Deck 51: Adrenal Hormones and Hypertension

Question 1

Which of the following patients should undergo screening for Cushing's syndrome?

A)a patient with osteoporosis
B)a woman with polycystic ovary syndrome
C)a patient with poorly controlled diabetes
D)all of the above

Answer 1

all of the above

Question 2

A patient with intermittent hypertension has an elevated urinary vanillylmandelic acid (VMA).This result suggests:

A)hyperaldosteronism
B)hypercortisolism
C)idiopathic hypertension
D)pheochromocytoma

Answer 2

pheochromocytoma

Question 3

Primary autonomous hypersecretion of aldosterone by the zona glomerulosa is mainly caused by:

A)Conn's syndrome
B)idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia
C)Addison's disease
D)both a and b

Answer 3

both a and b

Question 4

In normal individuals, four main factors control the secretion of aldosterone from the zona glomerulosa.Under normal circumstances, which factor predominates?

A)potassium levels
B)natriuretic peptides
C)the renin-angiotensin system
D)ACTH levels

Question 5

The predominant androgens secreted by the adrenal cortex are:
1)dehydroepiandrosterone sulfate (DHEA-S)
2)dehydroepiandrosterone (DHEA)
3)androstenedione
4)dihydrotestosterone (DHT)

A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4

Question 6

In patients with suspected primary aldosteronism, screening can be accomplished by measuring a morning ambulatory paired random aldosterone and renin activity.A positive test result is defined as the combination of ______ aldosterone-to-plasma renin activity ratio and ______ aldosterone.

A)increased, increased
B)increased, decreased
C)decreased, increased
D)decreased, decreased

Question 7

Symptoms of secondary adrenal insufficiency include which of the following laboratory observations:
1)hypothyroidism
2)concomitant hypogonadism
3)hyperpigmentation
4)hypoglycemia

A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4

Question 8

Which of the following is considered a definitive laboratory finding for congenital adrenal hyperplasia?

A)increased testosterone in serum
B)increased pregnanetriol in urine
C)increased 17-hydroxyprogesterone in serum
D)increased 17-ketosteroid in urine

Question 9

Which of the following conditions results from excess cortisol production?

A)Cushing's syndrome
B)primary hyperaldosteronism
C)Conn's syndrome
D)pheochromocytoma

Question 10

Which of the following patients could have a false-positive late-night salivary cortisol?
1)a patient with hypertension
2)a patient with advanced age
3)a patient with psychiatric problems

A)1, 2, 3
B)1, 2
C)2, 3
D)1, 3

Question 11

Adrenal androgens can be converted by peripheral tissues to which primary sex hormone(s)?

A)testosterone
B)dihydrotestosterone
C)estradiol
D)all of the above

Question 12

When is cortisol usually at its lowest concentration in the circulation?

A)4:00 pm
B)Midnight
C)4:00 am
D)8:00 am

Question 13

Which of the following is an indication for screening hypertensive patients for primary aldosteronism?
1)spontaneous hyperkalemia
2)hypertension refractory to treatment with three or more drugs
3)adrenal incidentaloma
4)onset of hypertension at a young age

A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4

Question 14

Which of the following laboratory observations would be seen in an Addisonian crisis?
1)hypokalemia
2)hyponatremia
3)hemoconcentration
4)increased urea levels

A)1, 2, 3
B)1, 2, 4
C)1, 3, 4
D)2, 3, 4

Question 15

A morning cortisol level of ______ is normal and usually excludes Cushing's syndrome, but a level of ______ indicates hypercortisolism.

A)<30 nmol/L, >150 nmol/L
B)<40 nmol/L, >200 nmol/L
C)<50 nmol/L, >280 nmol/L
D)<60 nmol/L, >300 nmol/L

Question 16

Which of the following is considered the most sensitive test for the diagnosis and exclusion of pheochromocytoma?

A)plasma free metanephrines
B)the low-dose dexamethasone suppression test
C)plasma ACTH
D)plasma epinephrine

Question 17

Which of the following are characteristic of ketosteroids?
1)contain 21 carbon atoms
2)contain a hydroxyl group at the carbon 17 position
3)contain 19 carbon atoms
4)contain a ketone group at the carbon 17 position

A)1, 2
B)3, 4
C)1, 4
D)2, 3

Question 18

Which of the following is the most common pattern of urine free catecholamine findings in patients with pheochromocytoma?

A)pronounced increase in both norepinephrine and epinephrine, with a smaller increase in dopamine
B)increased levels of norepinephrine, with smaller increases or normal levels of epinephrine and dopamine
C)a pronounced increase in epinephrine, with smaller increases or normal levels of norepinephrine and dopamine
D)none of the above