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Endocrine > 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

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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2
Q

What causes Secondary Hyperaldosteronism?

A

activation of the renin-angiotensin system

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3
Q

What inhibits many enzymes of the steroid biosynthetic pathway? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole

A

d. Ketoconazole

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4
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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5
Q

Which catecholamine receptors increase cardiac output in times of stress? a. a1 b. a2 c. b1 d. b2 e. b3

A

c. b1

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6
Q

What lab finding is most likely associated with a patient who lacks 21
hydroxylase enzyme?

  1. High cortisol
  2. Low 17-oxosteroid
  3. Low aldosterone
  4. Low androgens
A

C. Low aldosterone

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7
Q

What hormone decreases transcortin levels?

A

testosterone

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8
Q

Which enzyme activates steroidogenic acute regulatory (StAR) protein?

A

PKA

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9
Q

What gene encodes for 11-b-hydroxylase?

A

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

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10
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

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11
Q

Which of the following causes hyperpigmentation? a. cushing syndrome b. cushing disease

A

b. cushing disease (high ACTH)

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12
Q

What catalyzes the conversion of angiotensin I to angiotensin II?

A

angiotensin-converting enzyme (ACE) (made in the lung)

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13
Q

When is cortisol the highest/lowest?

A

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

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14
Q

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

A

steroidogenic acute regulatory (StAR) protein

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15
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))

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16
Q

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

A

cortisol low aldosterone low ACTH high

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17
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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18
Q

Which of the following has an abnormal electrolyte balance? a. primary adrenal insufficiency b. secondary adrenal insufficiency

A

a. primary adrenal insufficiency

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19
Q

What is Addison disease?

A

primary hypoaldosteronism

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20
Q

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

  1. Cholesterol ester hydrolase
  2. Acyl-CoA cholesterol acyltransferase I
  3. cytochrome P450scc
  4. 3b-Hydroxy steroid dehydrogenase (3bHSD)
  5. 17,20-Lyase
A

e. 17,20-Lyase

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21
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

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22
Q

Which of the following drain directly into the IVC?

  1. right suprarenal vein
  2. left suprarenal vein
A

a. right suprarenal vein

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23
Q

Which receptor does aldosterone act on?

A

mineralocorticoid receptor (MR)

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24
Q

What catalyzes the conversion of angiotensinogen to angiotensin I?

A

Circulating renin

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25
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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26
Q

Which of the following is more frequently elevated in Pheochromocytomas? a. epinephrine b. norepinephrine

A

b. norepinephrine

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27
Q

What prevents edema in conn’s syndrome?

A

Atrial natriuretic peptide (ANP)

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28
Q

Which of the following secretes aldosterone?

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

a. Zona Glomerulosa

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29
Q

Which neoplasm which stains positive for potassium dichromate?

A

Pheochromocytoma (neoplasm made from chromaffin cells)

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30
Q

What converts cholesterol to pregnenolone?

A

by an enzyme called 20-22 desmolase

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31
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)

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32
Q

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

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

a. Zona Glomerulosa

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33
Q

Which age does Waterhouse-Friderichsen Syndrome most likely affect?

A

children

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34
Q

Which of the following has a higher mineralocorticoid activity? a. Betamethasone b. 9-Flurocortisol c. Triamcinolone d. Prednisolone

A

b. 9-Flurocortisol

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35
Q

Where is androstenedione converted to testosterone?

A

adrenal cortex or in peripheral tissues

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36
Q

Which do NSAIDs inhibit? a. prostaglandins b. leukotrienes

A

a. prostaglandins

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37
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)

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38
Q

Describe the binding of transcortin (CBG) to glucocorticoids

A

high affinity but low capacity (80% of glucocorticoids are bound to CBG)

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39
Q

Which hormones do not have a negative feedback inhibition?

A

Mineralocorticoids & Sex steroids

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40
Q

Which of the following is more common? a. cushing syndrome b. cushing disease c. ectopic cushing syndrome

A

b. cushing disease

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41
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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42
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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43
Q

Which is most likely to be affected by liver abscesses?

