Chapter 10: Endocrine

Question 1

Likely causes of Hyperpituitarism

Answer 1

benign pituitary adenoma
microdenoma (< 1cm) or macroadenoma (> 1 cm)

Question 2

Manifestations of a microadenoma (lactotroph)

Answer 2

hyperpituitarism
manifestations of hormone excess
lactotroph = increased prolactin = hypogonadism and infertility

Question 3

Manifestations of a macroadenoma

Answer 3

hyperpituitarism
headache, visual disturbances (impingement on cranial nerves and optic chiasm [where optic nerves cross])

Question 4

causes of hypopituitarism

Answer 4

pituitary = congenital defect, surgery/radiation, infection (TB, meningitis), pituitary tumor, pituitary infarction (Sheehan syndrome)

hypothalmic = hypothalmic tumor, infection, infiltrative disorder (histocytosis, sarcoidosis), TBI, Radiation

Question 5

hypopitiuitarism manifestations

Answer 5

growth hormone deficiency = delayed growth and development
fsh/lh deficiency = impaired reproductive (infertility, amenorrhea, irregular menses, hot flashes)
tsh deficiency = central hypothyroidism
acth deficiency = secondary adrenal insufficiency (cortisol deficiency, not aldosterone)- weakness, nausea, anorexia, hypotension
ADH deficiency = diabetes insipidus – excessive urination.

Question 6

signs of SIADH

Answer 6

hyponatremia (dilutional), high urine osmolality (concentrated), low urine output, low serum hypo-osmolarity (<270), n/v, confusion, weakness, cramping

Question 7

signs of DI

Answer 7

hypernatremia, low urine osmolarity, high urine output, serum hyperosmolarity (>320), polydipsia, nocturia

Question 8

cause of acromegaly or gigantism,

Answer 8

excess GH and IGF-1
often due to an adenoma

Question 9

cause of dwarfism

Answer 9

growth hormone deficiency d/t tumor, GHRH receptor mutations, pituitary agenesis (no organ development), panhypopituitarism

Question 10

what is a pheochromocytoma

Answer 10

As a tumor of adrenal medullary tissue, a pheochromocytoma produces symptoms of catecholamine excess. Anxiety, headache, and palpitations are direct effects of catecholamine discharge; weight loss is secondary to one of the metabolic effects of excessive circulating catecholamines. These include an increase in basal metabolic rate and an increase in glycolysis and glycogenolysis, leading to hyperglycemia and glycosuria

Question 11

causes of goiters

Answer 11

increased intake of foods containing goitrogens (eg, rutabaga, cabbage, turnip, cassava)
A diminished intake of foods containing iodine (eg, fish)
Use of medications associated with goiter (eg, propylthiouracil, methimazole, nitroprusside, sulfonylureas, lithium)
Symptoms of thyroid encroachment on surrounding structures such as respiratory or swallowing difficulties should be elicited.
Because of this patient’s fatigue and depression, the physician should also probe for other symptoms of hypothyroidism.

Question 12

1. A predominant effect of a prolonged excessive growth hormone level is:
   A) short stature with obesity.
   B) high androgen hormone levels.
   C) increased blood glucose levels.
   D) insulin-like growth factor (IGF) depletion.

Answer 12

C) increased blood glucose levels.

Question 13

2. The most common cause of hypothyroidism is:
   A) goiter.
   B) myxedema.
   C) thyroidectomy.
   D) autoimmune thyroiditis.

Answer 13

D) autoimmune thyroiditis.

Question 14

3. Thyroid hormone deficit , which alters the function of all major organs in the body.
   A) decreases metabolism
   B) increases protein synthesis
   C) causes vitamin deficiencies
   D) enhances absorption of glucose

Answer 14

A) decreases metabolism

Question 15

4. The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteristic of in addition to a diffuse goiter.
   A) muscle fatigue
   B) facial myxedema
   C) ophthalmopathy
   D) decreased cholesterol

Answer 15

C) ophthalmopathy

Question 16

5. The major adrenal cortical hormones are steroids and are synthesized from acetate and:
   A) ACTH.
   B) albumin.
   C) amino acids.
   D) cholesterol.

