[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 3

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Disorders of the Anterior Pituitary and Hypothalamus- Part 3

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Question 1

Which of the following is false about prolactin (PRL) ?

A	Peak serum PRL levels occur between 4 - 6 AM
B	Circulating half-life of PRL is 50 minutes
C	Predominant central control mechanism is inhibitory
D	None of the above

Question 1 Explanation:

Normal adult serum PRL levels are ~10 to 25 μg/L in women & 10 to 20 μg/L in men. PRL secretion is pulsatile, with the highest secretory peaks occurring during rapid eye movement sleep. Peak serum PRL levels occur between 4 & 6 AM. Circulating half-life of PRL is ~50 minutes. Central control mechanism of PRL is inhibitory

Question 2

Systemic disorder associated with hyperprolactinemia is ?

A	Chronic renal failure
B	Primary hypothyroidism
C	Cirrhosis
D	All of the above

Question 2 Explanation:

Chronic renal failure elevates prolactin by decreasing peripheral prolactin clearance. Primary hypothyroidism causes hyperprolactinemia because of enhanced TRH secretion.

Question 3

The most common pituitary hormone hypersecretion syndrome in both males and females is ?

A	Acromegaly
B	Hyperprolactinemia
C	Secondary hyperthyroidism
D	Cushing’s syndrome

Question 4

When PRL level is >200 μg/L, the most common cause is ?

A	Pituitary stalk compression
B	Prolactinoma
C	Antipsychotic and antidepressant drugs
D	Pregnancy and lactation

Question 4 Explanation:

Prolactinomas are the most common cause of PRL levels >200 μg/L. Hypothalamus stimulates production of all anterior pituitary hormones except prolactin, where it has an inhibitory effect. Prolactin inhibitory hormone resembles catecholamine dopamine, secreted by arcuate nuclei of hypothalamus and decreases prolactin secretion. Thus, damage to hypothalamus or blockage of hypothalamic-hypophysial portal system increases prolactin secretion.

Question 5

“Colostrum” does not contain which of the following ?

A	Protein
B	Lactose
C	Fats
D	Calcium

Question 6

Hormonal agents that induce prolactin include ?

A	Estrogens
B	Antiandrogens
C	TRH
D	All of the above

Question 7

Which of the following causes increase in prolactin level ?

A	Sleep
B	Sexual orgasm
C	Chest stimulation
D	All of the above

Question 8

Which of the following produce “drug-induced hyperprolactinemia” by blocking dopamine receptors ?

A	Chlorpromazine
B	Haloperidol
C	Metoclopramide
D	All of the above

Question 9

Which of the following produce “drug-induced hyperprolactinemia” by inhibiting dopamine synthesis ?

A	Alpha-Methyldopa
B	Metoclopramide
C	Chlorpromazine
D	Haloperidol

Question 10

Which of the following produce “drug-induced hyperprolactinemia” by depleting catecholamine ?

A	Alpha-Methyldopa
B	Metoclopramide
C	Chlorpromazine
D	Reserpine

Question 11

Which of the following produce “drug-induced hyperprolactinemia” by blocking dopamine release ?

A	Alpha-Methyldopa
B	Metoclopramide
C	Verapamil
D	Reserpine

Question 11 Explanation:

Dopamine receptors are blocked by Phenothiazines like chlorpromazine, perphenazine, butyrophenones like haloperidol, thioxanthenes & metoclopramide. Alpha-methyldopa inhibits dopamine synthesis. Reserpine is a catecholamine depletor. Verapamil blocks dopamine release. Estrogens, antiandrogens & TRH induce prolactin.

Question 12

Galactorrhea is present in what percentage of hyperprolactinemic women ?

A	Up to 80%
B	Up to 85%
C	Up to 90%
D	Up to 95%

Question 13

Which of the following in not a presenting feature of hyperprolactinemia in women ?

A	Reduced vertebral bone density
B	Decreased libido
C	Weight loss
D	Hirsutism

Question 13 Explanation:

Chief presentations of hyperprolactinemia in women are oligomenorrhea / amenorrhea, galactorrhea, infertility, reduced vertebral bone mineral density due to hypoestrogenemia, decreased libido, weight gain & hirsutism.

Question 14

What is the normal basal, fasting morning prolactin level ?

A	< 5 μg/L
B	< 10 μg/L
C	< 15 μg/L
D	< 20 μg/L

Question 14 Explanation:

Basal, fasting morning PRL levels are normally <20 g/L. Prolactin secretion occurs in a pulsatile manner & levels vary widely. Assays on multiple occasions may be needed to document hyperprolactinemia. “Macroprolactinemia” refers to biologically inactive aggregated forms of circulating prolactin. It is a cause of false elevation of prolactin levels.