  1. right suprarenal gland
  2. left suprarenal gland
A

a. right suprarenal gland

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44
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)

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45
Q

What inhibits the enzyme 11 Beta hydroxylase? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole

A

c. Metyrapone

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46
Q

What medications are used to treat Addison’s disease?

A

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

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47
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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48
Q

Which of the following causes cushing syndrome? a. adrenal adenoma b. adrenal carcinoma c. both

A

c. both

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49
Q

What’s the metabolite of 17- Hydroxyprogesterone?

A

pregnanetriol

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50
Q

glucocorticoids are synthesized due to the deficiency of enzyme?

  1. 17 alpha-hydroxylase
  2. 21 hydroxylase
  3. 17,20-Lyase
  4. aromatase
  5. aldosterone synthase
A

e. aldosterone synthase

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51
Q

What percent of steroid hormones freely circulate in the bloodstream?

A

10%

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52
Q

Why does a fetus have a bigger suprarenal gland?

A

fetal adrenal cortisol secretion needed for labor

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53
Q

Which of the following is encoded by cyp11a1 gene?

  1. Cholesterol ester hydrolase
  2. Acyl-CoA cholesterol acyltransferase I
  3. cytochrome P450scc
  4. 3b-Hydroxy steroid dehydrogenase (3bHSD)
  5. 17,20-Lyase
A

c. cytochrome P450scc

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54
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

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55
Q

pheochromocytoma stains positive for what two stains?

A

chromogranin A and S100 (stains sustentacular cells)

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56
Q

Why are Glucocorticoids contraindicated in patients with Glaucoma?

A

they increase intraocular pressure

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57
Q

How does epinephrine increase glucocorticoid secretion?

A

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

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58
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

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59
Q

What activates Aldosterone is synthesis?

A

angiotensin 2 and plasma potassium

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60
Q

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

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

a. Zona Glomerulosa

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61
Q

Describe renin levels Conn’s syndrome

A

decreased plasma levels

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62
Q

Which of the following is transported via Albumin?

  1. Aldosterone
  2. DHEA
  3. Cortisol
  4. Androgens & Estrogens
A

a. Aldosterone

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63
Q

What inhibits the receptor for glucocorticoids? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole

A

b. Mifepristone

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64
Q

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

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

c. Zona Reticularis

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65
Q

What happens with the total removal of side-chain?

  1. androgens
  2. progesterone
  3. corticosteroids
  4. mineralocorticoids
A

a. androgens (progesterone, corticosteroids & mineralocorticoids= Partial removal)

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66
Q

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

  1. 17 alpha-hydroxylase
  2. 21 hydroxylase
  3. 17,20-Lyase
  4. aromatase
  5. aldosterone synthase
A

c. 17,20-Lyase

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67
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

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68
Q

Which hormones increase transcortin levels?

A

estrogen, progesterone, and thyroid hormones

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69
Q

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

A

the cytoplasm has many vacuoles filled with catecholamines

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70
Q

What is the function of aldosterone?

  1. Regulation of glucose metabolism
  2. Released when K+ levels increase
  3. Decrease Na+ renal reabsorption
  4. Decrease blood pressure
A

B. Released when K+ levels increase

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71
Q

give two examples of neuroectodermal cells

A

Chromaffin cells and pheochromocytes

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72
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.

  1. right suprarenal gland
  2. left suprarenal gland
A

b. left suprarenal gland

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73
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

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74
Q

What’s the most common cause of primary hyperaldosteronism?

A

aldosterone-producing adrenal tumor

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75
Q

Which cells produce chromogranin A?

A

chromaffin cells

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76
Q

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

A

cortisol low aldosterone normal (electrolytes not changed) ACTH low

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77
Q

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

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

b. Zona Fasciculata (by Zona Reticularis initially)

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78
Q

Which of the following has low renin levels? a. primary hyperaldosteronism b. secondary hyperaldosteronism

A

a. primary hyperaldosteronism

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79
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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80
Q

Which of the following causes paleness? a. primary adrenal insufficiency b. secondary adrenal insufficiency

A

b. secondary adrenal insufficiency

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81
Q

How can glucocorticoids result in secondary diabetes?

