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)
2
Q
What causes Secondary Hyperaldosteronism?
A
activation of the renin-angiotensin system
3
Q
What inhibits many enzymes of the steroid biosynthetic pathway? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole
A
d. Ketoconazole
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
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
6
Q
What lab finding is most likely associated with a patient who lacks 21
hydroxylase enzyme?
- High cortisol
- Low 17-oxosteroid
- Low aldosterone
- Low androgens
A
C. Low aldosterone
7
Q
What hormone decreases transcortin levels?
A
testosterone
8
Q
Which enzyme activates steroidogenic acute regulatory (StAR) protein?
A
PKA
9
Q
What gene encodes for 11-b-hydroxylase?
A
Cytochrome P450 Family 11 Subfamily B Member 1 (CYP11B1) gene
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
11
Q
Which of the following causes hyperpigmentation? a. cushing syndrome b. cushing disease
A
b. cushing disease (high ACTH)
12
Q
What catalyzes the conversion of angiotensin I to angiotensin II?
A
angiotensin-converting enzyme (ACE) (made in the lung)
13
Q
When is cortisol the highest/lowest?
A
highest in early mornings (8/9AM) and least at midnight
14
Q
What’s the regulator of the rate-limiting step in steroid biosynthesis?
A
steroidogenic acute regulatory (StAR) protein
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))
16
Q
Describe the levels of cortisol, aldosterone, and ACTH in primary adrenal insufficiency?
A
cortisol low aldosterone low ACTH high
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
18
Q
Which of the following has an abnormal electrolyte balance? a. primary adrenal insufficiency b. secondary adrenal insufficiency
A
a. primary adrenal insufficiency
19
Q
What is Addison disease?
A
primary hypoaldosteronism
20
Q
Which of the following is known as the second SCC enzyme?
- Cholesterol ester hydrolase
- Acyl-CoA cholesterol acyltransferase I
- cytochrome P450scc
- 3b-Hydroxy steroid dehydrogenase (3bHSD)
- 17,20-Lyase
A
e. 17,20-Lyase
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
22
Q
Which of the following drain directly into the IVC?
- right suprarenal vein
- left suprarenal vein
A
a. right suprarenal vein
23
Q
Which receptor does aldosterone act on?
A
mineralocorticoid receptor (MR)
24
Q
What catalyzes the conversion of angiotensinogen to angiotensin I?
A
Circulating renin
25
When is aldosterone secreted? a. low potassium levels b. low blood pressure c. increased sodium levels d. increased blood volume
b. low blood pressure (released when low blood pressure, volume, and sodium, also when potassium levels are high)
26
Which of the following is more frequently elevated in Pheochromocytomas? a. epinephrine b. norepinephrine
b. norepinephrine
27
What prevents edema in conn's syndrome?
Atrial natriuretic peptide (ANP)
28
Which of the following secretes aldosterone?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
a. Zona Glomerulosa
29
Which neoplasm which stains positive for potassium dichromate?
Pheochromocytoma (neoplasm made from chromaffin cells)
30
What converts cholesterol to pregnenolone?
by an enzyme called 20-22 desmolase
31
Which of the following cortisol actions is FALSE? a. depression b. RBC production c. ADH stimulation d. stimulate appetite
c. ADH stimulation (it actually inhibits ADH secretion)
32
Which of the following consists of columnar cells arranges in inverted columns?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
a. Zona Glomerulosa
33
Which age does Waterhouse-Friderichsen Syndrome most likely affect?
children
34
Which of the following has a higher mineralocorticoid activity? a. Betamethasone b. 9-Flurocortisol c. Triamcinolone d. Prednisolone
b. 9-Flurocortisol
35
Where is androstenedione converted to testosterone?
adrenal cortex or in peripheral tissues
36
Which do NSAIDs inhibit? a. prostaglandins b. leukotrienes
a. prostaglandins
37
high-dose dexamethasone test suppressed the cortisol concentration in a patient with cushing syndrome. What's the cause of cushing?
pituitary (cannot be ectopic or adrenal because they wouldn't respond)
38
Describe the binding of transcortin (CBG) to glucocorticoids
high affinity but low capacity (80% of glucocorticoids are bound to CBG)
39
Which hormones do not have a negative feedback inhibition?
Mineralocorticoids & Sex steroids
40
Which of the following is more common? a. cushing syndrome b. cushing disease c. ectopic cushing syndrome
b. cushing disease
41
How many sites in steroidogenic acute regulatory (StAR) protein are available for phosphorylation by protein kinase C (PKC)?
6
42
Patient presents with high vaniyll mandelic acid (VMA) levels in urine. Which pathology is most likely?
Pheochromocytoma (tumor of the medulla; excessive catecholamines)
43
Which is most likely to be affected by liver abscesses?
