Question 1

Renin is synthesized in the _____ and stimulates the production of angiotensin I,which eventually leads to _____.&#10;A) kidney; lowering of the blood pressure and volume&#10;B) adrenal gland; an increase in blood pressure and volume&#10;C) kidney; stimulation of aldosterone production&#10;D) adrenal gland; stimulation of cortisol production

Accepted Answer

Renin is synthesized and released by the kidney in response to a drop in blood pressure or volume. Renin stimulates the production of angiotensin I, which is further converted to angiotensin II. Angiotensin II is a potent vasoconstrictor, leading to an increase in blood pressure and volume. Additionally, angiotensin II stimulates the production of aldosterone in the adrenal gland, which increases sodium reabsorption and potassium secretion in the kidney, leading to an increase in blood volume and pressure.

Question 2

During an evaluation of adrenal function,a patient had plasma cortisol determinations in the morning after awakening and in the evening at approximately 7:30 PM.Laboratory results indicated that the evening value was approximately half as high as the morning concentration.This is indicative of:

A) a normal finding.
B) Cushing syndrome.
C) adrenal gland tumor.
D) ectopic hormone production.

a normal finding.

Accepted Answer

A normal finding is for cortisol levels to be highest in the morning and gradually decrease throughout the day, leading to lower levels in the evening. A decrease in cortisol levels from morning to evening is a normal diurnal pattern. Cushing syndrome would result in elevated cortisol levels, ectopic hormone production would lead to abnormal hormone patterns, and an adrenal gland tumor could cause either elevated or decreased cortisol levels, not just decreased levels in the evening.

Question 3

Because of the biochemical properties of steroid hormones,the majority of these hormones,at physiological concentration:&#10;A) are bound with high affinity to a carrier protein in the circulation.&#10;B) remain free in the circulation.&#10;C) are conjugated to glucuronides.&#10;D) are bound with low affinity to albumin.

Accepted Answer

Steroid hormones have low solubility in water and need to be carried by carrier proteins. The majority of steroid hormones are bound with high affinity to carrier proteins such as sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) in the circulation. This binding helps to increase their solubility in the blood and transport them to their target tissues.

Question 4

The primary glucocorticoid is:&#10;A) glucose.&#10;B) cortisol.&#10;C) aldosterone.&#10;D) epinephrine.

Accepted Answer

The primary glucocorticoid is cortisol. Glucocorticoids are a class of steroid hormones that are produced by the adrenal gland, with cortisol being the primary glucocorticoid. It plays a vital role in the regulation of glucose metabolism, immune response, and inflammation.

Question 5

Following multiple-day cosyntropin stimulation,an individual with Addison disease (primary adrenal insufficiency)will:&#10;A) show markedly elevated cortisol production.&#10;B) fail to demonstrate increased cortisol production.&#10;C) demonstrate markedly elevated serum aldosterone.

Accepted Answer

Individuals with primary adrenal insufficiency or Addison disease have damaged adrenal glands, leading to decreased production of cortisol and aldosterone. Therefore, they will fail to demonstrate increased cortisol production following cosyntropin stimulation.

Question 6

Deficiency of which of the following enzymes can lead to congenital adrenal hyperplasia (CAH)?&#10;A) 21-Alpha-hydroxylase&#10;B) 11-Beta-hydroxylase&#10;C) 17-Ketosteroidase&#10;D) Both a and b

Accepted Answer

The answer of Deficiency of which of the following enzymes...

Question 7

A hypertensive,hypokalemic patient with increased aldosterone production and decreased plasma renin activity likely has:&#10;A) Cushing syndrome.&#10;B) Addison disease.&#10;C) Conn syndrome.&#10;D) congenital adrenal hyperplasia.

Accepted Answer

The description given matches the symptoms of Conn syndrome, which is caused by a benign tumor in the adrenal gland that produces excess aldosterone. This leads to high blood pressure and low potassium levels. Addison disease is characterized by low levels of cortisol and aldosterone, while Cushing syndrome is caused by excess cortisol production. Congenital adrenal hyperplasia is a genetic disorder that affects the production of various hormones in the adrenal glands. None of these conditions match the given symptoms as well as Conn syndrome.

Question 8

Which one of the following statements concerning cortisol is incorrect?&#10;A) Cushing syndrome is the syndrome of hypercortisolism.&#10;B) A cortisol-secreting tumor can lead to Cushing disease.&#10;C) Plasma cortisol levels show a diurnal variation,with the highest level present in the morning and the lowest level in the late afternoon.&#10;D) Hypocortisolism due to primary adrenal disease is referred to as Addison disease.

Accepted Answer

Cushing disease specifically refers to the condition caused by a pituitary adenoma leading to increased ACTH secretion, which in turn causes increased cortisol production. A cortisol-secreting tumor directly causing increased cortisol levels without involving the pituitary gland would lead to Cushing syndrome, not Cushing disease.