A

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

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82
Q

Which of the following drugs blocks glucocorticoid receptor and can be used in
the treatment of Cushing’s syndrome?

  1. Prednisolone
  2. Beclomethasone
  3. Mifepristone (RU 486)
  4. Aminoglutethimide
A

C. Mifepristone (RU 486)

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83
Q

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

A

autoimmune destruction of the adrenal cortex

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84
Q

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

  1. Aldosterone
  2. DHEA
  3. Cortisol
  4. Androgens & Estrogens
A

d. Androgens & Estrogens

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85
Q

What is most likely to be affected when approaching the right suprarenal gland
from the peritoneal cavity?

  1. Diaphragm
  2. Stomach
  3. Liver
  4. Duodenum
A

C. Liver

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86
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)

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87
Q

Give an example of a cancer that may induce cushing syndrome

A

small cell lung carcinoma

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88
Q

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

A

low potassium levels

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89
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

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90
Q

Which of the following genes codes for desmolase?

  1. CYP11A1
  2. CYP21A2
  3. CYP11B1
  4. CYP11B2
  5. CYP17
  6. CYP19
  7. 3 beta-HSD
A

a. CYP11A1 (desmolase aka SCC enzyme)

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91
Q

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

  1. anterior surface
  2. posterior surface
  3. medial border
A

a. anterior surface

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92
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)

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93
Q

0lkikiiWhich is a branch of the abdominal aorta?

  1. Superior suprarenal artery
  2. Middle suprarenal artery
  3. Inferior suprarenal artery
A

b. Middle suprarenal artery

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94
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)

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95
Q

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

A

diaphragm

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96
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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97
Q

How does aldosterone affect sodium levels in saliva?

A

decrease the Na levels

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98
Q

Which part of the suprarenal gland develops from the mesoderm?

A

cortex

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99
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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100
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)

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101
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

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102
Q

Which of the following is the thickest layer?

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

b. Zona Fasciculata

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103
Q

What converts estrone into estradiol?

A

17β-Hydroxysteroid dehydrogenase

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104
Q

When do cells of the cortex differentiate into 3 zones?

  1. first trimester
  2. second trimester
  3. third trimester
  4. during birth
  5. after birth
A

e. after birth

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105
Q

Which of the following tests deficiencies? a. Stimulation Tests b. Suppression Tests

A

a. Stimulation Tests

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106
Q

Which of the following is more freely available in the plasma? a. Aldosterone b. Glucocorticoid

A

a. Aldosterone

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107
Q

Which of the following converts cholesterol into pregnenolone?

  1. CYP11A1
  2. CYP21A2
  3. CYP11B1
  4. CYP11B2
  5. CYP17
  6. CYP19
  7. 3 beta-HSD
A

a. CYP11A1 (aka P450scc)

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108
Q

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

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
A

b. Zona Fasciculata

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109
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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110
Q

Which is derived from the fibrous stroma of the gland?

  1. true capsule
  2. false capsule
A

a. true capsule

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111
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

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112
Q

Which is more potent? a. Cortisol b. Cortisone

A

a. Cortisol

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113
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

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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

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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116
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)

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117
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.

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118
Q

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

  1. autosomal dominant
  2. autosomal recessive
  3. X linked
A

b. autosomal recessive

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119
Q

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

A

hydrocortisone succinate/phosphate

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120
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

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121
Q

Which of the following is true regarding dexamethasone?

  1. Has shorter half-life than cortisol
  2. Has higher anti-inflammatory activity than cortisol
  3. Has higher salt-retaining activity than cortisol
  4. Has higher affinity binding to transcortin
  5. Used in treatment of osteoporosis
A

B. Has higher anti-inflammatory activity than cortisol

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122
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

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123
Q

Which of the following does cortisol bind to? a. albumin b. transcortin

A

b. transcortin

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124
Q

3 clinical features of Hyperaldosteronism

A

Hypertension Postassium loss Sodium retention

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125
Q

Most common cause of hypercortisolism?

A

exogenous administration of steroids

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126
Q

Which of the following contains chromaffin cells?

