b) Platelets Chapter 3: Multiple Choice Questions . Relation between serum immunoreactive parathyroid hormone (iPTH) and serum calcium in patients with hypoparathyroidism, pseudohypoparathyroidism, ectopic hyperparathyroidism, and primary, secondary, and tertiary hyperparathyroidism. DISCUSSION: The incidental adrenal mass is seen in as many as 1.3% of abdominal CT scans performed for other reasons. View Answer, 14. Patients with adrenal or ectopic etiologies do not experience suppression with either dose. A. Islet cell neoplasms in patients with MEN 1 are characteristically multicentric. DISCUSSION: Addisonian crisis, or acute adrenal insufficiency, may be seen following even mild illness in patients with suppression of the hypothalamic-pituitary-adrenal axis. Fewer than 50% of patients will have growth hormone levels over 10 ng/mL, b. Exceptions are women in the childbearing years where a subsequent fetus would be affected, patients with concomitant thyroid nodules where carcinoma is a concern, those with extremely large glands and, increasingly, those who are opposed to 131I therapy. E. May be relieved by emergent transsphenoidal decompression of the sella turcica. The chemical groups into which hormones can be divided include a. carbohydrate derivatives b. amino acids and peptides c. steroids d. carbohydrates and sugars e. b and c from above are correct 2. There is, however, an increased incidence of complications. Most commonly, it is the result of a single diseased gland still remaining in the neck or in the mediastinum. Diurnal variation of plasma cortisol levels is lost in hypercortisolism, caused by both adrenal tumors and pituitary lesions. Gastrinomas associated with MEN 1 probably account for 20% to 50% of all cases of the Zollinger-Ellison syndrome. The male infant with congenital adrenal hyperplasia is likely to have a normal appearance of the external genitalia as a neonate. This may have important implications for the cytoprotective mechanisms in the stomach. Timing of the collection is critical in patients who have only episodic hypertension. Lastly, the likelihood of metastatic brain disease is very low in this circumstance. per liter/mg. d) Pancreas The pituitary gland is controlled by the: A) Anterior Lobe B) Hypothalamus C) Posterior Lobe D) Frontal Cortex. It is then hydroxylated in the liver (25 position) and kidney (1 position) to form the active 1,25 dihydroxyvitamin D3 (calcitriol). The prognosis for adrenocortical carcinoma is not good. Cushing disease is best treated by transsphenoidal resection of the pituitary adenoma. 8. Choose the pair of hormones that have agonistic effects on blood sugar levels: In one recent study of a group of 142 asymptomatic patients followed without operation, after 10 years, more than 20% of the patients had required surgery for an increase in serum calcium to greater than 11 mg/dL or for specific complications attributable to the disease. Plasma 17-ketosteroid levels reflect the degree of adrenal cortisol production, c. Renin undergoes enzymatic cleavage in the lung to angiotensin I, d. The plasma half-life of ACTH is relatively long (> 24 hrs). The ability to measure catecholamines in the plasma has made possible the clonidine suppression test. The diagnosis of primary hyperparathyroidism is supported by these serum levels: calcium, 10.8 mg. per dl. Norwalk, CT, Appleton & Lange, 1989:249), a. Recurrent postoperative hypercalcemia occurs in approximately 20% of patients with this clinical scenario, b. Localization studies via selective angiography are successful in 50% to 80% of these patients, c. The risk of permanent hypoparathyroidism is approximately 10% to 20% following reexploration in this setting, d. Surgical reexploration by an experienced endocrine surgeon has a success rate of less than 50% in this circumstance. Chemical messengers secreted by ductless glands are called___________ The most efficient and sensitive means of screening for pheochromocytoma is measurement of the catecholamines, or metabolic products thereof, in the urine. More MCQs: || All MCQs Quiz on "Biology" || "Human Physiology" || "Human Endocrine System" || Main Page of Biology MCQs Second, MCT occurs as a component of the MEN IIa syndrome with or without adrenal medullary disease (pheochromocytoma) or hyperparathyroidism. Men usually have macroprolactinomas and experience symptoms of a space-occupying lesion of the sella (i.e., headache). May be suspected in a patient with rapidly progressive Cushing's syndrome and virilizing features or in asymptomatic patients with adrenal tumors larger than 6 cm on CT. B. Radiographic evidence of an adrenal tumor must be supported by biochemical testing to confirm that the adrenal is the primary cause of Cushing's syndrome. Graves’ disease, or toxic diffuse goiter, is most common, accounting for more than 80% of all patients with hyperthyroidism. Patients with MEN 2A may also develop hyperplasia of the parathyroid glands. E. May be effectively treated with intravenous “stress-dose” glucocorticoid and mineralocorticoid replacement. Common Questions from Customers 14 Terms. Because of its early point of action in the steroidogenic pathway, ACTH also increases secretion of aldosterone, although it is much less potent in this regard than in its stimulation of cortisol. 