anterior

A

c. anterior

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34
Q

T/F: posterior and lateral approaches to suprarenal gland excision involves the removal of rib 11 and rib 12

A

false, the removal or rib 11 OR rib 12 is needed

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35
Q

What percentage of the suprarenal gland is the medulla?

A

10%

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36
Q

Which suprarenal gland is being excised in this procedure: The splenic flexure is mobilized inferiorly revealing the kidney and the lateral phrenicocolic and splenorenal ligaments are then fully divided.

a. right suprarenal gland
b. left suprarenal gland

A

b. left suprarenal gland

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37
Q

Which releases catecholamines?

a. cortex
b. medulla

A

b. medulla

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38
Q

Which of the following is the thickest layer?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

b. Zona Fasciculata

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39
Q

Which of the following secretes aldosterone?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

a. Zona Glomerulosa

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40
Q

Which releases steroids?

a. cortex
b. medulla

A

a. cortex

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41
Q

Which of the following secretes cortisol?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

b. Zona Fasciculata

secretes glucocorticoids

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42
Q

Which of the following is responsible for axillary and pubic hair growth during puberty (in females)?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

c. Zona Reticularis

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43
Q

Adrenal androgens are secreted by Zona Reticularis in response to what hormone? What receptor does the hormone use?

A

ACTH

ACTH receptor called melanocortin receptor 2

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44
Q

Which of the following have uniform polyhedral cells with distinct outlines, indistinct nucleoli, and vacuolated cytoplasm?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis

A

b. Zona Fasciculata

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45
Q

Which of the following increases hormone release when renin is high?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

a. Zona Glomerulosa

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46
Q

Which of the following releases adrenal androgens after prolonged ACTH stimulation?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

b. Zona Fasciculata

by Zona Reticularis initially

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47
Q

Which of the following consists of columnar cells arranges in inverted columns?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

a. Zona Glomerulosa

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48
Q

Which of the following contains chromaffin cells?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

d. Medulla

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49
Q

Patient presents with high vaniyll mandelic acid (VMA) levels in urine. Which pathology is most likely?

A

Pheochromocytoma (tumor of the medulla; excessive catecholamines)

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50
Q

Describe the dual blood supply of the medulla

A

arterial blood from the medullary arterioles

venous blood from the cortical sinusoids

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51
Q

How does the adrenomedullary vein aid in the efflux of hormones?

A

tunica media of vein contains longitudinally oriented smooth muscles, their contraction causes the adrenal gland volume to decrease leading to hormone efflux

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52
Q

Which two things work together to form the fight/flight response?

A

glucocorticoids (secreted in the cortex- they induce conversion of NE to epinephrine) and catecholamines (secreted in the medulla)

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53
Q

What do Chromaffin cells secrete?

A

secrete noradrenaline and adrenaline (and chromogranin a)

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54
Q

In which area do the anterior and posterior renal fascia NOT fuse?

a. superiorly
b. inferiorly

A

b. inferiorly

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55
Q

Which of the following drain directly into the IVC?

a. right suprarenal vein
b. left suprarenal vein

A

a. right suprarenal vein

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56
Q

Which of the following’s hormone release is regulated by juxtaglomerular cells of the kidney and partly by the pituitary?

a. Zona Glomerulosa
b. Zona Fasciculata
c. Zona Reticularis
d. Medulla

A

a. Zona Glomerulosa

juxtaglomerular cells release renin

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57
Q

What catalyzes the conversion of angiotensinogen to angiotensin I?

A

Circulating renin

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58
Q

What catalyzes the conversion of angiotensin I to angiotensin II?

A

angiotensin-converting enzyme (ACE)

made in the lung

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59
Q

What method can be used to treat chronic essential hypertension?

A

give drugs that inhibit ACE in the lung (it stops the synthesis of angiotensin II, which stops aldosterone secretion)

(we took “Captopril” in a learning topic which is an ACE inhibitor)

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60
Q

patient comes in with muscular weakness, low blood pressure, anemia, hyperpigmentation, and weight loss. What do you suspect?

A

Addison’s disease (deficiency of mineralocorticoids)

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61
Q

Patient comes in with hypertension, edema due to sodium and water retention and hypokalemia. What do you suspect?

A

Conn’s syndrome (excessive aldosterone secretion)

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62
Q

patient comes in with obesity, diabetes and hypogonadism. What do you suspect?

A

Cushing’s syndrome (excessive secretion of glucocorticoids)

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63
Q

explain why Cushing’s syndrome causes slow wound healing?

A

Cortisol is diabetogenic and delays wound healing by diminishing the activity of fibrocytes. It’s also anti-allergic and diminishes antibody formation

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64
Q

cells of which area stain positive (brown) when treated with potassium bichromate?

A

The cells of the medulla (Chromaffin cells stain positive, chromaffin reaction)

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65
Q

What do you call a steroid made of 17 carbons containing tetracyclic hydrocarbons?

A

gonane

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66
Q

In which location is the side chain arranged to the steroid nucleus?

A

carbon 17 of the D ring

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67
Q

Where does most of the cholesterol used for the steroid synthesis come from?

A

from the circulation (80%)

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68
Q

Which of the following goes through aromatization to be made?

a. Androgens
b. Bile acids
c. Estrogens
d. Progesterone

A

c. Estrogens

aromatization in ring A

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69
Q

Which of the following is made by adding an OH to cholesterol?

a. Androgens
b. Bile acids
c. Estrogens
d. Progesterone

A

b. Bile acids

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70
Q

Which is used to esterify cholesterol?

a. Cholesterol ester hydrolase
b. Acyl-CoA cholesterol acyltransferase I
c. cytochrome P450scc
d. 3b-Hydroxy steroid dehydrogenase (3bHSD)
e. 17,20-Lyase

A

b. Acyl-CoA cholesterol acyltransferase I (ACAT)

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71
Q

How many sites in steroidogenic acute regulatory (StAR) protein are available for phosphorylation by protein kinase C (PKC)?