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

d. Medulla

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127
Q

Which of the following causes hyperpigmentation? a. primary adrenal insufficiency b. secondary adrenal insufficiency

A

a. primary adrenal insufficiency

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128
Q

What does cortisol stimulate in the liver?

A

gluconeogenesis (only acts anabolically in the liver)

129
Q

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

A

3rd and/or 17th Carbon positions.

130
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.

131
Q

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

A

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

132
Q

Which is used to treat rheumatoid arthritis? a. Metyrapone b. Beclomethasone c. Methylprednisolone/polyethylene glycol

A

c. Methylprednisolone/polyethylene glycol

133
Q

Whats needed to diagnose cushing syndrome?

A

at least two positive tests

134
Q

What enhances the clearance/biotransformation of glucocorticoids?

A

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

135
Q

Most common cause of Cushing syndrome is

A

Prolonged corticosteroid therapy (iatrogenic)

136
Q

A deficiency of which hormone(s) causes hyperkalemia

A

aldosterone

137
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

138
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

139
Q

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

A

chromaffin cells don’t have axonal processes

140
Q

What is Conn’s syndrome?

A

primary hyperaldosteronism, where the adrenal glands make too much aldosterone

141
Q

Most common cause of Hypoaldosteronism?

A

Abrupt withdrawal of corticosteroids

142
Q

A deficiency of which hormone(s) causes hypoglycemia?

A

cortisol

143
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)

144
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

145
Q

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

  1. CYP11A1
  2. CYP21A2
  3. CYP11B1
  4. CYP11B2
  5. CYP17
  6. CYP19
  7. 3 beta-HSD
A

e. CYP17

146
Q

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

A

absence of 21-hydroxylase.

147
Q

Which catecholamine receptors decrease insulin secretion in times of stress? a. a1 b. a2 c. b1 d. b2 e. b3

A

b. a2

148
Q

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

  1. posterior
  2. lateral
  3. anterior
A

c. anterior

149
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

150
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)

151
Q

Which fo the following has a bigger suprarenal gland?

  1. male adult
  2. female adult
  3. fetus
A

c. fetus

152
Q

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

A

fast-twitch, type 2 muscles

153
Q

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

A

at position 18 & 19

154
Q

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

  1. greater splanchnic nerve
  2. coeliac ganglion
A

a. greater splanchnic nerve

155
Q

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

  1. Aldosterone
  2. DHEA
  3. Cortisol
  4. Androgens & Estrogens
A

b. DHEA

156
Q

What are the four Aldosterone-target cells?

A

Kidney, colon, vascular wall, placenta

157
Q

Which requires a higher dose to produce the same effect? a. Cortisol b. Cortisone

A

b. Cortisone

158
Q

Which enzyme inactivates steroidogenic acute regulatory (StAR) protein?

A

PKC

159
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

160
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)

161
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

162
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

163
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)

164
Q

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

A

neuroblastoma

165
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

166
Q

What is an anti-fungal? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole

A

d. Ketoconazole

167
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)

168
Q

What is the metabolite of cortisol?

A

tetrahydrocortisol glucuronide

169
Q

What hormones acts on the mineralocorticoid receptors (MR)?

A

Aldosterone and cortisol

170
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

171
Q

What is used to confirm hyperaldosteronism?

A

aldosterone suppression test

172
Q

When do cells of the cortex produce DHEA?

  1. first trimester
  2. second trimester
  3. third trimester
  4. during birth
  5. after birth
A

b. second trimester

173
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

174
Q

Most common cause of Hyperaldosteronism?

A

idiopathic

175
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.

176
Q

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

A

90%

177
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)

178
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)

179
Q

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

A

T8-L1

180
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)

181
Q

Which of the following has the highest glucocorticoid activity? a. Aminoglutethimide b. Betamethasone c. Cortisone d. Dexamethasone

A

b. Betamethasone (Betamethasone>Dexamethasone)

182
Q

Which is a branch of the renal artery?

  1. Superior suprarenal artery
  2. Middle suprarenal artery
  3. Inferior suprarenal artery
A

c. Inferior suprarenal artery

183
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)

184
Q

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

A

due to weak collagen

185
Q

What’s th metabolite of androstenedione?

