[MCQ] Disorders of the Adrenal Cortex- Part 6

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Disorders of the Adrenal Cortex- Part 6

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Question 1

Criteria for the diagnosis of primary aldosteronism include ?

A	Diastolic hypertension without edema
B	Hyposecretion of renin (low PRA levels) that do not increase during volume depletion
C	Hypersecretion of aldosterone that does not suppress in response to volume expansion
D	All of the above

Question 1 Explanation:

Criteria for the diagnosis of primary aldosteronism are diastolic hypertension without edema, hyposecretion of renin (low PRA levels) that fails to increase appropriately during volume depletion (upright posture, sodium depletion), and hypersecretion of aldosterone that does not suppress appropriately in response to volume expansion.

Question 2

Which of the following is false about primary aldosteronism ?

A	Hypokalemia
B	Diastolic hypertension
C	No edema
D	None of the above

Question 2 Explanation:

Hypersecretion of aldosterone causes hypokalemia, diastolic hypertension, headaches, polyuria, polydipsia, left ventricular hypertrophy disproportionate to level of BP. Edema is characteristically absent they exhibit an “escape” phenomenon from the sodium-retaining aspects of mineralocorticoids

Question 3

Which of the following is false about bilateral cortical nodular hyperplasia ?

A	~80% of patients with primary aldosteronism
B	Hypokalemia less likely
C	Less radiologic evidence for adrenal pathology
D	None of the above

Question 3 Explanation:

Patients with bilateral hyperplasia are unlikely to have hypokalemia & have lower levels of aldosterone & less radiologic evidence for adrenal pathology. They constitute ~80% of patients 564 MCQ’s FOR MEDICAL PROFESSIONALS BY PROF. AJAY MATHUR Endocrinology with primary aldosteronism. Hypertension associated with idiopathic bilateral nodular hyperplasia does not usually benefit from bilateral adrenalectomy, whereas hypertension associated with aldosterone-producing tumors is usually improved or cured by removal of the adenoma.

Question 4

What ratio of serum aldosterone to PRA suggests autonomy of aldosterone secretion ?

A	> 10
B	> 15
C	> 20
D	> 30

Question 4 Explanation:

Ratio of serum aldosterone to plasma renin activity if high (>30) strongly suggests autonomy of aldosterone secretion in all normokalemic/hypokalemic and difficult-to-control hypertensive patients.

Question 5

Drug that is of use in primary aldosteronism is ?

A	Spironolactone
B	Eplerenone
C	Triamterene
D	All of the above

Question 6

Increased production of aldosterone occurs in secondary aldosteronism in response to ?

A	Activation of sympathetic system
B	Activation of parasympathetic system
C	Activation of renin-angiotensin system
D	All of the above

Question 6 Explanation:

In secondary aldosteronism, an appropriately increased production of aldosterone in response to activation of renin-angiotensin system occurs

Question 7

Secondary aldosteronism occurs in association with ?

A	Accelerated phase of hypertension
B	Underlying edema disorder
C	Bartter & Gitelman syndromes
D	All of the above

Question 7 Explanation:

Secondary aldosteronism occurs with accelerated phase of hypertension or an underlying edema disorder. Secondary hyperaldosteronism occurs without edema or hypertension in Bartter & Gitelman syndromes.

Question 8

Secondary aldosteronism is a feature of ?

A	Cirrhosis
B	Nephrotic syndrome
C	Congestive heart failure
D	All of the above

Question 8 Explanation:

Secondary aldosteronism is present edematous states like cirrhosis, nephrotic syndrome and congestive heart failure. Stimulus for aldosterone release is arterial hypovolemia and/or hypotension

Question 9

As compared to essential hypertension, patients with primary aldosteronism have a higher incidence of ?

A	Left ventricular hypertrophy (LVH)
B	Albuminuria
C	Stroke
D	All of the above

Question 10

What percentage of adrenal glands are destroyed before adrenal insufficiency appears ?

A	> 25 %
B	> 50 %
C	> 75 %
D	> 90 %

Question 10 Explanation:

Addison’s disease results from progressive destruction of adrenals, which must involve >90% of the glands before adrenal insufficiency appears.

Question 11

Adrenals is a frequent site for which of the following chronic granulomatous diseases ?

A	Tuberculosis
B	Histoplasmosis
C	Coccidioidomycosis
D	All of the above

Question 11 Explanation:

The adrenal is a frequent site for chronic granulomatous diseases, mainly tuberculosis but also histoplasmosis, coccidioidomycosis& cryptococcosis.

Question 12

Specific adrenal antigens to which autoantibodies may be directed include ?