1. right suprarenal gland
2. left suprarenal gland
a. right suprarenal gland
44
Which enzyme is responsible for the conversion of deoxycortisol to cortisol?
11 beta hydroxylase enzyme (Google says: In the human adrenal, the mitochondrial cytochrome P450 enzyme CYP11B1 catalyzes the conversion of 11-deoxycortisol to cortisol)
45
What inhibits the enzyme 11 Beta hydroxylase? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole
c. Metyrapone
46
What medications are used to treat Addison's disease?
you need both mineralocorticoid and glucocorticoid activity, so give cortisol and flurocortisol
47
What converst insoluble cholesterol (27C) is into soluble pregnenolone (21C)?
CYP11A1 (aka P450scc aka desmolase) it does it via three steps (hydroxylation, hydroxylation, Scission)
48
Which of the following causes cushing syndrome? a. adrenal adenoma b. adrenal carcinoma c. both
c. both
49
What's the metabolite of 17- Hydroxyprogesterone?
pregnanetriol
50
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
e. aldosterone synthase
51
What percent of steroid hormones freely circulate in the bloodstream?
10%
52
Why does a fetus have a bigger suprarenal gland?
fetal adrenal cortisol secretion needed for labor
53
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
c. cytochrome P450scc
54
Which inhibits both prostaglandins and leukotrienes? explain the mechanism. a. annexin A1 b. NSAIDs
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
55
pheochromocytoma stains positive for what two stains?
chromogranin A and S100 (stains sustentacular cells)
56
Why are Glucocorticoids contraindicated in patients with Glaucoma?
they increase intraocular pressure
57
How does epinephrine increase glucocorticoid secretion?
by enhancing ACTH secretion, leading to the activation of the adrenal cortex and glucocorticoid release
58
How can we minimize the side effects of glucocorticoid drugs by changing the dosage? (2 ways)
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
59
What activates Aldosterone is synthesis?
angiotensin 2 and plasma potassium
60
Which of the following increases hormone release when renin is high?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
a. Zona Glomerulosa
61
Describe renin levels Conn's syndrome
decreased plasma levels
62
Which of the following is transported via Albumin?
1. Aldosterone
2. DHEA
3. Cortisol
4. Androgens & Estrogens
a. Aldosterone
63
What inhibits the receptor for glucocorticoids? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole
b. Mifepristone
64
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
c. Zona Reticularis
65
What happens with the total removal of side-chain?
1. androgens
2. progesterone
3. corticosteroids
4. mineralocorticoids
a. androgens (progesterone, corticosteroids & mineralocorticoids= Partial removal)
66
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
c. 17,20-Lyase
67
Patient has hypertension, elevated K levels, hypokalemic alkalosis, and low renin levels. Which is the diagnosis? a. primary hyperaldosteronism b. secondary hyperaldosteronism
a. primary hyperaldosteronism
68
Which hormones increase transcortin levels?
estrogen, progesterone, and thyroid hormones
69
Pheochromocytoma have a granular cytoplasm, what is an explanation for this?
the cytoplasm has many vacuoles filled with catecholamines
70
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
B. Released when K+ levels increase
71
give two examples of neuroectodermal cells
Chromaffin cells and pheochromocytes
72
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
b. left suprarenal gland
73
A person is running away from a lion, is cortisol necessary to deal with the high amounts of catecholamines in the circulation?
No, they're only necessary if catecholamines are administered pharmacologically
74
What's the most common cause of primary hyperaldosteronism?
aldosterone-producing adrenal tumor
75
Which cells produce chromogranin A?
chromaffin cells
76
Describe the levels of cortisol, aldosterone, and ACTH in secondary adrenal insufficiency?
cortisol low aldosterone normal (electrolytes not changed) ACTH low
77
Which of the following releases adrenal androgens after prolonged ACTH stimulation?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
b. Zona Fasciculata (by Zona Reticularis initially)
78
Which of the following has low renin levels? a. primary hyperaldosteronism b. secondary hyperaldosteronism
a. primary hyperaldosteronism
79
What method can be used to treat chronic essential hypertension?
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)
80
Which of the following causes paleness? a. primary adrenal insufficiency b. secondary adrenal insufficiency
b. secondary adrenal insufficiency
81
How can glucocorticoids result in secondary diabetes?
they induce hepatic gluconeogenesis and inhibit the uptake of glucose by the cells
82
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
C. Mifepristone (RU 486)
83
What's the most common cause of Addison's disease?
autoimmune destruction of the adrenal cortex
84
Which of the following is transported via Sex hormone binding globulin (SHBG)?
