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DIRECTIONS: Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is the BEST in each case.

1. Which of the following sources of cholesterol is most important for sustaining adrenal steroidogenesis when it occurs at a high rate for a long time?

(A) De novo synthesis of cholesterol from acetate

(B) Cholesterol in LDL particles

(C) Cholesterol in the plasma membrane

(D) Cholesterol in lipid droplets within adrenal cortical cells

(E) Cholesterol from the endoplasmic reticulum

(F) Cholesterol in lipid droplets within adrenal medullary cells

2. A 7-year-old boy comes to the pediatric endocrine unit for evaluation of excess body weight. Review of his growth charts indicates substantial weight gain over the previous 3 years but little increase in height. To differentiate between the development of obesity and Cushing's disease, blood and urine samples are taken. Which of the following would be most diagnostic of Cushing's disease?

(A) Increased serum ACTH, decreased serum cortisol, and increased urinary free cortisol

(B) Decreased serum ACTH, increased serum cortisol, and increased serum insulin

(C) Increased serum ACTH, increased serum cortisol, and increased serum insulin

(D) Increased serum ACTH, decreased serum cortisol, and decreased serum insulin

(E) Increased serum ACTH, decreased serum cortisol, and decreased urinary free cortisol

(F) Decreased serum ACTH, decreased serum cortisol, and increased serum insulin

3. Congenital adrenal hyperplasia is most likely a result of

(A) Defects in adrenal steroidogenic enzymes

(B) Addison's disease

(C) Defects in ACTH secretion

(D) Defects in corticosteroid-binding globulin

(E) Cushing's disease

(F) Defects in aldosterone synthase

4. What is the mechanism through which catecholamines stabilize blood glucose concentration in response to hypoglycemia?

(A) Catecholamines stimulate glycogen phosphorylase to release glucose from muscle

(B) Catecholamines inhibit glycogenolysis in the liver

(C) Catecholamines stimulate the release of insulin from the pancreas

(D) Catecholamines inhibit the release of fatty acids from adipose tissue

(E) Catecholamines stimulate gluconeogenesis in the liver

(F) Catecholamines inhibit the release of lactate from muscle

5. A patient receiving long-term glucocorticoid therapy plans to undergo hip replacement surgery. What would the physician recommend prior to surgery and why?

(A) Glucocorticoids should be decreased to prevent serious hypoglycemia during recovery

(B) Glucocorticoids should be increased to stimulate immune function and prevent possible infection

(C) Glucocorticoids should be decreased to minimize potential interactions with anesthetics

(D) Glucocorticoids should be increased to stimulate ACTH secretion during surgery to promote wound healing

(E) Glucocorticoids should be decreased to prevent inadequate vascular response to catecholamines during recovery

(F) Glucocorticoids should be increased to compensate for the increased stress associated with surgery

6. Which of the following is most likely to result in a decreased rate of aldosterone release?

(A) An increase in renin secretion by the kidney

(B) A rise in serum potassium

(C) A fall in blood pressure in the kidney

(D) A decrease in tubule fluid sodium concentration at the macula densa

(E) An increase in renal sympathetic nerve activity

(F) A decrease in IP3 in cells of the zona glomerulosa

7. The rate-limiting step in the synthesis of cortisol is catalyzed by

(A) 21-Hydroxylase

(B) 3P-Hydroxysteroid dehydrogenase

(C) Cholesterol side-chain cleavage enzyme

(D) 11P-Hydroxylase

(E) 3-Hydroxy-3-methylglutaryl CoA reductase

(F) 17a-Hydroxylase

8. A patient complains of generalized weakness and fatigue, anorexia, and weight loss associated with gastrointestinal symptoms (nausea, vomiting). Physical examination notes hyperpigmentation and hypotension. Laboratory findings include hyponatremia (low plasma sodium) and hyperkalemia (high plasma potassium). The most likely diagnosis is

(A) Cushing's disease

(B) Addison's disease

(C) Primary hypoaldosteronism

(D) Congenital adrenal hyperplasia

(E) Hypopituitarism

(F) Glucocorticoid-suppressible hyperaldosteronism

9. Through what "permissive action" do glucocorticoids accelerate gluconeogenesis during fasting?

(A) Glucocorticoids stimulate the secretion of insulin, which activates gluconeogenic enzymes in the liver

(B) Glucocorticoids inhibit the use of glucose by skeletal muscle

(C) Glucocorticoids maintain the vascular response to norepinephrine

(D) Glucocorticoids inhibit glycogenolysis

(E) Glucocorticoids maintain the intracellular concentrations of many of the enzymes needed to carry out gluconeogenesis through effects on transcription

(F) Glucocorticoids inhibit the release of fatty acids from adipose tissue

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