Question 15

Breast milk secretion is considered abnormal if it persists for ?

A	> 3 months after childbirth or discontinuation of breastfeeding
B	> 6 months after childbirth or discontinuation of breastfeeding
C	> 9 months after childbirth or discontinuation of breastfeeding
D	> 12 months after childbirth or discontinuation of breastfeeding

Question 15 Explanation:

Galactorrhea, the inappropriate discharge of milk-containing fluid from the breast, is considered abnormal if it persists for > 6 months after childbirth or discontinuation of breastfeeding

Question 16

The female : male ratio for microprolactinomas is ?

A	1:1
B	5:1
C	10:1
D	20:1

Question 17

The female:male ratio for macroadenomas is ?

A	1:1
B	5:1
C	10:1
D	20:1

Question 17 Explanation:

Female:male ratio for microprolactinomas is 20:1, whereas it is 1:1 for macroadenomas. Males tend to present with larger macroadenomas than females because of delay in appreciating signs & symptoms

Question 18

Which of the following is the least common hormone secreted by mixed tumors that secrete prolactin ?

A	GH
B	ACTH
C	TSH
D	None of the above

Question 18 Explanation:

Tumors arising from lactotrope cells account for ~ half of all functioning pituitary tumors. Mixed tumors secreting combinations of GH & PRL, ACTH & PRL & rarely TSH & PRL are also seen.

Question 19

For defining “microadenoma” of pituitary gland, what is its cutoff diameter ?

A	< 0.2 cm
B	< 0.5 cm
C	< 0.8 cm
D	1.0 cm

Question 19 Explanation:

Pituitary tumours <1 cm in diameter are termed microadenomas. They do not invade parasellar structures. Macroadenomas are >1 cm in diameter and are locally invasive & encroach on surrounding structures.

Question 20

If fertility is not desired, what should be the line of management of microadenomas ?

A	Dopamine agonists
B	Surgery
C	Radiation
D	No treatment

Question 20 Explanation:

Pituitary microadenomas are slow growing tumours and only ~5% go on to be macroadenomas. In ~30% of microadenomas, hyperprolactinemia resolves spontaneously. Such asymptomatic patients should be monitored by regular serial prolactin and MRI. No treatment is advocated, if fertility is not desired. However, estrogen replacement may be given to prevent bone loss

Question 21

Dopamine agonists act by ?

A	Suppressing prolactin secretion
B	Suppressing prolactin synthesis
C	Suppressing lactotrope cell proliferation
D	All of the above

Question 22

Which of the following is a nonergot oral dopamine agonist ?

A	Pergolide mesylate
B	Lisuride
C	Quinagolide
D	Bromocriptine

Question 23

Fungus that produces “Ergot alkaloids” is ?

A	Hortaea werneckii
B	Trichosporon asahii
C	Sporothrix schenckii
D	Claviceps purpurea

Question 23 Explanation:

Claviceps purpurea is known for epidemics of ergot poisoning (ergotism or St. Anthony’s fire). Besides ergot alkaloids, this fungus synthesizes histamine, acetylcholine & tyramine. Bromocriptine, cabergoline & pergolide are ergot alkaloids that have the highest suppressive selectivity for pituitary dopamine D2 receptors. Quinagolide is a nonergot drug with similar D2 receptor affinity. Lysergic acid diethylamide (LSD) is a synthetic ergot compound & its behavioral effects are mediated by agonist effects at prejunctional or postjunctional 5-HT2 receptors in CNS. Cabergoline has a half-life of 63 - 69 hours.

Question 24

Salt of bromocriptine used as dopamine receptor agonist for treatment of hyperprolactinemia is ?

