Question 1

Which of the following stimulates secretion of aldosterone?&#10;A) stress&#10;B) hypoglycemia&#10;C) a decrease in renal blood pressure&#10;D) an increase in renal blood pressure

Accepted Answer

Aldosterone secretion is regulated by the renin-angiotensin system,ACTH,and plasma sodium and potassium levels.Aldosterone secretion is stimulated by a drop in renal blood pressure,which results from decreased intravascular volume or a sodium imbalance.The decrease in volume and/or pressure causes renin release from the kidney,which activates angiotensinogen to form angiotensin I and II.Angiotensin II,in turn,stimulates secretion of aldosterone from the adrenal cortex.When blood pressure rises,renin-angiotensin release diminishes,serving as a negative feedback loop that inhibits additional production of aldosterone.

Question 2

Primary adrenocortical insufficiency is known as ________.&#10;A) Addison's disease&#10;B) Cushing's syndrome&#10;C) hypoglycemia&#10;D) hyperglycemia

Accepted Answer

Primary adrenocortical insufficiency is known as Addison's disease.It is characterized by destruction of the adrenal cortex with resulting deficiency of all of the adrenocortical hormones.Secondary adrenocortical insufficiency is the more common form,and may be a consequence of hypothalmic or pituitary disease,critical illness,or the administration of exogenous corticosteroids,with a deficiency of primarily cortisol.

Question 3

&#34;Moon facies&#34; is associated with ________.&#10;A) mineralocorticoid excess&#10;B) mineralocorticoid deficiency&#10;C) glucocorticoid excess&#10;D) glucocorticoid deficiency

Accepted Answer

Cushing's syndrome classically produces weight gain,a broad and round face ("moon facies"),a "buffalo hump" on the upper back,abdominal striae,hypertension,hirsutism,and acne.Other findings may include glucose intolerance,heart failure,osteoporosis and bone fractures,impaired healing,and psychiatric disorders.Long-term steroid use also may increase risks for insomnia,peptic ulceration,cataract formation,glaucoma,growth suppression,and delayed wound healing.

Question 4

Which of the following is true of the physiologic actions of cortisol?&#10;A) insulin agonist&#10;B) increases blood pressure&#10;C) anti-inflammatory action&#10;D) a and b&#10;E) b and c

Accepted Answer

Cortisol acts as an insulin antagonist,increasing blood levels and peripheral use of glucose by activating key enzymes involved in hepatic gluconeogenesis and inhibiting glucose uptake in peripheral tissue.Cortisol increases blood pressure by potentiating the vasoconstrictor action of catecholamines and angiotensin II on the kidney and vasculature.Its anti-inflammatory action is modulated by its inhibitory action on (1)lysosome release, (
2)prostaglandin production, (
3)eicosanoid and cytokine release, (
4)endothelial cell expression of intracellular and extracellular adhesion molecules that attract neutrophils,and (5)leukocyte function.

Question 5

Immediate treatment during an adrenal crisis consists of the administration of ________.&#10;A) 1000 &#181;g beclomethasone dipropionate&#10;B) 100 mg of hydrocortisone or 4 mg of dexamethasone IV&#10;C) 30 mg cortisone&#10;D) 0.2 mg fludrocortisone

Accepted Answer

Immediate treatment consists of the administration of 100 mg of hydrocortisone or 4 mg of dexamethasone IV and immediate trAnswerportation to a medical facility.

Question 6

Which of the following is the predominant product of the zona glomerulosa of the adrenal cortex?&#10;A) glucocorticoids&#10;B) aldosterone&#10;C) androgens&#10;D) epinephrine

Accepted Answer

The adrenal medulla functions as a sympathetic ganglion and secretes catecholamines,primarily epinephrine,whereas the adrenal cortex secretes several steroid hormones with multiple actions.The predominant product of the zona glomerulosa is aldosterone,a mineralocorticoid.Aldosterone primarily regulates physiologic levels of sodium and potassium.The zona fasciculata secretes glucocorticoids,and the zona reticularis secretes androgens,or sex hormones.

Question 7

Which of the following is the most reliable and most commonly used laboratory test to determine adrenal insufficiency?&#10;A) dexamethasone suppression test&#10;B) CRH test&#10;C) synthetic ACTH (cosyntropin) stimulation test&#10;D) insulin tolerance test

Accepted Answer

The ACTH stimulation test is the most reliable and most commonly used test of the three.It is carried out by injecting a synthetic ACTH hormone,such as cosyntropin,either at 1 µg in the physiologic low-dose test or at 250 µg in the conventional-dose short test.The insulin tolerance test is costly and unpleasant for the patient because the insulin bolus induces severe hypoglycemia,and constant medical supervision is required.

Question 8

Hyperpigmentation of the skin and mucous membranes is associated with a deficiency of ________.&#10;A) androgen&#10;B) estrogen&#10;C) mineralocorticoid&#10;D) cortisol

Accepted Answer

Primary adrenal insufficiency (Addison's disease)produces signs and symptoms that relate to a deficiency of aldosterone and cortisol.The most common complaints are weakness,fatigue,abdominal pain,and hyperpigmentation of the skin and mucous membranes.Hypotension,anorexia,salt craving,myalgia,hypoglycemia,and weight loss are additional commonly associated features.

Question 9

Which of the following is the most common cause of secondary adrenal insufficiency?&#10;A) structural lesions of the hypothalamus or pituitary gland&#10;B) administration of specific drugs&#10;C) administration of exogenous corticosteroids&#10;D) a critical illness

Accepted Answer

Suppression of the HPA axis by exogenous or endogenous glucocorticoids is the most common cause of secondary adrenal insufficiency.The secretion of cortisol is directly dependent on the level of circulating ACTH.As plasma cortisol level increases,the production of ACTH decreases by virtue of negative feedback to the pituitary and hypothalamus.With the administration of corticosteroids,the feedback system senses the elevated plasma steroid levels and inhibits ACTH production,which in turn suppresses adrenal production of cortisol.

Question 10

According to current recommendations,which of the following groups of patients should receive additional (supplemental)corticosteroids to prevent adrenal crisis during and after surgery?&#10;A) Patients with either primary adrenal insufficiency or secondary adrenal insufficiency should receive additional corticosteroids.&#10;B) Patients with primary adrenal insufficiency, but not patients with secondary adrenal insufficiency, should receive additional corticosteroids.&#10;C) Patients with secondary adrenal insufficiency, but not patients with primary adrenal insufficiency, should receive additional corticosteroids.&#10;D) Neither patients with primary adrenal insufficiency nor patients with secondary adrenal insufficiency should receive additional corticosteroids.

Accepted Answer

The new recommendations,based on evidence-based reviews,suggest that only patients with primary adrenal insufficiency receive supplemental doses of steroid,whereas those with secondary adrenal insufficiency who take daily corticosteroids,regardless of the type of surgery,should receive only their usual daily dose of corticosteroids before the surgery.

Deck 15: Adrenal Insufficiency