1. Aldosterone
2. DHEA
3. Cortisol
4. Androgens & Estrogens
d. Androgens & Estrogens
85
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
C. Liver
86
Which of the following do glucocorticoids NOT inhibit? a. histamine release b. neutrophils c. antibody formation d. lymphocytes
b. neutrophils (it inhibits their migration, so they increase in the blood)
87
Give an example of a cancer that may induce cushing syndrome
small cell lung carcinoma
88
A patient with known hyperaldosteronism complains of numbness and tingling. What causes this?
low potassium levels
89
Patient comes in complaining of loss of appetite, salt craving, and pigmentation of gums. What's the diagnosis? explain the cause each symptom
Addison's Salt craving= low aldosterone Loss of appitite= low cortisol Pigmentation= high ACTH leading to MSH stimulation
90
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. CYP11A1 (desmolase aka SCC enzyme)
91
the suprarenal vein emerges from which part of the suprarenal gland?
1. anterior surface
2. posterior surface
3. medial border
a. anterior surface
92
What do you call an extra-adrenal pheochromocytoma?
paraganglioma (a rare neuroendocrine neoplasm that may develop at various body sites, including the head, neck, thorax and abdomen)
93
0lkikiiWhich is a branch of the abdominal aorta?
1. Superior suprarenal artery
2. Middle suprarenal artery
3. Inferior suprarenal artery
b. Middle suprarenal artery
94
What is Waterhouse–Friderichsen syndrome (WFS)?
adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection (N. meningitidis)
95
Which structure is related to the lateral side of the posterior surface of the left suprarenal gland?
diaphragm
96
Describe the dual blood supply of the medulla
arterial blood from the medullary arterioles venous blood from the cortical sinusoids
97
How does aldosterone affect sodium levels in saliva?
decrease the Na levels
98
Which part of the suprarenal gland develops from the mesoderm?
cortex
99
patient comes in with muscular weakness, low blood pressure, anemia, hyperpigmentation, and weight loss. What do you suspect?
Addison’s disease (deficiency of mineralocorticoids)
100
Describe the ACTH levels of a CAH patient, why is this?
high ACTH, since the cortisol is low or nonexistent there's no negative inhibition and the pituitary continuously stimulates the adrenals (-\>hypertrophy)
101
Why are glucocorticoids used to treat asthma?
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
102
Which of the following is the thickest layer?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
b. Zona Fasciculata
103
What converts estrone into estradiol?
17β-Hydroxysteroid dehydrogenase
104
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
e. after birth
105
Which of the following tests deficiencies? a. Stimulation Tests b. Suppression Tests
a. Stimulation Tests
106
Which of the following is more freely available in the plasma? a. Aldosterone b. Glucocorticoid
a. Aldosterone
107
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. CYP11A1 (aka P450scc)
108
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
b. Zona Fasciculata
109
explain the mechanism of how congenital adrenal hyperplasia (CAH) leads to abnormal genital development in infant girls
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
110
Which is derived from the fibrous stroma of the gland?
1. true capsule
2. false capsule
a. true capsule
111
Which is more common in men above the age of forty? a. Adrenal cushing syndrome b. cushing disease c. Ectopic Cushing syndrome
c. Ectopic Cushing syndrome
112
Which is more potent? a. Cortisol b. Cortisone
a. Cortisol
113
When is cortisol needed to respond to catecholamines?
only when catecholamines are in high concentrations (administered pharmacologically). It increases cardiac output and blood pressure
114
What increases blood glucose in short term stress response?
epinephrine and norepinephrine
115
Adrenal androgens are secreted by Zona Reticularis in response to what hormone? What receptor does the hormone use?
ACTH (ACTH receptor called melanocortin receptor 2)
116
Which of the following have better oral bioavailability? Why? a. glucocorticoids b. glucocorticoids synthetic analogs
b. glucocorticoids synthetic analogs (cortisol gets degraded by first-pass metabolism in the liver)
117
A patient with an adrenal insufficiency takes an ACTH and cosyntropin test and his cortisol levels increase. What does this indicate and why?
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.
118
Which describes the inheritance pattern of congenital adrenal hyperplasia (CAH)?
1. autosomal dominant
2. autosomal recessive
3. X linked
b. autosomal recessive
119
What are the only glucocorticoids that can be given via IV?
hydrocortisone succinate/phosphate
120
Explain how glucocorticoid use can lead to secondary osteoporosis?