A

6

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72
Q

Which of the following is encoded by cyp11a1 gene?

a. Cholesterol ester hydrolase
b. Acyl-CoA cholesterol acyltransferase I
c. cytochrome P450scc
d. 3b-Hydroxy steroid dehydrogenase (3bHSD)
e. 17,20-Lyase

A

c. cytochrome P450scc

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73
Q

How many sites in steroidogenic acute regulatory (StAR) protein are available for phosphorylation by protein kinase A (PKA)?

A

3

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74
Q

In which two locations does steroid hormone synthesis take place?

A

ER

mitochondria

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75
Q

Which of the following is responsible for creating androgens from cholesterol?

a. 17 alpha-hydroxylase
b. 21 hydroxylase
c. 17,20-Lyase
d. aromatase
e. aldosterone synthase

A

c. 17,20-Lyase

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76
Q

mineralocorticoids are synthesized due to the deficiency of enzyme?

a. 17 alpha-hydroxylase
b. 21 hydroxylase
c. 17,20-Lyase
d. aromatase
e. aldosterone synthase

A

a. 17 alpha-hydroxylase

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77
Q

Androgens are synthesized due to the deficiency of enzyme?

a. 17 alpha-hydroxylase
b. 21 hydroxylase
c. 17,20-Lyase
d. aromatase
e. aldosterone synthase

A

b. 21 hydroxylase

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78
Q

Which of the following genes codes for 21-hydroxylase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

b. CYP21A2

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79
Q

glucocorticoids are synthesized due to the deficiency of enzyme?

a. 17 alpha-hydroxylase
b. 21 hydroxylase
c. 17,20-Lyase
d. aromatase
e. aldosterone synthase

A

e. aldosterone synthase

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80
Q

What happens with the total removal of side-chain?

a. androgens
b. progesterone
c. corticosteroids
d. mineralocorticoids

A

a. androgens

progesterone, corticosteroids & mineralocorticoids= Partial removal

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81
Q

Which of the following genes codes for aromatase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

f. CYP19

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82
Q

Which of the following genes codes for aldosterone synthase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

d. CYP11B2

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83
Q

Which of the following genes codes for 17,20 lyase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

e. CYP17

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84
Q

Which of the following genes codes for desmolase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

a. CYP11A1

desmolase aka SCC enzyme

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85
Q

Leydig cells express high levels of which two hormones? What activates Leydig cells to produce testosterone?

A

3β-HSD and 17β-HSD are highly expressed in Leydig cells

LH activates Leydig cells

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86
Q

What four actions does PKA do when activated by camp?

A

1- import of cholesterol via LDL
2- activates CEH enzyme
3- activates Star
4 activates TF CREB

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87
Q

Which of the following converts cholesterol into pregnenolone?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

a. CYP11A1

aka P450scc

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88
Q

What converts estrone into estradiol?

A

17β-Hydroxysteroid dehydrogenase

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89
Q

What converts androstendione into estrone?

A

Aromatase

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90
Q

Which of the following is transported via Corticosteroid binding globulin (CBG)?

a. Aldosterone
b. DHEA
c. Cortisol
d. Androgens & Estrogens

A

c. Cortisol

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91
Q

Which of the following is transported via Albumin?

a. Aldosterone
b. DHEA
c. Cortisol
d. Androgens & Estrogens

A

a. Aldosterone

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92
Q

Which of the following does not have a specific carrier protein?

a. Aldosterone
b. DHEA
c. Cortisol
d. Androgens & Estrogens

A

b. DHEA

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93
Q

What percent of steroid hormones freely circulate in the bloodstream?

A

10%

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94
Q

T/F: steroid hormones do not use secondary messengers, but rather act directly to change gene transcription

A

true

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95
Q

Which of the following is transported via Sex hormone binding globulin (SHBG)?

a. Aldosterone
b. DHEA
c. Cortisol
d. Androgens & Estrogens

A

d. Androgens & Estrogens

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96
Q

Which stage of steroid inactivation leads to the transformation of the lipophilic compounds into water soluble metabolites?

a. phase 1
b. phase 2

A

b. phase 2

Sulfation or glucuronidation

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97
Q

The Sulfation or glucuronidation in phase 2 of steroid inactivation occurs in which carbon positions?

A

3rd and/or 17th Carbon positions.

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98
Q

Which carbon positions are the two methyl groups of cholesterol located?

A

at position 18 & 19

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99
Q

Which is used to breaks down cholesterol esters and produces free cholesterol and FFA?

a. Cholesterol ester hydrolase
b. Acyl-CoA cholesterol acyltransferase I
c. cytochrome P450scc
d. 3b-Hydroxy steroid dehydrogenase (3bHSD)
e. 17,20-Lyase

A

a. Cholesterol ester hydrolase

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100
Q

What receptor is used to capture cholesterol from circulatory LDL?

A

Scavenger receptor class B, type I (SR-BI)

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101
Q

What is the first and rate-limiting step in any steroid synthesis?

A

Cleavage of 6 carbons (C22-C26) of the side chain (via cytochrome P450scc)

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102
Q

What converst insoluble cholesterol (27C) is into soluble pregnenolone (21C)?

A

CYP11A1 (aka P450scc aka desmolase)

it does it via three steps (hydroxylation, hydroxylation, Scission)

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103
Q

Which enzyme inactivates steroidogenic acute regulatory (StAR) protein?

A

PKC

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104
Q

Which enzyme activates steroidogenic acute regulatory (StAR) protein?