A

17-oxosteroid

186
Q

Catecholamine secretion results in which of the following?

  1. Increase venous return
  2. Increase blood flow to gastrointestinal tract
  3. Decrease blood flow to skeletal muscles
  4. Decrease glucagon : insulin ratio
A

A. Increase venous return

187
Q

What does administering dexamethasone in a normal patient cause?

A

suppress ACTH which then suppresses cortisol production

188
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

189
Q

Patient presented with hyperpigmentation in addition to slightly raised blood
glucose levels and hypertension. What is the most likely diagnosis?

  1. Cushing’s syndrome
  2. Cushing’s disease
  3. Addison’s disease
  4. Hyperaldosteronism
A

B. Cushing’s disease

190
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.

191
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)

192
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

193
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

194
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)

195
Q

Which has characteristically very high ACTH? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome

A

c. Ectopic Cushing syndrome

196
Q

What suppresses the immune system in long term stress response?

A

glucocorticoids

197
Q

Which of the following does cortisol function as? a. glucocorticoid b. mineralocorticoids c. both d. neither

A

c. both

198
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.

199
Q

Which is a branch of the inferior phrenic artery?

  1. Superior suprarenal artery
  2. Middle suprarenal artery
  3. Inferior suprarenal artery
A

a. Superior suprarenal artery

200
Q

Hypercortisolism is also known as

A

Cushing Syndrome

201
Q

mineralocorticoids are synthesized due to the deficiency of enzyme?

  1. 17 alpha-hydroxylase
  2. 21 hydroxylase
  3. 17,20-Lyase
  4. aromatase
  5. aldosterone synthase
A

a. 17 alpha-hydroxylase

202
Q

Androgens are synthesized due to the deficiency of enzyme?

  1. 17 alpha-hydroxylase
  2. 21 hydroxylase
  3. 17,20-Lyase
  4. aromatase
  5. aldosterone synthase
A

b. 21 hydroxylase

203
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.

204
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

205
Q

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

  1. phase 1
  2. phase 2
A

b. phase 2 (Sulfation or glucuronidation)

206
Q

Which releases catecholamines?

  1. cortex
  2. medulla
A

b. medulla

207
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)

208
Q

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

A

from the circulation (80%)

209
Q

In which two locations does steroid hormone synthesis take place?

A

ER mitochondria

210
Q

Denovo synthesis of cholesterol requires which precursor?

A

acetyl coA

211
Q

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

A

by changing the route of administration

212
Q

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

  1. Cholesterol ester hydrolase
  2. Acyl-CoA cholesterol acyltransferase I
  3. cytochrome P450scc
  4. 3b-Hydroxy steroid dehydrogenase (3bHSD)
  5. 17,20-Lyase
A

a. Cholesterol ester hydrolase

213
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

214
Q

anterior and posterior renal fascia join to form which structure?

A

false capsule

215
Q

Which of the following is true regarding chromaffin cells?

  1. Modified postganglionic parasympathetic neurons
  2. Develop from neural crest cells
  3. Important in the development of the fetal cortex
  4. Secrete acetylcholine
A

B. Develop from neural crest cells

216
Q

Patient with cushing has high glucose, explain the etiology?

A

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

217
Q

What hormone is produced after complete removal of the side chain of
cholesterol?

  1. Cortisol
  2. Progesterone
  3. Androstenedione
  4. Estradiol
A

C. Androstenedione

218
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

219
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

220
Q

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

A

carbon 17 of the D ring

221
Q

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

A

right kidney

222
Q

What gene encodes for 21-hydroxylase?

A

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

223
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

224
Q
A
225
Q

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

A

stomach

226
Q

How do glucocorticoids decrease vascular permeability?

A

by increasing the expression of vasocortin

227
Q

Patient presented with low 17-oxosteroid. What enzyme is the patient deficient
in?