A	Acetate
B	Mesylate
C	Cryptate
D	Sulphate

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See all quizzes of Disorders of the Anterior Pituitary and Hypothalamus at here:

Disorders of the Anterior Pituitary and Hypothalamus- Part 1| Disorders of the Anterior Pituitary and Hypothalamus- Part 2| Disorders of the Anterior Pituitary and Hypothalamus- Part 3| Disorders of the Anterior Pituitary and Hypothalamus- Part 4|Disorders of the Anterior Pituitary and Hypothalamus- Part 5 |Disorders of the Anterior Pituitary and Hypothalamus- Part 6| Disorders of the Anterior Pituitary and Hypothalamus- Part 7

1.Which of the following is false about prolactin (PRL) ?
A. Peak serum PRL levels occur between 4 – 6 AM

B. Circulating half-life of PRL is 50 minutes
C. Predominant central control mechanism is inhibitory
D. None of the above

2 Systemic disorder associated with hyperprolactinemia is ?
A. Chronic renal failure
B. Primary hypothyroidism
C. Cirrhosis
D. All of the above

3 The most common pituitary hormone hypersecretion syndrome
in both males and females is ?
A. Acromegaly
B. Hyperprolactinemia
C. Secondary hyperthyroidism
D. Cushing’s syndrome
4 When PRL level is >200 μg/L, the most common cause is ?
A. Pituitary stalk compression
B. Prolactinoma
C. Antipsychotic and antidepressant drugs
D. Pregnancy and lactation

5 “Colostrum” does not contain which of the following ?
A. Protein
B. Lactose
C. Fats
D. Calcium
6 Hormonal agents that induce prolactin include ?
A. Estrogens
B. Antiandrogens
C. TRH
D. All of the above
7 Which of the following causes increase in prolactin level ?
A. Sleep
B. Sexual orgasm
C. Chest stimulation
D. All of the above

8 Which of the following produce “drug-induced
hyperprolactinemia” by blocking dopamine receptors ?
A. Chlorpromazine
B. Haloperidol
C. Metoclopramide
D. All of the above
9 Which of the following produce “drug-induced
hyperprolactinemia” by inhibiting dopamine synthesis ?
A. Alpha-Methyldopa
B. Metoclopramide
C. Chlorpromazine
D. Haloperidol
10 Which of the following produce “drug-induced
hyperprolactinemia” by depleting catecholamine ?
A. Alpha-Methyldopa
B. Metoclopramide
C. Chlorpromazine
D. Reserpine
11 Which of the following produce “drug-induced
hyperprolactinemia” by blocking dopamine release ?
A. Alpha-Methyldopa
B. Metoclopramide
C. Verapamil
D. Reserpine

12 Galactorrhea is present in what percentage of hyperprolactinemic
women ?
A. Up to 80%
B. Up to 85%
C. Up to 90%
D. Up to 95%
13 Which of the following in not a presenting feature of
hyperprolactinemia in women ?
A. Reduced vertebral bone density
B. Decreased libido
C. Weight loss
D. Hirsutism

14 What is the normal basal, fasting morning prolactin level ?
A. < 5 μg/L

B. < 10 μg/L
C. < 15 μg/L
D. < 20 μg/L

15 Breast milk secretion is considered abnormal if it persists for ?
A. > 3 months after childbirth or discontinuation of breastfeeding
B. > 6 months after childbirth or discontinuation of breastfeeding
C. > 9 months after childbirth or discontinuation of breastfeeding
D. > 12 months after childbirth or discontinuation of breastfeeding

16 The female : male ratio for microprolactinomas is ?
A. 1:1
B. 5:1
C. 10:1
D. 20:1
17 The female:male ratio for macroadenomas is ?
A. 1:1
B. 5:1
C. 10:1
D. 20:1

18 Which of the following is the least common hormone secreted by
mixed tumors that secrete prolactin ?
A. GH
B. ACTH
C. TSH
D. None of the above

19 For defining “microadenoma” of pituitary gland, what is its cutoff
diameter ?
A. < 0.2 cm
B. < 0.5 cm
C. < 0.8 cm
D. < 1.0 cm

20 If fertility is not desired, what should be the line of management
of microadenomas ?
A. Dopamine agonists

B. Surgery
C. Radiation
D. No treatment

21 Dopamine agonists act by ?
A. Suppressing prolactin secretion
B. Suppressing prolactin synthesis
C. Suppressing lactotrope cell proliferation
D. All of the above
22 Which of the following is a nonergot oral dopamine agonist ?
A. Pergolide mesylate
B. Lisuride
C. Quinagolide
D. Bromocriptine
23 Fungus that produces “Ergot alkaloids” is ?
A. Hortaea werneckii
B. Trichosporon asahii
C. Sporothrix schenckii
D. Claviceps purpurea

24 Salt of bromocriptine used as dopamine receptor agonist for
treatment of hyperprolactinemia is ?
A. Acetate
B. Mesylate
C. Cryptate
D. Sulphate

Disorders of the Anterior Pituitary and Hypothalamus

[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 3

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Disorders of the Anterior Pituitary and Hypothalamus- Part 3

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