[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 6

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Disorders of the Anterior Pituitary and Hypothalamus- Part 6

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Question 1

In acromegaly, following oral glucose load, GH levels remain more than ?

A	> 0.1 μg/liter
B	> 0.2 μg/liter
C	> 0.3 μg/liter
D	> 0.4 μg/liter

Question 1 Explanation:

Diagnosis of acromegaly is confirmed by demonstrating failure of GH suppression to <0.4 μg/L within 1 to 2 hours of 75 gram oral glucose load.

Question 2

In GH-secreting microadenomas, which of the following is the preferred primary treatment for most patients ?

A	Surgical resection
B	Somatostatin analogues
C	Dopamine agonists
D	Irradiation

Question 2 Explanation:

Surgery is the preferred primary treatment for GH secreting microadenomas. The high frequency of GH hypersecretion after macroadenoma resection usually necessitates adjuvant or primary medical therapy for these larger tumors. Patients unable to receive or respond to medical treatment can be offered radiation

Question 3

Which of the following is false about Octreotide ?

A	Synthetic somatostatin analogue
B	40 times more potent than native somatostatin
C	Administered subcutaneously
D	None of the above

Question 4

Which of the following is a side effect of Octreotide ?

A	Tachycardia
B	Cholesterol gallstones
C	Hypoglycemia
D	All of the above

Question 4 Explanation:

Octreotide suppresses postprandial gallbladder contractility & delays GB emptying. ~30% of patients treated with long-term Octreotide develop echogenic sludge or asymptomatic cholesterol gallstones. Octreotide suppresses gastrointestinal motility & secretion. It may also produce mild glucose intolerance due to transient insulin suppression, asymptomatic bradycardia, hypothyroxinemia & local pain at the injection site.

Question 5

Which of the following act by antagonizing endogenous GH binding to its receptor ?

A	Cabergoline
B	Lanreotide
C	Octreotide acetate
D	Pegvisomant

Question 5 Explanation:

Pegvisomant is a GH analogue that antagonizes endogenous GH action by blocking peripheral GH binding to its receptor. Consequently, serum IGF-I levels are suppressed, potentially reducing the deleterious effects of excess endogenous GH. Cabergoline suppresses GH. Bromocriptine suppresses GH secretion particularly those with cosecretion of PRL. Lanreotide is a cyclic somatostatin octapeptide analogue that suppresses GH & IGF-I hypersecretion. Sandostatin-LAR is a long-acting formulation of octreotide causing GH suppression.

Question 6

What proportion of pituitary cell population are ACTH-secreting corticotrope cells ?

A	~ 10 %
B	~ 20 %
C	~ 30 %
D	~ 40 %

Question 6 Explanation:

ACTH-secreting corticotrope cells constitute ~20% of pituitary cell population.

Question 7

Besides ACTH, POMC precursor protein also produces which of the following peptides ?

A	β-lipotropin
B	β-endorphin
C	Met-enkephalin
D	All of the above

Question 8

Besides ACTH, POMC precursor protein also produces which of the following peptides ?

A	α melanocyte-stimulating hormone (MSH)
B	β-endorphin
C	Corticotropin-like intermediate lobe protein (CLIP)
D	All of the above

Question 8 Explanation:

ACTH (39 amino acids) is derived from POMC precursor protein (266 amino acids) that also produces -lipotropin, -endorphin, met-enkephalin,  melanocyte-stimulating hormone (MSH) & corticotropin-like intermediate lobe protein (CLIP).

Question 9

POMC gene is induced by ?

A	CRH
B	Arginine vasopressin (AVP)
C	IL-6
D	All of the above

Question 9 Explanation:

POMC gene is powerfully suppressed by glucocorticoids & induced by CRH, arginine vasopressin (AVP) & proinflammatory cytokines, including IL-6 & leukemia inhibitory factor.

Question 10

Peak ACTH secretion occurs at ?

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

Question 10 Explanation:

ACTH secretion is pulsatile with circadian rhythm, peaking at 6 AM & reaching a nadir around midnight

Question 11

ACTH levels are increased by ?

A	AVP
B	Physical stress
C	Insulin-induced hypoglycemia
D	All of the above

Question 11 Explanation:

ACTH circadian rhymicity is determined by variations in secretory pulse amplitude rather than changes in pulse frequency. ACTH levels are increased by AVP, physical stress, exercise, acute illness & insulin-induced hypoglycemia.

Question 12

The receptor for ACTH is ?

A	Melanocortin-1 receptor
B	Melanocortin-2 receptor
C	Melanocortin-3 receptor
D	Melanocortin-4 receptor

Question 13

In ACTH deficiency, total daily dose of hydrocortisone replacement therapy should not exceed ?

A	10 mg daily
B	20 mg daily
C	25 mg daily
D	40 mg daily

Question 13 Explanation:

In ACTH deficiency, total daily dose of hydrocortisone replacement should not exceed 25 mg daily.