  1. 3β-hydroxysteroid dehydrogenase
  2. 18β-hydroxysteroid dehydrogenase
  3. 11β-hydroxylase
  4. 21β-hydroxylase
A

A. β-hydroxysteroid dehydrogenase

228
Q

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

A

5a-reductase in peripheral tissue

229
Q

Which of the following genes codes for 21-hydroxylase?

  1. CYP11A1
  2. CYP21A2
  3. CYP11B1
  4. CYP11B2
  5. CYP17
  6. CYP19
  7. 3 beta-HSD
A

b. CYP21A2

230
Q

Describe the gross appearance of pheochromocytoma

A

tan and well defined tumor

231
Q

Which is more common in the adrenal gland? a. primary pituitary tumors b. metastatic tumors

A

b. metastatic tumors

232
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

233
Q

Secondary hyperaldosteronism is caused by a deficiency in

A

ACTH

234
Q

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

A

brain tumors

235
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 


236
Q

Which is used to esterify cholesterol?

  1. Cholesterol ester hydrolase
  2. Acyl-CoA cholesterol acyltransferase I
  3. cytochrome P450scc
  4. 3b-Hydroxy steroid dehydrogenase (3bHSD)
  5. 17,20-Lyase
A

b. Acyl-CoA cholesterol acyltransferase I (ACAT)

237
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

238
Q

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

  1. greater splanchnic nerve
  2. coeliac ganglion
A

b. coeliac ganglion

239
Q

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

A

3

240
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)

241
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)

242
Q

What is a long-term effect of prednisolone use?

  1. Decrease hepatic gluconeogenesis
  2. Increase circulating neutrophils
  3. Decrease immunity
  4. Increase lymphocytic apoptosis
A

B. Increase circulating neutrophils

243
Q

What converts androstendione into estrone?

A

Aromatase

244
Q

What percentage of the suprarenal gland is the medulla?

A

10%

245
Q

How does serotonin increase glucocorticoid secretion?

A

by enhancing CRH secretion

246
Q

Which of the following bind to albumin? a. glucocorticoids b. glucocorticoids synthetic analogs

A

b. glucocorticoids synthetic analogs

247
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

248
Q

Which has low ACTH? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome

A

a. Adrenal Cushing syndrome

249
Q

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

  1. Androgens
  2. Bile acids
  3. Estrogens
  4. Progesterone
A

b. Bile acids

250
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)

251
Q

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

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

a. Zona Glomerulosa (juxtaglomerular cells release renin)

252
Q

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

A

sodium retention, and salt-dependent hypertension

253
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)

254
Q

Describe clinical features of a patient with pheochromocytoma

A

chronic hypertension

255
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)

256
Q

Which releases steroids?

  1. cortex
  2. medulla
A

a. cortex

257
Q

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

  1. anterior surface
  2. posterior surface
  3. medial border
A

b. (upper part of the) posterior surface

258
Q

Which of the following is secreted almost entirely from the adrenal medulla? a. epinephrine b. norepinephrine

A

a. epinephrine

259
Q

Which of the following tests overactivity? a. Stimulation Tests b. Suppression Tests

A

b. Suppression Tests

260
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)

261
Q

Which of the following genes codes for aromatase?

  1. CYP11A1
  2. CYP21A2
  3. CYP11B1
  4. CYP11B2
  5. CYP17
  6. CYP19
  7. 3 beta-HSD
A

f. CYP19

262
Q

What two things drain into the Left Renal vein?

A

Left suprarenal vein Left gonadal vein

263
Q

Cortisol stimulates which of the following? a. bone resorption b. bone formation

A

a. bone resorption (again, mainly a catabolic hormone)

264
Q

Why are glucocorticoids used to treat septic shock?

A

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

265
Q

Which of the following goes through aromatization to be made?

  1. Androgens
  2. Bile acids
  3. Estrogens
  4. Progesterone
A

c. Estrogens (aromatization in ring A)

266
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)

267
Q

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

A

zona glomerulosa and fasiculata

268
Q

What receptor is used to capture cholesterol from circulatory LDL?

A

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

269
Q

What do Chromaffin cells secrete?