A

PKA

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105
Q

Which is used to convert Pregnenolone into progesterone?

a. Cholesterol ester hydrolase
b. Acyl-CoA cholesterol acyltransferase I
c. cytochrome P450scc
d. 3b-Hydroxy steroid dehydrogenase (3bHSD)
e. 17,20-Lyase

A

d. 3b-Hydroxy steroid dehydrogenase (3bHSD)

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106
Q

Which of the following is known as the second SCC enzyme?

a. Cholesterol ester hydrolase
b. Acyl-CoA cholesterol acyltransferase I
c. cytochrome P450scc
d. 3b-Hydroxy steroid dehydrogenase (3bHSD)
e. 17,20-Lyase

A

e. 17,20-Lyase

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107
Q

Which of the following codes for 11 beta hydroxylase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

c. CYP11B1

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108
Q

Which of the following codes for 3 beta-hydroxysteroid dehydrogenase?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A

g. 3 beta-HSD

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109
Q

Which THREE of the following code for enzymes located in the ER?

a. CYP11A1
b. CYP21A2
c. CYP11B1
d. CYP11B2
e. CYP17
f. CYP19
g. 3 beta-HSD

A 
b. CYP21A2
&
e. CYP17
&
g. 3 beta-HSD

(the rest code for mitochondrial enzymes)

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110
Q

Which TWO of the following are found in the Mitochondria?

a. CYP-450scc / 20,22-lyase
b. 3b-hydroxysteroid dehydrogenase
c. 17a-hydroxylase
d. 21-hydroxylase
e. 11b-hydroxylase

A

a. CYP-450scc / 20,22-lyase
&
e. 11b-hydroxylase

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111
Q

Which of the following releases LDL from the LDL receptors in endosomes?

a. Cholesterol ester hydrolase
b. endosomal ATPase 

c. Acyl-CoA cholesterol acyltransferase I
d. Cholesterol ester hydrolase

A

b. endosomal ATPase 


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112
Q

What suppresses the immune system in long term stress response?

A

glucocorticoids

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113
Q

What increases blood volume and pressure in long term stress response?

A

mineralocorticoids

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114
Q

What increases blood glucose in short term stress response?

A

epinephrine and norepinephrine

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115
Q

Sterol carrier protein-2 (SCP-2) carries free Cholesterol to which of the following sites?

a. inner mitochondrial matrix
b. outer mitochondrial matrix

A

b. outer mitochondrial matrix

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116
Q

Whos is most likely to get steroidogenic cell hyperplasia?

a. person on vacation
b. person with pet
c. medical student

A

c. medical student

chronic stress

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117
Q

What activates Aldosterone is synthesis?

A

angiotensin 2 and plasma potassium

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118
Q

Which receptor does aldosterone act on?

A

mineralocorticoid receptor (MR)

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119
Q

What’s the function of hormone-sensitive lipase (HSL)?

A

liberates free Cholesterol from lipid droplets

Hormone-sensitive lipase HSL, AKA cholesteryl ester hydrolase (CEH)

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120
Q

What type of stress induces protein and fat breakdown into sugar? What induces these changes?

A

long term stress converts proteins and fats into glucose (while short term raises glucose by breaking down glycogen)
glucocorticoids induce this

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121
Q

When is aldosterone secreted?

a. low potassium levels
b. low blood pressure
c. increased sodium levels
d. increased blood volume

A

b. low blood pressure

released when low blood pressure, volume, and sodium, also when potassium levels are high

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122
Q

What enzymes do Aldosterone-target cells express?

A

11β-hydroxysteroid dehydrogenase –Type II (11β-HSD-II)

123
Q

What’s the regulator of the rate-limiting step in steroid biosynthesis?

A

steroidogenic acute regulatory (StAR) protein

124
Q

What hormones acts on the mineralocorticoid receptors (MR)?

A

Aldosterone and cortisol

125
Q

Circulating cortisol is 3x higher than aldosterone, so how do mineralocorticoid receptors get more aldosterone?

A

11β-HSD-II converts cortisol to the inactive cortisone, permitting aldosterone to activate mineralocorticoid receptor

126
Q

Defective 11β-HSD-II leads to which pathologies?

A

sodium retention, and salt-dependent hypertension

127
Q

Denovo synthesis of cholesterol requires which precursor?

A

acetyl coA

128
Q

What does steroidogenic acute regulatory (StAR) protein do?

A

speeds the transport of cholesterol from the outer mitochondrial membrane (OMM) to the inner mitochondrial membrane (IMM)

129
Q

What are the four Aldosterone-target cells?

A

Kidney, colon, vascular wall, placenta

130
Q

Which of the following is NOT controlled by ACTH levels?

a. Adrenal androgens
b. Glucocorticoids
c. Mineralocorticoids

A

c. Mineralocorticoids

mainly controlled by the renin angiotensin system

131
Q

Which of the following tests deficiencies?

a. Stimulation Tests
b. Suppression Tests

A

a. Stimulation Tests

132
Q

Hypercortisolism is also known as

A

Cushing Syndrome

133
Q

Which hormones do not have a negative feedback inhibition?

A

Mineralocorticoids & Sex steroids

134
Q

Why do patients with Cushing syndrome have purple striae and poor wound healing?

A

due to weak collagen

135
Q

Which of the following tests overactivity?

a. Stimulation Tests
b. Suppression Tests

A

b. Suppression Tests

136
Q

Which muscle type is most affected in patients with Cushing syndrome?