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
121
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
B. Has higher anti-inflammatory activity than cortisol
122
Which catecholamine receptors break down fat tissue in times of stress? a. a1 b. a2 c. b1 d. b2 e. b3
e. b3
123
Which of the following does cortisol bind to? a. albumin b. transcortin
b. transcortin
124
3 clinical features of Hyperaldosteronism
Hypertension Postassium loss Sodium retention
125
Most common cause of hypercortisolism?
exogenous administration of steroids
126
Which of the following contains chromaffin cells?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
d. Medulla
127
Which of the following causes hyperpigmentation? a. primary adrenal insufficiency b. secondary adrenal insufficiency
a. primary adrenal insufficiency
128
What does cortisol stimulate in the liver?
gluconeogenesis (only acts anabolically in the liver)
129
The Sulfation or glucuronidation in phase 2 of steroid inactivation occurs in which carbon positions?
3rd and/or 17th Carbon positions.
130
What's the mechanism of action of orthostatic hypotension in Pheochromocytomas?
down-regulation of α-adrenergic receptors resulting from persistent elevation of norepinephrine. Thus the baroreceptor response to blood shifts is blunted.
131
How do glucocorticoids affect muscle capacity when taken acutely versus chronically?
increase muscle work capacity acutely, but is associated with myopathy chronically
132
Which is used to treat rheumatoid arthritis? a. Metyrapone b. Beclomethasone c. Methylprednisolone/polyethylene glycol
c. Methylprednisolone/polyethylene glycol
133
Whats needed to diagnose cushing syndrome?
at least two positive tests
134
What enhances the clearance/biotransformation of glucocorticoids?
hyperthyroidism ((phenobarbital rifampine carbamazopine phenytoin \*\*\* NOT in drug list))
135
Most common cause of Cushing syndrome is
Prolonged corticosteroid therapy (iatrogenic)
136
A deficiency of which hormone(s) causes hyperkalemia
aldosterone
137
What type of stress induces protein and fat breakdown into sugar? What induces these changes?
long term stress converts proteins and fats into glucose (while short term raises glucose by breaking down glycogen) glucocorticoids induce this
138
Why does the tumor surface of pheochromocytoma turn dark brown when immersed in potassium dichromate solution?
due to oxidation of stored catecholamines synthesized by the tumor
139
What's the main difference between postsynaptic neurons and chromaffin cells?
chromaffin cells don't have axonal processes
140
What is Conn's syndrome?
primary hyperaldosteronism, where the adrenal glands make too much aldosterone
141
Most common cause of Hypoaldosteronism?
Abrupt withdrawal of corticosteroids
142
A deficiency of which hormone(s) causes hypoglycemia?
cortisol
143
Which of the following is low in a CAH patient? a. pregnanetriol b. tetrahydrocortisol glucuronide c. 17-oxosteroid
b. tetrahydrocortisol glucuronide (no cortisol is made)
144
Addisons disease that was caused by a pituitary adenoma causes which of the following? a. high cortisol b. low ACTH c. high ACTH
b. low ACTH
145
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
e. CYP17
146
What's the most common cause of congenital adrenal hyperplasia (CAH)?
absence of 21-hydroxylase.
147
Which catecholamine receptors decrease insulin secretion in times of stress? a. a1 b. a2 c. b1 d. b2 e. b3
b. a2
148
Which approach to suprarenal gland excision is commonly used in laparoscopy?
1. posterior
2. lateral
3. anterior
c. anterior
149
What's the mechanism of action of hypertension in Pheochromocytomas?
high norepinephrine acts with alpha receptors, which constricts blood vessels and leads to hypertension
150
Which two things work together to form the fight/flight response?
glucocorticoids (secreted in the cortex- they induce conversion of NE to epinephrine) and catecholamines (secreted in the medulla)
151
Which fo the following has a bigger suprarenal gland?
1. male adult
2. female adult
3. fetus
c. fetus
152
Which muscle type is most affected in patients with Cushing syndrome?
fast-twitch, type 2 muscles
153
Which carbon positions are the two methyl groups of cholesterol located?
at position 18 & 19
154
Nerves supplying the chromaffin cells of the suprarenal gland go through which of the following?
1. greater splanchnic nerve
2. coeliac ganglion
a. greater splanchnic nerve
155
Which of the following does not have a specific carrier protein?
1. Aldosterone
2. DHEA
3. Cortisol
4. Androgens & Estrogens
b. DHEA
156
What are the four Aldosterone-target cells?
Kidney, colon, vascular wall, placenta
157
Which requires a higher dose to produce the same effect? a. Cortisol b. Cortisone
b. Cortisone
158
Which enzyme inactivates steroidogenic acute regulatory (StAR) protein?
