As part of their annual wellness visit, two patients underwent routine blood wor

Question

As part of their annual wellness visit, two patients underwent routine blood work for hormones in the hypothalamic-pituitary-adrenal (HPA) axis. Both patient A and B demonstrated reduced levels of CRH. Patient A demonstrated elevated levels of cortisol, while patient B failed to produce any detectable cortisol. The results for ACTH levels could not be obtained due to laboratory error.

1) Based on the available blood work, what type of pathology could patient A have? (2 points)

A. secondary hypersecretion

B. primary hypersecretion

C. tertiary hyposecretion

D. secondary hyposecretion

E. A and B

2) Based on the available blood work, what type of pathology could patient B have? (2 points)

A. secondary hypersecretion

B. primary hypersecretion

C. tertiary hyposecretion

D. secondary hyposecretion

E. A and B

3) Which patient(s) could have an enlarged adrenal gland? (2 points)

A. patient A

B. patient B

C. both patients

D. neither patient

4) The release of which hormone(s) will decrease after a few hours if you severed the axons of magnocellular neurons in the hypothalamus? (2 points)

A. -lipotropin (-LPH)

B. oxytocin

C. vasopressin

D. All of the above

E. B and C

5) A magnetic resonance image (MRI) of the brain of a male patient reveals blockage of the hypothalamic-pituitary portal system. If not immediately treated, this disruption could eventually lead to: (2 points)

A. atrophy of the thyroid gland

B. decreased testosterone production by Leydig cells

C. increased thirst

D. All of the above

E. A and B

6) Which drug(s) could an endocrinologist prescribe to a new mother struggling with breastfeeding to stimulate milk ejection? (2 points)

a. dopamine receptor (DR2) antagonist b. prolactin receptor (PRLR) agonist

c. oxytocin receptor (OXTR) agonist

d. All of the above

e. A and B

7) What is (are) the consequence(s) of injecting high doses of growth hormone into an organism? (2 points)

A. increased cartilage production

B. increased carbohydrate metabolism

C. increased lipid metabolism

D. All of the above

E. B and C

9) Which of the following treatments would provide the greatest therapeutic benefit in patients with acromegaly? (2 points)

A. glucocorticoids

B. growth hormone (GH)

C. growth hormone releasing hormone (GHRH)

D. insulin

E. somatostatin (SST)

10) A 12-year-old male with early-onset obesity, adrenal insufficiency, and red hair is brought to the clinic by his parents. Genetic testing reveals mutations in his POMC genes. As a result of the POMC mutation, the patient has difficulty producing all of the following hormones except one. Identify the exception. (2 points)

A. adrenocorticotropic hormone (ACTH)

B. -melanocyte-stimulating hormone (-MSH)

C. -endorphin (-END)

D. -lipotropin (-LPH)

E. insulin-like growth factor (IGF-1)

Explanation / Answer

1) Hypothalamus secrete corticotropin releasing hormone (CRH) which stimulates anterior pituitary gland to secrete Adreno-cortico trophic hormone (ACTH). ACTH in turn stimulates adrenal cortex to secrete cortisol. Excessive cortisol levels in blood has a negative feedback effect on secretion of CRH in Hypothalamus and ACTH from anterior pituitary and decrease both their levels.

Patient A has elevated levels of cortisol but reduced levels of CRH. Therefore, the patient is having primary hypersecretion of cortisol from adrenal cortex (option b).

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