A

fast-twitch, type 2 muscles

137
Q

Most common cause of Cushing syndrome is

A

Prolonged corticosteroid therapy (iatrogenic)

138
Q

Which has low ACTH?

a. Adrenal Cushing syndrome
b. Cushing disease
c. Ectopic Cushing syndrome

A

a. Adrenal Cushing syndrome

139
Q

Which of the following has a positive high-dose dexamethasone suppression test?

a. Adrenal Cushing syndrome
b. Cushing disease
c. Ectopic Cushing syndrome

A

b. Cushing disease

dexamethasone= cortisol analog

140
Q

Which is used to confirm the diagnosis of Cushing?

a. low-dose dexamethasone suppression test
b. high-dose dexamethasone suppression test

A

a. low-dose dexamethasone suppression test

confirm Cushing but not identify its cause

141
Q

When is cortisol the highest/lowest?

A

highest in early mornings (8/9AM) and least at midnight

142
Q

Which is used to know the cause of Cushing?

a. low-dose dexamethasone suppression test
b. high-dose dexamethasone suppression test

A

b. high-dose dexamethasone suppression test

143
Q

Which has characteristically very high ACTH?

a. Adrenal Cushing syndrome
b. Cushing disease
c. Ectopic Cushing syndrome

A

c. Ectopic Cushing syndrome

144
Q

On average, which undergoes larger cortical hyperplasia (adrenal enlargement) and why?

a. Adrenal Cushing syndrome
b. Cushing disease
c. Ectopic Cushing syndrome

A

b. Cushing disease

(Ectopic Cushing syndrome also have it, but the rapid downhill of patients with these cancers often limits the extent of the adrenal enlargement)

145
Q

Which of the following is caused by “incidentalomas”?

a. Adrenal Cushing syndrome
b. Cushing disease
c. Ectopic Cushing syndrome

A

a. Adrenal Cushing syndrome

incidentalomas= adrenocortical adenomas that are clinically silent and found incidentally

146
Q

Most common cause of hypercortisolism?

A

exogenous administration of steroids

147
Q

3 clinical features of Hyperaldosteronism

A

Hypertension
Postassium loss
Sodium retention

148
Q

What causes Secondary Hyperaldosteronism?

A

activation of the renin-angiotensin system

149
Q

What causes the Spironolactone bodies in histology samples?

A

When you take the anti-hypertensive medication, Spironolactone (prevents your body from absorbing too much salt and keeps your potassium levels from getting too low)

150
Q

What is Conn’s syndrome?

A

primary hyperaldosteronism, where the adrenal glands make too much aldosterone

151
Q

Describe renin levels Conn’s syndrome

A

decreased plasma levels

152
Q

Most common cause of Hyperaldosteronism?

A

idiopathic

153
Q

Most common cause of Hypoaldosteronism?

A

Abrupt withdrawal of corticosteroids

154
Q

dexamethasone is an analog for

A

cortisol

155
Q

What is Waterhouse–Friderichsen syndrome (WFS)?

A

adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection (N. meningitidis)

156
Q

What is Addison disease?

A

primary hypoaldosteronism

157
Q

When can hypercortisolism cause bilateral cortical atrophy?

A

When its caused by exogenous steroids, they suppress ACTH, which stops the adrenals from producing cortisol. That leads to atrophy.

158
Q

Which of the following is more common?

a. cushing syndrome
b. cushing disease
c. ectopic cushing syndrome

A

b. cushing disease

159
Q

Which is more common in men above the age of forty?

a. Adrenal cushing syndrome
b. cushing disease
c. Ectopic Cushing syndrome

A

c. Ectopic Cushing syndrome

160
Q

What is used to screen for hyperaldosteronism?

A

aldosterone:renin ratio

161
Q

What is used to confirm hyperaldosteronism?

A

aldosterone suppression test

162
Q

Secondary hyperaldosteronism is caused by a deficiency in

A

ACTH

163
Q

A patient has an autoimmune disease against the adrenal gland. What kind of hypoaldosteronism can this lead to?

a. primary acute
b. primary chronic
c. secondary

A

b. primary chronic

164
Q

primary hyperaldosteronism VERSUS secondary hyperaldosteronism
Which one causes pigmentation and why?

A

Primary causes high ACTH. To make ACTH POMC is required, which is what stimulates MSH and leads to pigmentation.
(secondary hyperaldosteronism has low ACTH, thus low POMC)

165
Q

Which neoplasm which stains positive for potassium dichromate?

A

Pheochromocytoma (neoplasm made from chromaffin cells)

166
Q

Pheochromocytoma have a granular cytoplasm, what is an explanation for this?

A

the cytoplasm has many vacuoles filled with catecholamines

167
Q

Describe clinical features of a patient with pheochromocytoma

A

chronic hypertension

168
Q

Describe the gross appearance of pheochromocytoma

A

tan and well defined tumor

169
Q

pheochromocytoma stains positive for what two stains?

A

chromogranin A and S100 (stains sustentacular cells)

170
Q

What are four things you can test to confirm the presence of a pheochromocytoma?

A 
Catecholamines
Vanillylmandelic acid (VMA)
Metanephrines 
Chromogranin A
(you can also use nuclear medicine scan to locate the tumor)
171
Q

Which four genetic defects lead to pheochromocytomas?

A

RET gene
SDH gene
VHL gene
NF1 gene

172
Q

What’s a tumor of the sympathetic ganglia and adrenal medulla

A

neuroblastoma

173
Q

What’s the most common solid malignancy of childhood and infancy?

A

brain tumors

174
Q

What’s the second most common solid malignancy of childhood and infancy?

A

neuroblastoma

175
Q

catecholamines metabolites can be used to do which of the following?

a. screen for neuroblastoma
b. confirm neuroblastoma

A

a. screen for neuroblastoma

176
Q

Which of the following symptoms is a more specific sign of cushing syndrome?

a. depression
b. abdominal striae
c. buffalo hump
c. moon face

A

b. abdominal striae

spontaneous bruising, proximal myopathy, and abdominal striae are the most specific signs

177
Q

Whats needed to diagnose cushing syndrome?