PKC
159
11-Deoxycortisol protein is high in a case of CAH. Which enzyme is low? a. 11-b-hydroxylase b. 21- hydroxylase
a. 11-b-hydroxylase
160
Which of the following has the highest glucocorticoid activity? a. Dexamethasone b. 9-Flurocortisol c. Triamcinolone d. Prednisolone
a. Dexamethasone (Dexamethasone & Betamethasone have very high glucocorticoid activity)
161
Explain how juxtaglomerular cells work and its relation with aldosterone
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
How does serotonin increase glucocorticoid secretion?
serotonin enhances CRH, which leads to ACTH release. ACTH activates the adrenal cortex, leading to glucocorticoid release
163
Which is used to confirm the diagnosis of Cushing? a. low-dose dexamethasone suppression test b. high-dose dexamethasone suppression test
a. low-dose dexamethasone suppression test (confirm Cushing but not identify its cause)
164
What's a tumor of the sympathetic ganglia and adrenal medulla
neuroblastoma
165
Which is used to know the cause of Cushing? a. low-dose dexamethasone suppression test b. high-dose dexamethasone suppression test
b. high-dose dexamethasone suppression test
166
What is an anti-fungal? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole
d. Ketoconazole
167
Which of the following is caused by “incidentalomas"? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome
a. Adrenal Cushing syndrome (incidentalomas= adrenocortical adenomas that are clinically silent and found incidentally)
168
What is the metabolite of cortisol?
tetrahydrocortisol glucuronide
169
What hormones acts on the mineralocorticoid receptors (MR)?
Aldosterone and cortisol
170
T/F: posterior and lateral approaches to suprarenal gland excision involves the removal of rib 11 and rib 12
false, the removal or rib 11 OR rib 12 is needed
171
What is used to confirm hyperaldosteronism?
aldosterone suppression test
172
When do cells of the cortex produce DHEA?
1. first trimester
2. second trimester
3. third trimester
4. during birth
5. after birth
b. second trimester
173
How can abrupt cessation of steroid therapy adrenal crisis?
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
Most common cause of Hyperaldosteronism?
idiopathic
175
Explain how Atrial natriuretic peptide (ANP) works and its relation with aldosterone
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
How much of the adrenal cortex must be destroyed for the effects to be evident?
90%
177
What is the first and rate-limiting step in any steroid synthesis?
Cleavage of 6 carbons (C22-C26) of the side chain (via cytochrome P450scc)
178
Which of the following has a positive high-dose dexamethasone suppression test? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome
b. Cushing disease (dexamethasone= cortisol analog)
179
Which spinal cord segment supplies preganglionic sympathetic fibers to the suprarenal medulla?
T8-L1
180
Which of the following is NOT controlled by ACTH levels? a. Adrenal androgens b. Glucocorticoids c. Mineralocorticoids
c. Mineralocorticoids (mainly controlled by the renin angiotensin system)
181
Which of the following has the highest glucocorticoid activity? a. Aminoglutethimide b. Betamethasone c. Cortisone d. Dexamethasone
b. Betamethasone (Betamethasone\>Dexamethasone)
182
Which is a branch of the renal artery?
1. Superior suprarenal artery
2. Middle suprarenal artery
3. Inferior suprarenal artery
c. Inferior suprarenal artery
183
What does a positive synacthen stimulation test indicate? a. adrenal glands functional b. adrenal glands non-functional
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
Why do patients with Cushing syndrome have purple striae and poor wound healing?
due to weak collagen
185
What's th metabolite of androstenedione?
17-oxosteroid
186
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. Increase venous return
187
What does administering dexamethasone in a normal patient cause?
suppress ACTH which then suppresses cortisol production
188
Which converts cortisol to inactive cortisone? a. 11-β-hydroxysteroid dehydrogenase type-1 b. 11-β-hydroxysteroid dehydrogenase type-2
b. 11-β-hydroxysteroid dehydrogenase type-2
189
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
B. Cushing's disease
190
When can hypercortisolism cause bilateral cortical atrophy?
When its caused by exogenous steroids, they suppress ACTH, which stops the adrenals from producing cortisol. That leads to atrophy.
191
Which of the following has normal electrolyte balance? a. primary adrenal insufficiency b. secondary adrenal insufficiency
b. secondary adrenal insufficiency (because of the presence of aldosterone)
192
Which of the following has a lower half-life? why? a. aldosterone b. cortisol
a. aldosterone because it has a lower affinity to albumin, transcortin, and aldosterone binding globin
193
Circulating cortisol is 3x higher than aldosterone, so how do mineralocorticoid receptors get more aldosterone?
11β-HSD-II converts cortisol to the inactive cortisone, permitting aldosterone to activate mineralocorticoid receptor
194
What's the second most common cause of Addison's disease?
Tuberculosis, it infiltrates and destructs the adrenal gland (causes cortisol deficiency -\> high ACTH)
195
Which has characteristically very high ACTH? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome
c. Ectopic Cushing syndrome
196
What suppresses the immune system in long term stress response?
glucocorticoids
197
Which of the following does cortisol function as? a. glucocorticoid b. mineralocorticoids c. both d. neither
c. both
198
Patient takes a metyrapone suppression test and we find out that his ACTH levels are low. What does this indicate and why?