Question 14

Most common cause of cushingoid features is ?

A	Pituitary corticotrope adenoma
B	Iatrogenic hypercortisolism
C	Ectopic tumor ACTH production
D	Cortisol-producing adrenal adenoma

Question 14 Explanation:

Pituitary corticotrope adenomas account for 70% of patients with endogenous causes of Cushing’s syndrome. However, iatrogenic hypercortisolism is the most common cause of cushingoid features.

Question 15

What percentage of all pituitary tumors are ACTH-producing adenomas ?

A	2 to 5%
B	5 to 10%
C	10 to 15%
D	15 to 20%

Question 15 Explanation:

ACTH-producing adenomas account for ~10 to 15% of all pituitary tumors.

Question 16

Hematopoietic features of hypercortisolism include ?

A	Leukocytosis
B	Lymphopenia
C	Eosinopenia
D	All of the above

Question 16 Explanation:

Hematopoietic features of hypercortisolism include leukocytosis, lymphopenia, and eosinopenia.

Question 17

Diameter of most ACTH-secreting pituitary tumors is ?

A	< 2 mm
B	< 5 mm
C	< 8 mm
D	< 10 mm

Question 17 Explanation:

Most ACTH-secreting pituitary tumors are <5 mm in diameter & about half are undetectable by sensitive MRI

Question 18

Primary cause of death in patients of Cushing’s syndrome is ?

A	Cardiovascular disease
B	Infections
C	Suicide
D	Renal failure

Question 18 Explanation:

Primary cause of death in Cushing’s syndrome is cardiovascular disease, but infections and risk of suicide are also increased.

Question 19

Rapid development of skin hyperpigmentation, severe myopathy, hypertension, hypokalemic alkalosis & edema suggests the possibility of ?

A	Pituitary corticotrope adenoma
B	Iatrogenic hypercortisolism
C	Ectopic tumor ACTH production
D	Cortisol-producing adrenal adenoma

Question 19 Explanation:

Rapid development of features of hypercortisolism associated with skin hyperpigmentation & severe myopathy suggests ectopic production of ACTH. Hypertension, hypokalemic alkalosis, glucose intolerance & edema are also more pronounced. Serum potassium levels <3.3 mmol/L are evident in ~70% of patients with ectopic ACTH secretion but are seen in <10% of patients with pituitary-dependent Cushing’s disease.

Question 20

Most reliable test for confirmation of pituitary ACTH-secreting adenomas is ?

A	24-h urine free cortisol (UFC)
B	Bilateral inferior petrosal sinus ACTH sampling
C	Overnight 1-mg dexamethasone suppression test
D	Basal plasma ACTH levels

Question 20 Explanation:

Small pituitary ACTH-secreting adenomas (<2 mm) may go undetected by gadolinium enhancement pituitary MRI. Bilateral inferior petrosal sinus ACTH sampling distinguishes pituitary ACTHsecreting adenomas from ectopic ACTH-secreting tumors. An increased ratio (>2) of inferior petrosal : peripheral vein ACTH confirms pituitary Cushing’s disease.

Question 21

Mean basal ACTH levels are about how many times higher in patients with ectopic ACTH secretion as compared to pituitary ACTH-secreting adenomas ?

A	3
B	5
C	8
D	12

Question 21 Explanation:

Mean basal ACTH levels are about eightfold higher in patients with ectopic ACTH secretion compared to those with pituitary ACTH-secreting adenomas

Question 22

Endocrinopathies that frequently have associated hyperpigmentation include ?

A	Addison’s disease
B	Nelson syndrome
C	Ectopic ACTH syndrome
D	All of the above

Question 22 Explanation:

Endocrinopathies that frequently have associated hyperpigmentation include Addison’s disease, Nelson syndrome & ectopic ACTH syndrome

Question 23

Which of the following is false about Nelson’s syndrome ?

A	Pituitary enlargement
B	Increased skin pigmentation
C	High ACTH levels
D	None of the above

Question 23 Explanation:

Nelson’s syndrome is a disorder characterized by rapid pituitary tumor enlargement and increased pigmentation secondary to high ACTH levels. Adrenalectomy in the setting of residual corticotrope adenoma tissue predisposes to its development. Radiation therapy may be indicated to prevent the development of Nelson’s syndrome after adrenalectomy.

Question 24

In treatment of Cushing’s disease, which of the following drugs is useful ?

A	Ketoconazole
B	Metyrapone
C	Mitotane
D	All of the above

Question 24 Explanation:

In Cushing’s disease, steroidogenic inhibitors are used in combination with pituitary irradiation to block the adrenal effects of persistently high ACTH levels. Ketoconazole is an antimycotic drug that inhibits several P450 enzymes, Metyrapone inhibits 11-hydroxylase activity & Mitotane suppresses cortisol hypersecretion by inhibiting 11 -hydroxylase and cholesterol side-chain cleavage enzymes & by destroying adrenocortical cells.