A

at least two positive tests

178
Q

Explain how the diurnal variation test of cushing syndrome works?

A

test cortisol in the morning and at midnight, midnight test concentration should be 75% of the morning concentration

179
Q

What does it indicate when a patient has a positive low-dose dexamethasone suppression test?

A

that he has cushing (but we don’t know the cause)

180
Q

Patient with cushing has high glucose, explain the etiology?

A

cortisol acts against insulin (it releases the sugar from cells)

181
Q

Addisons disease that was caused by a pituitary adenoma causes which of the following?

a. high cortisol
b. low ACTH
c. high ACTH

A

b. low ACTH

182
Q

Describe the levels of cortisol, aldosterone, and ACTH in primary adrenal insufficiency?

A

cortisol low
aldosterone low
ACTH high

183
Q

Describe the levels of cortisol, aldosterone, and ACTH in secondary adrenal insufficiency?

A

cortisol low
aldosterone normal (electrolytes not changed)
ACTH low

184
Q

Which of the following causes hyperpigmentation?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

a. primary adrenal insufficiency

185
Q

Which of the following has normal electrolyte balance?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

b. secondary adrenal insufficiency

because of the presence of aldosterone

186
Q

How much of the adrenal cortex must be destroyed for the effects to be evident?

A

90%

187
Q

Which of the following causes paleness?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

b. secondary adrenal insufficiency

188
Q

You suspect a patient of adrenal insufficiency and test his cortisol level at 9 AM, which of the following excludes adrenal insufficiency?

a. low cortisol levels
b. normal cortisol levels
c. high cortisol levels

A

c. high cortisol levels

(a normal result doesn’t exclude adrenal insufficiency. WHY? because a patient with low cortisol may be stressed because of the doctor/hospital visit and that can increases the stress hormone cortisol, causing it do appear normal)

189
Q

Which of the following has a high renin concentration?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

a. primary adrenal insufficiency

(adrenal doesn’t produce enough aldosterone, so the Na is low and K is high -> low blood pressure. so the renin would increase to try and increase it back to normal)

190
Q

Which of the following has an abnormal electrolyte balance?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

a. primary adrenal insufficiency

191
Q

Which of the following has a low renin concentration?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

b. secondary adrenal insufficiency

not sure about this

192
Q

Which of the following has a low renin concentration?

a. primary hyperaldosteronism
b. secondary hyperaldosteronism

A

a. primary hyperaldosteronism

(the adrenal makes too much aldosterone-> Na-K pumps work hard so the Na becomes high and K low. This leads to high BP, the Renin-angiotensin system stops renin secretion to lower the BP)

193
Q

Which of the following has a high renin concentration?

a. primary hyperaldosteronism
b. secondary hyperaldosteronism

A

b. secondary hyperaldosteronism

194
Q

What does a positive synacthen stimulation test indicate?

a. adrenal glands functional
b. adrenal glands non-functional

A

b. adrenal glands non-functional

(positive tests always indicate abnormalities, so in this case it means that cortisol levels don’t respond to the ACTH analog)

195
Q

Which of the following has a higher response to ACTH analogs?

a. primary adrenal insufficiency
b. secondary adrenal insufficiency

A

b. secondary adrenal insufficiency

196
Q

Patient has hypertension, elevated K levels, hypokalemic alkalosis, and low renin levels. Which is the diagnosis?

a. primary hyperaldosteronism
b. secondary hyperaldosteronism

A

a. primary hyperaldosteronism

197
Q

What’s the most common cause of primary hyperaldosteronism?

A

aldosterone-producing adrenal tumor

198
Q

What’s th metabolite of androstenedione?

A

17-oxosteroid

199
Q

What’s the metabolite of 17- Hydroxyprogesterone?

A

pregnanetriol

200
Q

What is the metabolite of cortisol?

A

tetrahydrocortisol glucuronide

201
Q

11-Deoxycortisol protein is low in a case of CAH. Which enzyme is low?

a. 11-b-hydroxylase
b. 21- hydroxylase

A

b. 21- hydroxylase

202
Q

What gene encodes for 21-hydroxylase?

A

Cytochrome P450 Family 21 Subfamily A Member 2 (CYP21A2) gene encoding

203
Q

11-Deoxycortisol protein is high in a case of CAH. Which enzyme is low?

a. 11-b-hydroxylase
b. 21- hydroxylase

A

a. 11-b-hydroxylase

204
Q

What gene encodes for 11-b-hydroxylase?

A

Cytochrome P450 Family 11 Subfamily B Member 1 (CYP11B1) gene

205
Q

Which of the following is low in a CAH patient?

a. pregnanetriol
b. tetrahydrocortisol glucuronide
c. 17-oxosteroid

A

b. tetrahydrocortisol glucuronide

no cortisol is made

206
Q

Where is androstenedione converted to testosterone?

A

adrenal cortex or in peripheral tissues

207
Q

Describe the ACTH levels of a CAH patient, why is this?

A

high ACTH, since the cortisol is low or nonexistent there’s no negative inhibition and the pituitary continuously stimulates the adrenals (->hypertrophy)

208
Q

Testosterone is converted into dihydrotestosterone by what enzyme? Where does it take place?

A

5a-reductase in peripheral tissue

209
Q

Why does a fetus have a bigger suprarenal gland?