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
Which is a branch of the inferior phrenic artery?
1. Superior suprarenal artery
2. Middle suprarenal artery
3. Inferior suprarenal artery
a. Superior suprarenal artery
200
Hypercortisolism is also known as
Cushing Syndrome
201
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. 17 alpha-hydroxylase
202
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
b. 21 hydroxylase
203
Patient takes an ACTH and cosyntropin test and his cortisol levels remain constant. What does this indicate and why?
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
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. a1
205
Which stage of steroid inactivation leads to the transformation of the lipophilic compounds into water soluble metabolites?
1. phase 1
2. phase 2
b. phase 2 (Sulfation or glucuronidation)
206
Which releases catecholamines?
1. cortex
2. medulla
b. medulla
207
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
c. preganglionic sympathetic nerve fibers (release acetylcholine)
208
Where does most of the cholesterol used for the steroid synthesis come from?
from the circulation (80%)
209
In which two locations does steroid hormone synthesis take place?
ER mitochondria
210
Denovo synthesis of cholesterol requires which precursor?
acetyl coA
211
How can we minimize the side effects of glucocorticoid drugs without changing the dosage?
by changing the route of administration
212
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. Cholesterol ester hydrolase
213
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. CYP-450scc / 20,22-lyase & e. 11b-hydroxylase
214
anterior and posterior renal fascia join to form which structure?
false capsule
215
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
B. Develop from neural crest cells
216
Patient with cushing has high glucose, explain the etiology?
cortisol acts against insulin (it releases the sugar from cells)
217
What hormone is produced after complete removal of the side chain of
cholesterol?
1. Cortisol
2. Progesterone
3. Androstenedione
4. Estradiol
C. Androstenedione
218
Leydig cells express high levels of which two hormones? What activates Leydig cells to produce testosterone?
3β-HSD and 17β-HSD are highly expressed in Leydig cells LH activates Leydig cells
219
Which converts cortisone to physiologically active cortisol? a. 11-β-hydroxysteroid dehydrogenase type-1 b. 11-β-hydroxysteroid dehydrogenase type-2
a. 11-β-hydroxysteroid dehydrogenase type-1
220
In which location is the side chain arranged to the steroid nucleus?
carbon 17 of the D ring
221
Which structure is related to the inferior side of the posterior surface of the right suprarenal gland?
right kidney
222
What gene encodes for 21-hydroxylase?
Cytochrome P450 Family 21 Subfamily A Member 2 (CYP21A2) gene encoding
223
A deficiency in which of the following enzymes leads to feminine phenotypes? a. 11β hydroxylase b. 17α hydroxylase c. 21 hydroxylase
b. 17α hydroxylase
224
225
Which structure is related to the superior side of the anterior surface of the left suprarenal gland?
stomach
226
How do glucocorticoids decrease vascular permeability?
by increasing the expression of vasocortin
227
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. β-hydroxysteroid dehydrogenase
228
Testosterone is converted into dihydrotestosterone by what enzyme? Where does it take place?
5a-reductase in peripheral tissue
229
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
b. CYP21A2
230
Describe the gross appearance of pheochromocytoma
tan and well defined tumor
231
Which is more common in the adrenal gland? a. primary pituitary tumors b. metastatic tumors
b. metastatic tumors
232
once the nicotinic receptors of the medulla are activated (by acetylcholine) which catecholamines are released? and at which ratio?
epinephrine & norepinephrine at a 4:1 ratio
233
Secondary hyperaldosteronism is caused by a deficiency in
ACTH
234
What's the most common solid malignancy of childhood and infancy?
brain tumors
235
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
b. endosomal ATPase
236
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
b. Acyl-CoA cholesterol acyltransferase I (ACAT)
237
explain why Cushing's syndrome causes slow wound healing?
Cortisol is diabetogenic and delays wound healing by diminishing the activity of fibrocytes. It's also anti-allergic and diminishes antibody formation
238
Nerves supplying the cortex of the suprarenal gland go through which of the following?
1. greater splanchnic nerve
2. coeliac ganglion
b. coeliac ganglion
239
How many sites in steroidogenic acute regulatory (StAR) protein are available for phosphorylation by protein kinase A (PKA)?
3
240
Which of the following has a low renin concentration? a. primary hyperaldosteronism b. secondary hyperaldosteronism
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
On average, which undergoes larger cortical hyperplasia (adrenal enlargement) and why? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome
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
What is a long-term effect of prednisolone use?