Answer 16

D) cholesterol.

Question 17

6. Primary adrenal insufficiency is manifested by:
   A) truncal obesity and edema.
   B) hypokalemia and hypervolemia.
   C) hyponatremia and hypoglycemia.
   D) hypopigmentation and hypertension.

Answer 17

C) hyponatremia and hypoglycemia.

Question 18

7. One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and:
   A) GH.
   B) TSH.
   C) DHEA.
   D) ACTH.

Answer 18

D) ACTH.

Question 19

8. The iatrogenic form of Cushing syndrome is caused by:
   A) long-term cortisone therapy.
   B) pituitary tumor-secreting ACTH.
   C) benign or malignant adrenal tumor.
   D) ectopic ACTH secreting lung tumor.

Answer 19

A) long-term cortisone therapy.

Question 20

9. The major manifestations of Cushing syndrome include:
   A) excessive salt loss.
   B) muscle hypertrophy.
   C) overt diabetes mellitus.
   D) hair and weight loss.

Answer 20

C) overt diabetes mellitus.

Question 21

10 The immune suppressive and anti-inflammatory effects of cortisol cause:
.
A) moderate insulin resistance.
B) increased capillary permeability.
C) increased cell-mediated immunity.
D) inhibition of prostaglandin synthesis.

Answer 21

D) inhibition of prostaglandin synthesis

Question 22

11 Which of the following individuals is experiencing the effects of a primary
. endocrine disorder?
A) A patient with adrenal cortical insufficiency due to pituitary hyposecretion of ACTH
B) A patient who has hypothyroidism as a result of low TSH production
C) A patient whose dysfunctional hypothalamus has resulted in endocrine imbalances
D) A patient who has low calcium levels because of the loss of his parathyroid gland

Answer 22

D) A patient who has low calcium levels because of the loss of his parathyroid gland

Question 23

12 Which of the following physiologic processes is a direct effect of the release
. of growth hormone by the anterior pituitary?
A) Development of cartilage and bone
B) Production of insulin-like growth factors (IGFs) by the liver
C) Increase in overall metabolic rate and cardiovascular function
D) Positive feedback of the hypothalamic-pituitary-thyroid feedback system

Answer 23

B) Production of insulin-like growth factors (IGFs) by the liver

Question 24

13 Which of the following individuals displays the precursors to acromegaly?
.
A) An adult with an excess of growth hormone due to an adenoma
B) A girl who has been diagnosed with precocious puberty
C) An adult who has a diagnosis of Cushing syndrome
D) A patient who has recently developed primary adrenal carcinoma

Answer 24

A) An adult with an excess of growth hormone due to an adenoma

Question 25

14 Which of the following residents of a long-term facility is exhibiting signs . and symptoms that are indicative of hypothyroidism? A) An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold B) A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe C) An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering more frequently D) A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis

Answer 25

A) An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold

Question 26

15 Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is . implicated in cases of: A) Cushing syndrome. B) Graves disease. C) Addison disease. D) Cushing disease.

Answer 26

B) Graves disease.

Question 27

16 A patient has developed the facial appearance that is characteristic of . myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which of the following treatment modalities is most likely to benefit this patient? A) Synthetic preparations of T3 or T4 B) b-Adrenergic blocking drugs and antithyroid drugs C) Corticosteroid replacement therapy D) Oral or parenteral cortisol replacement

Answer 27

A) Synthetic preparations of T3 or T4

Question 28

17 A 33-year-old patient has been admitted to the hospital for the treatment of . Graves disease. Which of the following assessments should the patients care team prioritize? A) Assessment of the patients level of consciousness and neurologic status B) Assessment of the patients peripheral vascular system and assessing for thromboembolism C) Assessment of the patients vision and oculomotor function D) Cardiac monitoring and assessment of peripheral perfusion

Answer 28

C) Assessment of the patients vision and oculomotor function

Question 29

18 A patient who has been taking 80 mg of prednisone, a glucocorticoid, each . day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive? A) Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug. B) Stopping the drug suddenly may shock the HPA axis into overactivity. C) Sudden cessation of a glucocorticoid can result in adrenal gland necrosis. D) Stopping the drug suddenly may cause adrenal insufficiency.