A

fetal adrenal cortisol secretion needed for labor

210
Q

Which of the following has a greater effect on beta 2 receptors?

a. epinephrine
b. norepinephrine

A

a. epinephrine

norepinephrine mostly works on alpha receptors

211
Q

What activates the nicotinic receptors of the medulla?

a. pre-ganglionic fibers of the parasympathetic nervous system
b. post-ganglionic fibers of the parasympathetic nervous system
c. pre-ganglionic fibers of the sympathetic nervous system
d. post-ganglionic fibers of the sympathetic nervous system

A

c. preganglionic sympathetic nerve fibers (release acetylcholine)

212
Q

once the nicotinic receptors of the medulla are activated (by acetylcholine) which catecholamines are released? and at which ratio?

A

epinephrine & norepinephrine at a 4:1 ratio

213
Q

give two examples of neuroectodermal cells

A

Chromaffin cells and pheochromocytes

214
Q

Which of the following is secreted almost entirely from the adrenal medulla?

a. epinephrine
b. norepinephrine

A

a. epinephrine

215
Q

only 30% of norepinephrine comes from medulla, where does the rest of the 70% come from?

A

70% is released from nerve terminals (of the sympathetic nervous system) and diffuses into the vascular system
(post-ganglionic fibers of the sympathetic nervous system)

216
Q

Which catecholamine receptors decrease insulin secretion in times of stress?

a. a1
b. a2
c. b1
d. b2
e. b3

A

b. a2

217
Q

Which catecholamine receptors break down fat tissue in times of stress?

a. a1
b. a2
c. b1
d. b2
e. b3

A

e. b3

218
Q

Which catecholamine receptors decrease blood flow to the GI tract in times of stress?

a. a1
b. a2
c. b1
d. b2
e. b3

A

a. a1

219
Q

Which catecholamine receptors increase cardiac output in times of stress?

a. a1
b. a2
c. b1
d. b2
e. b3

A

c. b1

220
Q

Which catecholamine receptors increase gluconeogenesis in times of stress?

a. a1
b. a2
c. b1
d. b2
e. b3

A

d. b2

221
Q

Which of the following is more frequently elevated in Pheochromocytomas?

a. epinephrine
b. norepinephrine

A

b. norepinephrine

222
Q

What’s the mechanism of action of hypertension in Pheochromocytomas?

A

high norepinephrine acts with alpha receptors, which constricts blood vessels and leads to hypertension

223
Q

What’s the mechanism of action of orthostatic hypotension in Pheochromocytomas?

A

down-regulation of α-adrenergic receptors resulting from persistent elevation of norepinephrine. Thus the baroreceptor response to blood shifts is blunted.

224
Q

Which of the following has a lower half-life? why?

a. aldosterone
b. cortisol

A

a. aldosterone

because it has a lower affinity to albumin, transcortin, and aldosterone binding globin

225
Q

How does aldosterone affect sodium levels in saliva?

A

decrease the Na levels

226
Q

Explain how Atrial natriuretic peptide (ANP) works and its relation with aldosterone

A

ANP is a natriuretic peptide hormone secreted from the cardiac atria, these cells have volume receptors that respond to increased stretching of the atrial wall due to increased atrial blood volume. They want to reduce the blood volume/pressure, so they increase Na excretion and they stop aldosterone secretion.

227
Q

Explain how juxtaglomerular cells work and its relation with aldosterone

A

Juxtaglomerular cells secrete renin in response to a drop in pressure detected by stretch receptors in the vascular walls of the kidney. (secrete renin when they detect low Na) Renin then (together with ACE) help make angiotensin II and that stimulates aldosterone synthesis

228
Q

Cortisol stimulates which of the following?

a. bone resorption
b. bone formation

A

a. bone resorption

again, mainly a catabolic hormone

229
Q

When is cortisol needed to respond to catecholamines?

A

only when catecholamines are in high concentrations (administered pharmacologically). It increases cardiac output and blood pressure

230
Q

What does cortisol stimulate in the liver?

A

gluconeogenesis (only acts anabolically in the liver)

231
Q

Which of the following cortisol actions is FALSE?

a. depression
b. RBC production
c. ADH stimulation
d. stimulate appetite

A

c. ADH stimulation

it actually inhibits ADH secretion

232
Q

A person is running away from a lion, is cortisol necessary to deal with the high amounts of catecholamines in the circulation?

A

No, they’re only necessary if catecholamines are administered pharmacologically

233
Q

Which of the following causes hyperpigmentation?

a. cushing syndrome
b. cushing disease

A

b. cushing disease

high ACTH

234
Q

A deficiency in which of the following enzymes leads to feminine phenotypes?

a. 11β hydroxylase
b. 17α hydroxylase
c. 21 hydroxylase

A

b. 17α hydroxylase

235
Q

What prevents edema in conn’s syndrome?

A

Atrial natriuretic peptide (ANP)

236
Q

What’s the most common cause of Addison’s disease?

A

autoimmune destruction of the adrenal cortex

237
Q

What’s the second most common cause of Addison’s disease?

A

Tuberculosis, it infiltrates and destructs the adrenal gland (causes cortisol deficiency -> high ACTH)

238
Q

Patient comes in complaining of loss of appetite, salt craving, and pigmentation of gums. What’s the diagnosis? explain the cause each symptom

A

Addison’s

Salt craving= low aldosterone
Loss of appitite= low cortisol
Pigmentation= high ACTH leading to MSH stimulation

239
Q

How does serotonin increase glucocorticoid secretion?

A

serotonin enhances CRH, which leads to ACTH release. ACTH activates the adrenal cortex, leading to glucocorticoid release

240
Q

What converts cholesterol to pregnenolone?

A

by an enzyme called 20-22 desmolase

241
Q

Which of the following is more freely available in the plasma?

a. Aldosterone
b. Glucocorticoid

A

a. Aldosterone

242
Q

How does epinephrine increase glucocorticoid secretion?