1. Decrease hepatic gluconeogenesis
2. Increase circulating neutrophils
3. Decrease immunity
4. Increase lymphocytic apoptosis
B. Increase circulating neutrophils
243
What converts androstendione into estrone?
Aromatase
244
What percentage of the suprarenal gland is the medulla?
10%
245
How does serotonin increase glucocorticoid secretion?
by enhancing CRH secretion
246
Which of the following bind to albumin? a. glucocorticoids b. glucocorticoids synthetic analogs
b. glucocorticoids synthetic analogs
247
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
g. 3 beta-HSD
248
Which has low ACTH? a. Adrenal Cushing syndrome b. Cushing disease c. Ectopic Cushing syndrome
a. Adrenal Cushing syndrome
249
Which of the following is made by adding an OH to cholesterol?
1. Androgens
2. Bile acids
3. Estrogens
4. Progesterone
b. Bile acids
250
cells of which area stain positive (brown) when treated with potassium bichromate?
The cells of the medulla (Chromaffin cells stain positive, chromaffin reaction)
251
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. Zona Glomerulosa (juxtaglomerular cells release renin)
252
Defective 11β-HSD-II leads to which pathologies?
sodium retention, and salt-dependent hypertension
253
Which of the following has a greater effect on beta 2 receptors? a. epinephrine b. norepinephrine
a. epinephrine (norepinephrine mostly works on alpha receptors)
254
Describe clinical features of a patient with pheochromocytoma
chronic hypertension
255
primary hyperaldosteronism VERSUS secondary hyperaldosteronism Which one causes pigmentation and why?
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
Which releases steroids?
1. cortex
2. medulla
a. cortex
257
Which part of the right suprarenal gland is in contact with the diaphragm?
1. anterior surface
2. posterior surface
3. medial border
b. (upper part of the) posterior surface
258
Which of the following is secreted almost entirely from the adrenal medulla? a. epinephrine b. norepinephrine
a. epinephrine
259
Which of the following tests overactivity? a. Stimulation Tests b. Suppression Tests
b. Suppression Tests
260
What does it indicate when a patient has a positive low-dose dexamethasone suppression test?
that he has cushing (but we don't know the cause)
261
Which of the following genes codes for aromatase?
1. CYP11A1
2. CYP21A2
3. CYP11B1
4. CYP11B2
5. CYP17
6. CYP19
7. 3 beta-HSD
f. CYP19
262
What two things drain into the Left Renal vein?
Left suprarenal vein Left gonadal vein
263
Cortisol stimulates which of the following? a. bone resorption b. bone formation
a. bone resorption (again, mainly a catabolic hormone)
264
Why are glucocorticoids used to treat septic shock?
it increases the cardiac output, restores blood pressure, and restore plasma glucose levels
265
Which of the following goes through aromatization to be made?
1. Androgens
2. Bile acids
3. Estrogens
4. Progesterone
c. Estrogens (aromatization in ring A)
266
What causes the Spironolactone bodies in histology samples?
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
Which adrenal cortex zones are affected during Addison's disease?
zona glomerulosa and fasiculata
268
What receptor is used to capture cholesterol from circulatory LDL?
Scavenger receptor class B, type I (SR-BI)
269
What do Chromaffin cells secrete?
secrete noradrenaline and adrenaline (and chromogranin a)
270
Which structure is related to the medial side of the anterior surface of the right suprarenal gland?
IVC
271
How does the adrenomedullary vein aid in the efflux of hormones?
tunica media of vein contains longitudinally oriented smooth muscles, their contraction causes the adrenal gland volume to decrease leading to hormone efflux
272
only 30% of norepinephrine comes from medulla, where does the rest of the 70% come from?
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
Which of the following symptoms is a more specific sign of cushing syndrome? a. depression b. abdominal striae c. buffalo hump c. moon face
b. abdominal striae (spontaneous bruising, proximal myopathy, and abdominal striae are the most specific signs)
274
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. increase vitamin D action (antagonize the action of vit D)
275
Which of the following is transported via Corticosteroid binding globulin (CBG)? a
1. Aldosterone
2. DHEA
3. Cortisol
4. Androgens & Estrogens
c. Cortisol
276
Which catecholamine receptors increase gluconeogenesis in times of stress? a. a1 b. a2 c. b1 d. b2 e. b3
d. b2
277
Whos is most likely to get steroidogenic cell hyperplasia? a. person on vacation b. person with pet c. medical student
c. medical student (chronic stress)
278
chromogranin A is s storage protein complex for which hormones?
epinephrine nonepinephrine
279
Describe the solubility of most glucocorticoids? What does that mean for their route of administration?
very lipid-soluble. Most of them cannot be taken by IV
280
Which structure is related to the lateral side of the anterior surface of the right suprarenal gland?
liver
281
Which of the following has a low renin concentration?