A	SOX9
B	21-hydroxylase (CYP21A2)
C	RSPO1
D	CYP19

Question 12 Explanation:

Specific adrenal antigens to which autoantibodies may be directed include 21-hydroxylase (CYP21A2).

Question 13

In Addison’s disease, which of the following also occur with increased frequency ?

A	Chronic lymphocytic thyroiditis
B	Premature ovarian failure
C	Type 1 diabetes mellitus
D	All of the above

Question 14

In Addison’s disease, which of the following also occur with increased frequency ?

A	Hypo- or hyperthyroidism
B	Pernicious anemia
C	Myasthenia gravis
D	All of the above

Question 14 Explanation:

In Addison’s disease, there is an increased incidence of chronic lymphocytic thyroiditis, premature ovarian failure, type 1 diabetes mellitus, hypo- or hyperthyroidism, pernicious anemia, vitiligo, alopecia, nontropical sprue & myasthenia gravis.

Question 15

Mutant gene in Type I polyglandular syndrome is on ?

A	Chromosome 12
B	Chromosome 16
C	Chromosome 18
D	Chromosome 21

Question 16

“C” in APECED gene stands for ?

A	Carcinoma
B	Candidiasis
C	Calcinosis
D	Caif-au-lait

Question 16 Explanation:

Type I polyglandular syndrome is caused by mutations in the autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) gene located on chromosome 21q22.3.

Question 17

Mutant gene in Type II polyglandular syndrome is on ?

A	Chromosome 4
B	Chromosome 6
C	Chromosome 8
D	Chromosome 10

Question 17 Explanation:

Type II polyglandular syndrome is associated with a mutant gene on chromosome 6 as well as with HLA alleles B8 and DR3.

Question 18

Type I polyglandular autoimmune syndrome consists of all except ?

A	Parathyroid insufficiency
B	Adrenal insufficiency
C	Chronic mucocutaneous candidiasis
D	Myasthenia gravis

Question 18 Explanation:

Combination of parathyroid & adrenal insufficiency & chronic mucocutaneous candidiasis constitutes type I polyglandular autoimmune syndrome. Pernicious anemia, chronic active hepatitis, alopecia, primary hypothyroidism, and premature gonadal failure may also be associated.

Question 19

Which of the following may cause or potentiate adrenal insufficiency ?

A	Rifampin
B	Phenytoin
C	Ketoconazole
D	All of the above

Question 19 Explanation:

Medications like rifampin, phenytoin, ketoconazole, megestrol & opiates may cause or potentiate adrenal insufficiency.

Question 20

Which of the following is the most frequent presentation in adrenal insufficiency ?

A	Weakness
B	Pigmentation of mucous membranes
C	Salt craving
D	Diarrhea

Question 21

Which of the following is an early sign of hyperpigmentation in Addison’s disease ?

A	Darkening of areolae of nipples
B	Bluish-black patches on mucous membranes
C	Persistent tanning following sun exposure
D	Dark freckles

Question 21 Explanation:

Persistent tanning following sun exposure is an early sign in Addison’s disease.

Question 22

Hematologic abnormalities seen in adrenal insufficiency is ?

A	Normocytic anemia
B	Relative lymphocytosis
C	Moderate eosinophilia
D	All of the above

Question 23

In rapid ACTH stimulation test, dose of cosyntropin is ?

A	50 μg
B	150 μg
C	250 μg
D	500 μg

Question 23 Explanation:

In rapid ACTH stimulation test, 250 μg of cosyntropin is given IM or IV.

Question 24

In rapid ACTH stimulation test, cortisol level at 60 minutes after cosyntropin should be ?

A	> 6 μg/dL
B	> 12 μg/dL
C	> 18 μg/dL
D	> 24 μg/dL

Question 24 Explanation:

In adrenal insufficiency, upon ACTH stimulation testing, cortisol level at 60 minutes after cosyntropin should be > 18 μg/dL.

Question 25

Primary & secondary adrenal insufficiency can be distinguished by measuring ?

A	Renin
B	Aldosterone
C	Angiotensin I
D	Angiotensin II

Question 25 Explanation:

If rapid ACTH stimulation test is abnormal, then primary and secondary adrenal insufficiency can be distinguished by measuring aldosterone levels from the same blood samples. In secondary adrenal insufficiency, the aldosterone increment will be normal (> 5 ng/dL). In primary adrenal insufficiency, plasma ACTH and associated peptides (-LPT) are elevated.