A

by enhancing ACTH secretion, leading to the activation of the adrenal cortex and glucocorticoid release

243
Q

How does serotonin increase glucocorticoid secretion?

A

by enhancing CRH secretion

244
Q

What enhances the clearance/biotransformation of glucocorticoids?

A 
hyperthyroidism
((phenobarbital
rifampine
carbamazopine 
phenytoin 
*** NOT in drug list))
245
Q

Which hormones increase transcortin levels?

A

estrogen, progesterone, and thyroid hormones

246
Q

What reduces the clearance/biotransformation of glucocorticoids?

A 
estrogen
pregnancy
hypothyroidism
liver disease 
malnutrition 
low protein diet
247
Q

Which of the following does cortisol function as?

a. glucocorticoid
b. mineralocorticoids
c. both
d. neither

A

c. both

248
Q

Which of the following does cortisol bind to?

a. albumin
b. transcortin

A

b. transcortin

249
Q

Which is more potent?

a. Cortisol
b. Cortisone

A

a. Cortisol

250
Q

Which requires a higher dose to produce the same effect?

a. Cortisol
b. Cortisone

A

b. Cortisone

251
Q

Which of the following has a higher mineralocorticoid activity?

a. Betamethasone
b. 9-Flurocortisol
c. Triamcinolone
d. Prednisolone

A

b. 9-Flurocortisol

252
Q

Which of the following has the highest glucocorticoid activity?

a. Dexamethasone
b. 9-Flurocortisol
c. Triamcinolone
d. Prednisolone

A

a. Dexamethasone

Dexamethasone & Betamethasone have very high glucocorticoid activity

253
Q

Which of the following has the highest glucocorticoid activity?

a. Aminoglutethimide
b. Betamethasone
c. Cortisone
d. Dexamethasone

A

b. Betamethasone

Betamethasone>Dexamethasone

254
Q

Which of the following bind to albumin?

a. glucocorticoids
b. glucocorticoids synthetic analogs

A

b. glucocorticoids synthetic analogs

255
Q

Which of the following glucocorticoid functions is FALSE?

a. increase vitamin D action
b. decrease protein synthesis
c. increase myocardium sensitivity to catecholamines
d. decrease calcium absorption

A

a. increase vitamin D action

antagonize the action of vit D

256
Q

Which of the following have better oral bioavailability? Why?

a. glucocorticoids
b. glucocorticoids synthetic analogs

A

b. glucocorticoids synthetic analogs

cortisol gets degraded by first-pass metabolism in the liver

257
Q

Which of the following do glucocorticoids NOT inhibit?

a. histamine release
b. neutrophils
c. antibody formation
d. lymphocytes

A

b. neutrophils

it inhibits their migration, so they increase in the blood

258
Q

How do glucocorticoids decrease vascular permeability?

A

by increasing the expression of vasocortin

259
Q

Explain how glucocorticoid use can lead to secondary osteoporosis?

A

Glucocorticoids antagonize the action of vitamin D, thus decreasing calcium absorption. Low calcium causes release of parathyroid hormone. PTH breaks down bone to raise calcium levels.
Glucocorticoids can also suppress collagen formation which is an organic component in the bone

260
Q

Which adrenal cortex zones are affected during Addison’s disease?

A

zona glomerulosa and fasiculata

261
Q

What medications are used to treat Addison’s disease?

A

you need both mineralocorticoid and glucocorticoid activity, so give cortisol and flurocortisol

262
Q

Why are glucocorticoids used to treat asthma?

A

Increase expression of beta 2 adrenoreceptor, which increase catecholamines (primarily epinephrine) that then acts on both beta 1&2 receptors
Activation of beta 2 receptor causes relaxation of the smooth muscles of the lungs

263
Q

Which inhibits both prostaglandins and leukotrienes? explain the mechanism.

a. annexin A1
b. NSAIDs

A

a. annexin A1
(aka lipocortin) its an endogenous inhibitor of phospholipase A2. Phospholipase A2 is responsible for the formation of arachidonic acid, which starting material in the synthesis of prostaglandins and the leukotrienes

264
Q

Why are Glucocorticoids contraindicated in patients with Glaucoma?

A

they increase intraocular pressure

265
Q

Why are glucocorticoids used to treat septic shock?

A

it increases the cardiac output, restores blood pressure, and restore plasma glucose levels

266
Q

Which do NSAIDs inhibit?

a. prostaglandins
b. leukotrienes

A

a. prostaglandins

267
Q

Describe the binding of transcortin (CBG) to glucocorticoids

A

high affinity but low capacity

80% of glucocorticoids are bound to CBG

268
Q

What hormone decreases transcortin levels?

A

testosterone

269
Q

Which converts cortisone to physiologically active cortisol?

a. 11-β-hydroxysteroid dehydrogenase type-1
b. 11-β-hydroxysteroid dehydrogenase type-2

A

a. 11-β-hydroxysteroid dehydrogenase type-1

270
Q

How do glucocorticoids affect muscle capacity when taken acutely versus chronically?

A

increase muscle work capacity acutely, but is associated with myopathy chronically

271
Q

Which has a side effect of oral candida?

a. Metyrapone
b. Beclomethasone
c. Methylprednisolone/polyethylene glycol

A

b. Beclomethasone

272
Q

Which converts cortisol to inactive cortisone?

a. 11-β-hydroxysteroid dehydrogenase type-1
b. 11-β-hydroxysteroid dehydrogenase type-2

A

b. 11-β-hydroxysteroid dehydrogenase type-2

273
Q

Which is used to treat rheumatoid arthritis?

a. Metyrapone
b. Beclomethasone
c. Methylprednisolone/polyethylene glycol

A

c. Methylprednisolone/polyethylene glycol

274
Q

How can we minimize the side effects of glucocorticoid drugs without changing the dosage?