1. primary adrenal insufficiency
2. secondary adrenal insufficiency
b. secondary adrenal insufficiency (not sure about this)
282
Which pathology is most likely to be found in the bare area of the liver?
an abscess (more common in that area)
283
What enzymes do Aldosterone-target cells express?
11β-hydroxysteroid dehydrogenase –Type II (11β-HSD-II)
284
13. What is the effect of immune reactions on the adrenal glands in Addison’s
Disease?
1. Increased cortisol synthesis
2. Decreased cortisol production
3. Hyperactivity of steroid-producing cells
B. Decreased cortisol production
285
What increases blood volume and pressure in long term stress response?
mineralocorticoids
286
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
d. 3b-Hydroxy steroid dehydrogenase (3bHSD)
287
Which four genetic defects lead to pheochromocytomas?
RET gene SDH gene VHL gene NF1 gene
288
Which of the following has a high renin concentration? a. primary adrenal insufficiency b. secondary adrenal insufficiency
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
patient comes in with obesity, diabetes and hypogonadism. What do you suspect?
Cushing's syndrome (excessive secretion of glucocorticoids)
290
dexamethasone is an analog for
cortisol
291
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
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
In which area do the anterior and posterior renal fascia NOT fuse?
1. superiorly
2. inferiorly
b. inferiorly
293
11-Deoxycortisol protein is low in a case of CAH. Which enzyme is low? a. 11-b-hydroxylase b. 21- hydroxylase
b. 21- hydroxylase
294
What four actions does PKA do when activated by camp?
1- import of cholesterol via LDL 2- activates CEH enzyme 3- activates Star 4 activates TF CREB
295
What is used for the treatment of Cushing's syndrome? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole
b. Mifepristone
296
catecholamines metabolites can be used to do which of the following? a. screen for neuroblastoma b. confirm neuroblastoma
a. screen for neuroblastoma
297
What inhibits the rate-limiting enzyme in the biosynthesis of glucocorticoids? a. Aminoglutethimide b. Mifepristone c. Metyrapone d. Ketoconazole
a. Aminoglutethimide
298
Which of the following has a high renin concentration? a. primary hyperaldosteronism b. secondary hyperaldosteronism
b. secondary hyperaldosteronism
299
T/F: steroid hormones do not use secondary messengers, but rather act directly to change gene transcription
true
300
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
b. CYP21A2 & e. CYP17 & g. 3 beta-HSD (the rest code for mitochondrial enzymes)
301
Which structure is related to the inferior side of the anterior surface of the left suprarenal gland?
pancreas
302
What are four things you can test to confirm the presence of a pheochromocytoma?
Catecholamines Vanillylmandelic acid (VMA) Metanephrines Chromogranin A (you can also use nuclear medicine scan to locate the tumor)
303
Which part of the suprarenal gland develops from neural crest cells?
medulla
304
What do you call a steroid made of 17 carbons containing tetracyclic hydrocarbons?
gonane
305
What reduces the clearance/biotransformation of glucocorticoids?
estrogen pregnancy hypothyroidism liver disease malnutrition low protein diet
306
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. Cortisol + Flurocortisol (9 α flurocortisol)
307
A deficiency of which hormone(s) causes hyponatremia?
cortisol and aldosterone
308
What is used to screen for hyperaldosteronism?
aldosterone:renin ratio
309
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
d. CYP11B2
310
Which part of the right suprarenal gland is in contact with the bare area of the liver?
lateral side
311
Which of the following secretes cortisol?
1. Zona Glomerulosa
2. Zona Fasciculata
3. Zona Reticularis
4. Medulla
b. Zona Fasciculata (secretes glucocorticoids)
312
What does steroidogenic acute regulatory (StAR) protein do?
speeds the transport of cholesterol from the outer mitochondrial membrane (OMM) to the inner mitochondrial membrane (IMM)
313
Which has a side effect of oral candida? a. Metyrapone b. Beclomethasone c. Methylprednisolone/polyethylene glycol
b. Beclomethasone
314
What's the function of hormone-sensitive lipase (HSL)?
liberates free Cholesterol from lipid droplets (Hormone-sensitive lipase HSL, AKA cholesteryl ester hydrolase (CEH))
315
Which of the following has a higher response to ACTH analogs? a. primary adrenal insufficiency b. secondary adrenal insufficiency
b. secondary adrenal insufficiency
316
Explain how the diurnal variation test of cushing syndrome works?
test cortisol in the morning and at midnight, midnight test concentration should be 75% of the morning concentration
317
T/F: the left suprarenal gland is concave from the lateral border
true
318
What's the second most common solid malignancy of childhood and infancy?
neuroblastoma