A

secrete noradrenaline and adrenaline (and chromogranin a)

270
Q

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

A

IVC

271
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

272
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)

273
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)

274
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)

275
Q

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

  1. Aldosterone
  2. DHEA
  3. Cortisol
  4. Androgens & Estrogens
A

c. Cortisol

276
Q

Which catecholamine receptors increase gluconeogenesis in times of stress? a. a1 b. a2 c. b1 d. b2 e. b3

A

d. b2

277
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)

278
Q

chromogranin A is s storage protein complex for which hormones?

A

epinephrine nonepinephrine

279
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

280
Q

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

A

liver

281
Q

Which of the following has a low renin concentration?

  1. primary adrenal insufficiency
  2. secondary adrenal insufficiency
A

b. secondary adrenal insufficiency (not sure about this)

282
Q

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

A

an abscess (more common in that area)

283
Q

What enzymes do Aldosterone-target cells express?

A

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

284
Q
  1. What is the effect of immune reactions on the adrenal glands in Addison’s
    Disease?
  2. Increased cortisol synthesis
  3. Decreased cortisol production
  4. Hyperactivity of steroid-producing cells
A

B. Decreased cortisol production

285
Q

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

A

mineralocorticoids

286
Q

Which is used to convert Pregnenolone into progesterone?

  1. Cholesterol ester hydrolase
  2. Acyl-CoA cholesterol acyltransferase I
  3. cytochrome P450scc
  4. 3b-Hydroxy steroid dehydrogenase (3bHSD)
  5. 17,20-Lyase
A

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

287
Q

Which four genetic defects lead to pheochromocytomas?

A

RET gene SDH gene VHL gene NF1 gene

288
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)

289
Q

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

A

Cushing’s syndrome (excessive secretion of glucocorticoids)

290
Q

dexamethasone is an analog for

A

cortisol

291
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)

292
Q

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

  1. superiorly
  2. inferiorly
A

b. inferiorly

293
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

294
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

295
Q

What is used for the treatment of Cushing’s syndrome? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole

A

b. Mifepristone

296
Q

catecholamines metabolites can be used to do which of the following? a. screen for neuroblastoma b. confirm neuroblastoma

A

a. screen for neuroblastoma

297
Q

What inhibits the rate-limiting enzyme in the biosynthesis of glucocorticoids? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole

A

a. Aminoglutethimide

298
Q

Which of the following has a high renin concentration? a. primary hyperaldosteronism b. secondary hyperaldosteronism

A

b. secondary hyperaldosteronism

299
Q

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

A

true

300
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)

301
Q

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

A

pancreas

302
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)

303
Q

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

A

medulla

304
Q

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

A

gonane

305
Q

What reduces the clearance/biotransformation of glucocorticoids?

A

estrogen pregnancy hypothyroidism liver disease malnutrition low protein diet

306
Q

What is the best treatment for primary adrenocortical insufficiency?

  1. Cortisol + Flurocortisol (9 α flurocortisol)
  2. Dexamethasone + Metryapone
  3. Dexamethasone + Cortisone
  4. Prednisolone + Betamethasone
A

A. Cortisol + Flurocortisol (9 α flurocortisol)

307
Q

A deficiency of which hormone(s) causes hyponatremia?

A

cortisol and aldosterone

308
Q

What is used to screen for hyperaldosteronism?

A

aldosterone:renin ratio

309
Q

Which of the following genes codes for aldosterone synthase?

  1. CYP11A1
  2. CYP21A2
  3. CYP11B1
  4. CYP11B2
  5. CYP17
  6. CYP19
  7. 3 beta-HSD
A

d. CYP11B2

310
Q

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

A

lateral side

311
Q

Which of the following secretes cortisol?

  1. Zona Glomerulosa
  2. Zona Fasciculata
  3. Zona Reticularis
  4. Medulla
A

b. Zona Fasciculata (secretes glucocorticoids)

312
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)

313
Q

Which has a side effect of oral candida? a. Metyrapone b. Beclomethasone c. Methylprednisolone/polyethylene glycol

A

b. Beclomethasone

314
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))

315
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

316
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

317
Q

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

A

true

318
Q

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

A

neuroblastoma

Endocrine (8 decks)

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