A

by changing the route of administration

275
Q

Describe the solubility of most glucocorticoids? What does that mean for their route of administration?

A

very lipid-soluble. Most of them cannot be taken by IV

276
Q

What are the only glucocorticoids that can be given via IV?

A

hydrocortisone succinate/phosphate

277
Q

How can we minimize the side effects of glucocorticoid drugs by changing the dosage? (2 ways)

A

1- mimic the circadian rhythm by giving two doses in the morning and one at night
2- alternative therapy (day on, day off) which has less effect on the hormonal axis

278
Q

What inhibits the enzyme 11 Beta hydroxylase?

a. Aminoglutethimide
b. Mifepristone
c. Metyrapone
d. Ketoconazole

A

c. Metyrapone

279
Q

What is used for the treatment of Cushing’s syndrome?

a. Aminoglutethimide
b. Mifepristone
c. Metyrapone
d. Ketoconazole

A

b. Mifepristone

280
Q

What inhibits many enzymes of the steroid biosynthetic pathway?

a. Aminoglutethimide
b. Mifepristone
c. Metyrapone
d. Ketoconazole

A

d. Ketoconazole

281
Q

What is an anti-fungal?

a. Aminoglutethimide
b. Mifepristone
c. Metyrapone
d. Ketoconazole

A

d. Ketoconazole

282
Q

What inhibits the rate-limiting enzyme in the biosynthesis of glucocorticoids?

a. Aminoglutethimide
b. Mifepristone
c. Metyrapone
d. Ketoconazole

A

a. Aminoglutethimide

283
Q

What inhibits the receptor for glucocorticoids?

a. Aminoglutethimide
b. Mifepristone
c. Metyrapone
d. Ketoconazole

A

b. Mifepristone

284
Q

Which is used to differentiate between the different forms of cushing’s syndrome?

a. Metyrapone stimulation test
b. Dexamethasone suppression test
c. ACTH and cosyntropin test

A

b. Dexamethasone suppression test

285
Q

Patient takes a metyrapone suppression test and we find out that his ACTH levels are low. What does this indicate and why?

A

he has a secondary adrenal insufficiency. Metyrapone causes low cortisol levels, this means no negative feedback inhibition is available. ACTH should be high, and if it isn’t then there’s a problem with the pituitary.

286
Q

Patient takes an ACTH and cosyntropin test and his cortisol levels remain constant. What does this indicate and why?

A

Primary adrenal insufficiency. Cosyntropin is an ACTH analog, so if high ACTH doesn’t stimulate glucocorticoid synthesis that means there is a defect in the adrenal gland.

287
Q

A patient with an adrenal insufficiency takes an ACTH and cosyntropin test and his cortisol levels increase. What does this indicate and why?

A

Secondary adrenal insufficiency. Cosyntropin is an ACTH analog, so if high ACTH stimulates glucocorticoid synthesis that means that there’s nothing wrong with the adrenal, and the pituitary is just not stimulating it.

288
Q

Which enzyme is responsible for the conversion of deoxycortisol to cortisol?

A

11 beta hydroxylase enzyme
(Google says: In the human adrenal, the mitochondrial cytochrome P450 enzyme CYP11B1 catalyzes the conversion of 11-deoxycortisol to cortisol)

289
Q

What does administering dexamethasone in a normal patient cause?

A

suppress ACTH which then suppresses cortisol production

290
Q

high-dose dexamethasone test suppressed the cortisol concentration in a patient with cushing syndrome. What’s the cause of cushing?

A

pituitary (cannot be ectopic or adrenal because they wouldn’t respond)

291
Q

Which of the following has low renin levels?

a. primary hyperaldosteronism
b. secondary hyperaldosteronism

A

a. primary hyperaldosteronism

292
Q

How can glucocorticoids result in secondary diabetes?

A

they induce hepatic gluconeogenesis and inhibit the uptake of glucose by the cells

293
Q

Which of the following causes cushing syndrome?

a. adrenal adenoma
b. adrenal carcinoma
c. both

A

c. both

294
Q

Give an example of a cancer that may induce cushing syndrome

A

small cell lung carcinoma

295
Q

Which is more common in the adrenal gland?

a. primary pituitary tumors
b. metastatic tumors

A

b. metastatic tumors

296
Q

A patient with known hyperaldosteronism complains of numbness and tingling. What causes this?

A

low potassium levels

297
Q

A deficiency of which hormone(s) causes hyponatremia?

A

cortisol and aldosterone

298
Q

A deficiency of which hormone(s) causes hyperkalemia

A

aldosterone

299
Q

A deficiency of which hormone(s) causes hypoglycemia?

A

cortisol

300
Q

T/F: autoimmune adrenalitis (Addison’s disease) is almost always found as an isolated disease

A

false, its associated with other autoimmune diseases in half the cases (EX/autoimmune polyendocrinopathy syndromes (APS))

301
Q

Which age does Waterhouse-Friderichsen Syndrome most likely affect?

A

children

302
Q

How can abrupt cessation of steroid therapy adrenal crisis?

A

Longe term corticosteroid therapy shuts off ACTH stimulation to the adrenals, leading to adrenal atrophy. Studen withdrawal will not allow it to recover gradually and resume normal function-> crisis

303
Q

Why does the tumor surface of pheochromocytoma turn dark brown when immersed in potassium dichromate solution?

A

due to oxidation of stored catecholamines synthesized by the tumor

304
Q

What do you call an extra-adrenal pheochromocytoma?

A

paraganglioma (a rare neuroendocrine neoplasm that may develop at various body sites, including the head, neck, thorax and abdomen)

Endocrine - 3rd year (12 decks)

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