Question 9

In the corticotropin-releasing hormone stimulation test,an individual with secondary adrenal insufficiency (pituitary ACTH deficiency)will have which of the following laboratory test results?&#10;A) Plasma ACTH peak at 30 minutes and serum cortisol peak at 60 minutes&#10;B) Decreased plasma ACTH and decreased serum cortisol response times&#10;C) Prolonged ACTH response time and decreased cortisol response time&#10;D) Excessive increase in plasma response

Accepted Answer

In secondary adrenal insufficiency (pituitary ACTH deficiency), there is a lack of ACTH stimulation of the adrenal glands, resulting in decreased adrenal cortisol production. Therefore, in the corticotropin-releasing hormone stimulation test, there will be a decreased plasma ACTH and decreased serum cortisol response times. This is different from primary adrenal insufficiency (Addison's disease), where there is a lack of adrenal cortisol production due to adrenal gland dysfunction, resulting in an excessive increase in plasma response.

Question 10

The urinary metabolite of cortisol and adrenal androgens is:&#10;A) renin.&#10;B) 17-hydroxyprogesterone.&#10;C) 11-desoxycortisol.&#10;D) 17-ketosteroid.

Accepted Answer

The urinary metabolite of cortisol and adrenal androgens is 17-ketosteroid. Renin plays a role in regulating blood pressure, 17-hydroxyprogesterone is a precursor to cortisol and androgens, and 11-desoxycortisol is a precursor to cortisol.

Question 11

How would CAH affect cortisol and adrenal androgen levels in blood?&#10;A) Cortisol increased,adrenal androgens increased&#10;B) Cortisol decreased,adrenal androgens increased&#10;C) Cortisol increased,adrenal androgens decreased&#10;D) Cortisol decreased,adrenal androgens decreased

Accepted Answer

The answer of How would CAH affect cortisol and adrenal...

Question 12

The adrenal cortical hormone that promotes sodium resorption and potassium and hydrogen ion excretion by the renal tubules and thus affects water balance in the body is:&#10;A) androstenedione.&#10;B) cortisol.&#10;C) aldosterone.&#10;D) calcium.

Accepted Answer

The answer of The adrenal cortical hormone that promotes sodium...

Question 13

In the classic plasma renin activity assay that measures the main function of the enzyme and uses inhibitors of angiotensinase,what is actually measured at the end of the assay?&#10;A) Plasma renin&#10;B) Angiotensin-converting enzyme&#10;C) Angiotensin I&#10;D) Angiotensin II

Accepted Answer

The answer of In the classic plasma renin activity assay...

Question 14

Which one of the following statements concerning androstenedione is incorrect?&#10;A) In adrenal carcinoma,cortisol is greatly elevated,but androstenedione is greatly decreased.&#10;B) The precursor molecule in the formation of androstenedione is dihydroepiandrostenedione (DHEA).&#10;C) Androstenedione metabolites are measured as 17-ketosteroids.&#10;D) 11$\beta$-Hydroxylase deficiency leads to elevated plasma androstenedione.

Accepted Answer

The answer of Which one of the following statements concerning...

Question 15

A patient with Cushing syndrome has plasma cortisol measured at 8 AM.The nighttime cortisol level will be _____ from the 8 AM value.&#10;A) increased&#10;B) decreased&#10;C) unchanged

Accepted Answer

The answer of A patient with Cushing syndrome has plasma...

Question 16

Which of the following steroid hormones is (are)synthesized and secreted by the zona reticularis of the adrenal cortex?&#10;A) Cortisol&#10;B) Estradiol&#10;C) Androstenedione&#10;D) All of the above

Accepted Answer

The answer of Which of the following steroid hormones is...

Question 17

The major site of cortisol synthesis is the _____ of the adrenal gland.&#10;A) zona glomerulosa&#10;B) zona fasciculata&#10;C) zona reticularis&#10;D) medulla

Accepted Answer

The answer of The major site of cortisol synthesis is...

Question 18

The most reliable screening test for _____ is measurement of 24-hour urinary free cortisol.&#10;A) Cushing syndrome&#10;B) Addison disease&#10;C) Conn syndrome&#10;D) adrenal tumor

Accepted Answer

The answer of The most reliable screening test for _____...

Question 19

Glucocorticoids:&#10;A) decrease blood glucose concentration.&#10;B) repress inflammatory genes.&#10;C) stimulate erythropoiesis.&#10;D) stimulate lipogenesis.

Accepted Answer

The answer of Glucocorticoids:&#10;A) decrease blood glucose concentration.&#10;B) repress inflammatory...

Question 20

The principal site of steroid metabolism is the liver.

Accepted Answer

The answer of The principal site of steroid metabolism is...

Deck 41: Disorders of the Adrenal Cortex