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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.In acromegaly, following oral glucose load, GH levels remain
more than ?
A. > 0.1 μg/liter
B. > 0.2 μg/liter
C. > 0.3 μg/liter
D. > 0.4 μg/liter

2. In GH-secreting microadenomas, which of the following is the
preferred primary treatment for most patients ?
A. Surgical resection
B. Somatostatin analogues
C. Dopamine agonists
D. Irradiation

3 Which of the following is false about Octreotide ?
A. Synthetic somatostatin analogue
B. 40 times more potent than native somatostatin
C. Administered subcutaneously
D. None of the above
4 Which of the following is a side effect of Octreotide ?
A. Tachycardia
B. Cholesterol gallstones
C. Hypoglycemia
D. All of the above

5 Which of the following act by antagonizing endogenous GH
binding to its receptor ?
A. Cabergoline
B. Lanreotide
C. Octreotide acetate
D. Pegvisomant

6 What proportion of pituitary cell population are ACTH-secreting
corticotrope cells ?
A. ~ 10 %
B. ~ 20 %
C. ~ 30 %
D. ~ 40 %

7 Besides ACTH, POMC precursor protein also produces which of
the following peptides ?
A. -lipotropin
B. -endorphin
C. Met-enkephalin
D. All of the above
8 Besides ACTH, POMC precursor protein also produces which of
the following peptides ?
A.  melanocyte-stimulating hormone (MSH)
B. -endorphin
C. Corticotropin-like intermediate lobe protein (CLIP)
D. All of the above

9 POMC gene is induced by ?
A. CRH
B. Arginine vasopressin (AVP)
C. IL-6
D. All of the above

10 Peak ACTH secretion occurs at ?
A. 4 AM
B. 6 AM
C. 8 AM
D. 10 AM

11 ACTH levels are increased by ?
A. AVP
B. Physical stress
C. Insulin-induced hypoglycemia
D. All of the above

12 The receptor for ACTH is ?
A. Melanocortin-1 receptor
B. Melanocortin-2 receptor
C. Melanocortin-3 receptor
D. Melanocortin-4 receptor

13 In ACTH deficiency, total daily dose of hydrocortisone replacement
therapy should not exceed ?
A. 10 mg daily
B. 20 mg daily
C. 25 mg daily
D. 40 mg daily
14 Most common cause of cushingoid features is ?
A. Pituitary corticotrope adenoma
B. Iatrogenic hypercortisolism
C. Ectopic tumor ACTH production
D. Cortisol-producing adrenal adenoma

15 What percentage of all pituitary tumors are ACTH-producing
adenomas ?
A. 2 to 5%
B. 5 to 10%
C. 10 to 15%
D. 15 to 20%
16 Hematopoietic features of hypercortisolism include ?
A. Leukocytosis
B. Lymphopenia
C. Eosinopenia
D. All of the above

17 Diameter of most ACTH-secreting pituitary tumors is ?
A. < 2 mm
B. < 5 mm
C. < 8 mm
D. < 10 mm

18 Primary cause of death in patients of Cushing’s syndrome is ?
A. Cardiovascular disease
B. Infections
C. Suicide
D. Renal failure

19 Rapid development of skin hyperpigmentation, severe myopathy,
hypertension, hypokalemic alkalosis & edema suggests the possibility
of ?
A. Pituitary corticotrope adenoma
B. Iatrogenic hypercortisolism
C. Ectopic tumor ACTH production
D. Cortisol-producing adrenal adenoma

20 Most reliable test for confirmation of pituitary ACTH-secreting
adenomas is ?
A. 24-h urine free cortisol (UFC)
B. Bilateral inferior petrosal sinus ACTH sampling
C. Overnight 1-mg dexamethasone suppression test
D. Basal plasma ACTH levels

21 Mean basal ACTH levels are about how many times higher in
patients with ectopic ACTH secretion as compared to pituitary
ACTH-secreting adenomas ?
A. 3
B. 5
C. 8
D. 12

22 Endocrinopathies that frequently have associated
hyperpigmentation include ?
A. Addison’s disease

B. Nelson syndrome
C. Ectopic ACTH syndrome
D. All of the above

23 Which of the following is false about Nelson’s syndrome ?
A. Pituitary enlargement
B. Increased skin pigmentation
C. High ACTH levels
D. None of the above

24 In treatment of Cushing’s disease, which of the following drugs
is useful ?
A. Ketoconazole
B. Metyrapone
C. Mitotane
D. All of the above

Disorders of the Anterior Pituitary and Hypothalamus

[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 6

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Disorders of the Anterior Pituitary and Hypothalamus- Part 6

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