Answer 29

D) Stopping the drug suddenly may cause adrenal insufficiency.

Question 30

19 The signs and symptoms of abrupt cessation of pharmacologic . glucocorticoids closely resemble those of: A) Addison disease. B) Cushing disease. C) Cushing syndrome. D) Graves disease.

Answer 30

A) Addison disease.

Question 31

20 Which of the following pathophysiologic phenomena may result in a . diagnosis of Cushing disease? A) Hypopituitarism B) Excess ACTH production by a pituitary tumor C) Autoimmune destruction of the adrenal cortex D) Malfunction of the HPA system

Answer 31

B) Excess ACTH production by a pituitary tumor

Question 32

Why does Addisons lead to hyponatremia and hypotension?

Answer 32

Damage to the zona glomerulosa of the adrenal gland depletes levels of aldosterone, which contributes to retention of sodium and water

Question 33

manifestation of microadenoma? (somatotroph)

Answer 33

somatotroph = increased growth hormone = acromegaly/gigantism

Question 34

manifestation of microadenoma? (corticotroph)

Answer 34

corticotroph = increased ACTH = increased cortisol = cushings

Question 35

manifestation of microadenoma? (gonadotroph)

Answer 35

gonadotroph = increased LH, FSH = precocious puberty

Question 36

manifestation of microadenoma?(thyrotroph)

Answer 36

thyrotroph = hyperthyroidism

Question 37

The posterior pituitary gland is responsible for which 2 hormones? ADH and Oxytocin Oxytocin and GH ACTH and TSH ADH and GH

Answer 37

ADH and Oxytocin

Question 38

What are the clinical manifestations of a thyroid storm? Select all that apply High temp (104-106) Hypotension Abdominal pain Decreased mental alertness

Answer 38

High temp (104-106) Abdominal pain Decreased mental alertness

Question 39

1. Which of the following hormones is known to stimulate appetite and increase food intake? A. Ghrelin B. Leptin C. Glucagon-like peptide 1 (GLP-1) D. Peptide YY (PYY)

Answer 39

A. Ghrelin

Question 40

2. A 45-year-old patient presents with progressive enlargement of facial features, notably the jaw and brow, along with complaints of joint pain, fatigue, and a recent diagnosis of hypertension. Laboratory results reveal elevated insulin-like growth factor 1 (IGF-1) levels and a failure of growth hormone suppression following an oral glucose tolerance test. Which of the following is the most likely underlying cause of these findings? A. Pituitary microadenoma affecting corticotroph cells B. Hypothalamic dysfunction resulting in decreased dopamine levels C. Somatotroph adenoma in the anterior pituitary gland D. Gonadotroph adenoma leading to elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

Answer 40

C. Somatotroph adenoma in the anterior pituitary gland

Question 41

Insufficient PTH production in hypoparathyroidism results in which electrolyte abnormality? A: Hypophosphatemia B: Hypermagnesemia C: Hypocalcemia D: Hypercalcemia

Answer 41

C: Hypocalcemia

Question 42

Which of the following is not a typical manifestation of Addison’s Disease? A: Postural hypotension B: Hyperglycemia C: Dehydration D: Patchy vitiligo

Answer 42

B: Hyperglycemia

Question 43

What cell is responsible for the secretion of glucagon? A. Delta Cells B. Alpha Cells C. Pancreatic Polypeptide D. Epsilon Cells

Answer 43

B. Alpha Cells

Question 44

What is the criteria for diagnosis of Diabetes? A. HAB1C >5.7% B. Fasting Glucose <80 C. Random plasma glucose >100 D. HBA1C >6.5%

Answer 44

D. HBA1C >6.5%

Question 45

Which cell in the Islet of Langerhans is responsible for producing insulin? a. Alpha b. Beta c. Charlie d. Delta

Answer 45

b. Beta

Question 46

The thyroid gland DOES NOT produce which of the following hormones? a. Thyroxine b. Thyrotropin releasing hormone c. Triiodothyronine d. Thyrocalcitonin

Answer 46

b. Thyrotropin releasing hormone