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See all quizzes of Disorders of the Adrenal Cortex at here:

1.Criteria for the diagnosis of primary aldosteronism include ?
A. Diastolic hypertension without edema
B. Hyposecretion of renin (low PRA levels) that do not increase
during volume depletion
C. Hypersecretion of aldosterone that does not suppress in
response to volume expansion
D. All of the above

2.Which of the following is false about primary aldosteronism ?
A. Hypokalemia
B. Diastolic hypertension
C. No edema
D. None of the above

3. Which of the following is false about bilateral cortical nodular
hyperplasia ?
A. ~80% of patients with primary aldosteronism
B. Hypokalemia less likely
C. Less radiologic evidence for adrenal pathology
D. None of the above

4. What ratio of serum aldosterone to PRA suggests autonomy of
aldosterone secretion ?
A. > 10
B. > 15
C. > 20
D. > 30

5. Drug that is of use in primary aldosteronism is ?
A. Spironolactone
B. Eplerenone
C. Triamterene
D. All of the above
6. Increased production of aldosterone occurs in secondary
aldosteronism in response to ?
A. Activation of sympathetic system
B. Activation of parasympathetic system
C. Activation of renin-angiotensin system
D. All of the above

7. Secondary aldosteronism occurs in association with ?
A. Accelerated phase of hypertension
B. Underlying edema disorder
C. Bartter & Gitelman syndromes
D. All of the above

8. Secondary aldosteronism is a feature of ?
A. Cirrhosis
B. Nephrotic syndrome
C. Congestive heart failure
D. All of the above

9. As compared to essential hypertension, patients with primary
aldosteronism have a higher incidence of ?
A. Left ventricular hypertrophy (LVH)
B. Albuminuria
C. Stroke
D. All of the above
10. What percentage of adrenal glands are destroyed before adrenal
insufficiency appears ?
A. > 25 %
B. > 50 %
C. > 75 %
D. > 90 %

11. Adrenals is a frequent site for which of the following chronic
granulomatous diseases ?
A. Tuberculosis
B. Histoplasmosis
C. Coccidioidomycosis
D. All of the above

12. Specific adrenal antigens to which autoantibodies may be directed
include ?
A. SOX9
B. 21-hydroxylase (CYP21A2)
C. RSPO1
D. CYP19

13.In Addison’s disease, which of the following also occur with
increased frequency ?
A. Chronic lymphocytic thyroiditis
B. Premature ovarian failure
C. Type 1 diabetes mellitus
D. All of the above
14. In Addison’s disease, which of the following also occur with
increased frequency ?
A. Hypo- or hyperthyroidism
B. Pernicious anemia
C. Myasthenia gravis
D. All of the above

14. Mutant gene in Type I polyglandular syndrome is on ?
A. Chromosome 12
B. Chromosome 16
C. Chromosome 18
D. Chromosome 21
15. “C” in APECED gene stands for ?
A. Carcinoma
B. Candidiasis
C. Calcinosis
D. Caif-au-lait

16. Mutant gene in Type II polyglandular syndrome is on ?
A. Chromosome 4
B. Chromosome 6
C. Chromosome 8
D. Chromosome 10

17. Type I polyglandular autoimmune syndrome consists of all except ?
A. Parathyroid insufficiency
B. Adrenal insufficiency
C. Chronic mucocutaneous candidiasis
D. Myasthenia gravis

18. Which of the following may cause or potentiate adrenal
insufficiency ?
A. Rifampin
B. Phenytoin
C. Ketoconazole
D. All of the above

19. Which of the following is the most frequent presentation in adrenal
insufficiency ?
A. Weakness
B. Pigmentation of mucous membranes
C. Salt craving
D. Diarrhea
20. Which of the following is an early sign of hyperpigmentation in
Addison’s disease ?
A. Darkening of areolae of nipples
B. Bluish-black patches on mucous membranes
C. Persistent tanning following sun exposure
D. Dark freckles

21. Hematologic abnormalities seen in adrenal insufficiency is ?
A. Normocytic anemia
B. Relative lymphocytosis
C. Moderate eosinophilia
D. All of the above
22. In rapid ACTH stimulation test, dose of cosyntropin is ?
A. 50 μg
B. 150 μg
C. 250 μg
D. 500 μg

23. In rapid ACTH stimulation test, cortisol level at 60 minutes after
cosyntropin should be ?
A. > 6 μg/dL
B. > 12 μg/dL
C. > 18 μg/dL
D. > 24 μg/dL

24. Primary & secondary adrenal insufficiency can be distinguished
by measuring ?
A. Renin
B. Aldosterone
C. Angiotensin I
D. Angiotensin II

Disorders of the Adrenal Cortex

[MCQ] Disorders of the Adrenal Cortex- Part 6

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Disorders of the Adrenal Cortex- Part 6

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