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6.4 Adrenal Pathophysiology — Test 1
Q1. Addison disease is due to an abnormally functioning:✓ Adrenal gland
Q2. Increased ACTH would be expected in a patient with:✓ Chronic primary adrenal insufficiency (Addison disease)
Q3. Hyperpigmentation in Addison disease occurs because:✓ High ACTH/POMC contains the MSH fragment that stimulates melanocytes
Q4. Cushing's disease is caused by excess production of:✓ ACTH (from a pituitary tumour)
Q5. A 46-year-old woman has hirsutism, hyperglycaemia, central obesity, muscle wasting and raised ACTH. The likely cause is:✓ Primary overproduction of ACTH (Cushing disease)
Q6. Conn syndrome (an aldosterone-secreting tumour) characteristically causes:✓ Hypertension, hypokalemia and metabolic alkalosis with low renin
Q7. 21β-Hydroxylase deficiency (the commonest CAH) causes:✓ Low cortisol/aldosterone with virilization (androgen excess)
Q8. Congenital adrenal hyperplasia from 21-hydroxylase deficiency in a genetic female classically causes:✓ Female pseudohermaphroditism (virilized external genitalia)
Q9. 17α-Hydroxylase deficiency is characterised by:✓ Low androgens/cortisol with mineralocorticoid excess and hypertension
Q10. Match each disorder with a key feature and choose the correct option.✓ A-ii, B-iii, C-i
Q11. In Addison disease, aldosterone deficiency leads to:✓ Hyperkalemia, hypotension and metabolic acidosis
Q12. Cushing syndrome from primary adrenal hyperplasia (autonomous cortisol) shows ACTH that is:✓ Decreased (feedback from high cortisol)
Q13. Ketoconazole is used in Cushing's because it:✓ Inhibits steroid hormone synthesis
Q14. Conn syndrome is best treated with:✓ Spironolactone (aldosterone antagonist) and/or tumour removal
Q15. In 21-hydroxylase deficiency, the diagnostic biochemical marker is raised:✓ 17-hydroxyprogesterone
Q16. Secondary adrenal insufficiency (pituitary ACTH deficiency) differs from Addison disease in that it:✓ Lacks hyperpigmentation and usually preserves aldosterone
Q17. A patient with hypertension, hypokalemia and suppressed renin most likely has:✓ Primary hyperaldosteronism (Conn syndrome)
Q18. Cushing syndrome features include all of the following EXCEPT:✓ Hyperkalemia and hypotension
Q19. Production of excessive ACTH occurs in:✓ Cushing's disease/syndrome (ACTH-dependent forms)
Q20. The combination of low cortisol, low aldosterone, high ACTH and hyperpigmentation indicates:✓ Primary adrenal insufficiency (Addison disease)