1. In patients with thyroid nodules and a history of previous head and neck radiation, operation is generally recommended regardless of cytologic findings. A. This is sufficiently large in 97% of the patients to allow a transnasal, transsphenoidal surgical approach to the pituitary. Sanfoundry Global Education & Learning Series â Life Sciences. It presents at a later age than papillary carcinoma. Most commonly produce infertility in men. The NIH Consensus Development Conference mandated close (every 6 months) follow-up for patients with known primary hyperparathyroidism not treated by operation. If carcinoma is suspected, lobectomy should be performed, and if frozen section demonstrates carcinoma, subtotal or total thyroidectomy should be performed. D. Can have severe effects on bones exacerbated by aluminum contained in phosphate binders and dialysate water. DISCUSSION: Patients with adrenocortical carcinoma often present with rapidly progressive syndromes of combined adrenocortical hormone excess. Sodium wasting nephropathy with hypovolemia, c. Respiratory failure from surfactant deficiency, d. Spontaneous hemorrhage from thrombocytopenia, e. Pulmonary embolus from a hypercoaguable state. A. 3. Some 10% to 20% of ACTH-dependent Cushing's syndrome is caused by ectopic production of ACTH from small cell carcinoma of the lung, carcinoid tumors, tumors of the endocrine pancreas, pheochromocytoma, and MTC. Standard surgical treatment of toxic nodular goiter has consisted of bilateral subtotal thyroidectomy. Often, a patient presents without the classic cushingoid appearance and complains only of severe fatigue or depression. E. An increased serum cholesterol level in a hypothyroid patient indicates a thyroid cause. Partial lobectomy or excision of the nodule is associated with a higher risk of local recurrence if the nodule proves to be malignant. Pheochromocytoma associated with the MEN IIa syndrome is more often bilateral and more often malignant, therefore, abdominal exploration through an anterior approach is indicated. Papillary carcinomas of the thyroid include minimal thyroid carcinoma, intrathyroidal, and extrathyroidal (invasion through the true thyroid capsule) disease. per liter, urinary potassium excretion greater than 30 mEq. Depressions, Openings, and Processes 15 Terms. The true prognosis in childhood is not clear, but the data suggest a 2-year survival rate of about 20%. D. Should be resected only if disease is localized to the adrenal gland; otherwise treatment with mitotane is indicated. Enzymatic defects in the steroidogenic pathway produce a syndrome known as congenital adrenal hyperplasia. Although controversial in the past, it now appears that ocular involvement does not respond more favorably to thyroidectomy than to 131I ablation. a. 10% to 20% of patients who undergo exploration have macroadenomas, and the postoperative remission rates in these patients have been reported to be from 33% to 61%. CT scanning has a place in pituitary imaging if MRI scanning is unavailable. Cysts and hemorrhage can be differentiated, as can blood flowing within an aneurysm. These changes are sensed by the juxtaglomerular apparatus and by the macula densa and act through the renin angiotensin system. Thiazides may increase serum calcium to a mild degree, primarily through hemoconcentration. Renin cleaves angiotensin I, a decapeptide derived from the liver which serves as renin substrate. In contrast, secondary hyperparathyroidism occurs when there is a defect in mineral homeostasis that leads to a compensatory increase in parathyroid function. Read each question carefully and choose the best answer. E. Follicular carcinomas are frequently multicentric. D. May be caused by small cell carcinoma of the lung, carcinoid tumors, tumors of the endocrine pancreas, pheochromocytoma, or medullary thyroid carcinoma (MTC). Amplification of the N-myc gene, when present in neuroblastoma, suggests a poorer prognosis. DISCUSSION: There is no specific treatment for Hashimoto's disease. They are usually cystic and are calcified in 70% of children and 40% of adults. It also inhibits the peripheral conversion of T4 to T3. When there is localized disease at the time of surgery, the 5-year survival may be higher, in the 40% to 50% range. MRI has developed a certain usefulness even after retrenchment from early optimistic predictions. B. Simultaneous serum ACTH measurement in peripheral and inferior petrosal sinus sites. With Cushing disease, the ACTH and cortisol rise are accentuated. Iodine was the first effective drug to be used in the treatment of thyrotoxicosis. MCT or its precursor, C-cell hyperplasia, develops by age 2 in MEN IIb and is always bilateral and multicentric. Phenoxybenzamine and prazosin are two preferred agents that block the a-adrenergic effects of the catecholamines preoperatively with pheochromocytoma. The cavernous sinuses each contain the siphon region of the internal carotid artery and portions of the cranial nerves III, IV, V and VI all within the venous plexus. Although ultrasonography is the least expensive of the imaging procedures, its value is limited by the relative inaccessibility of the adrenal gland and by the small size of some adrenal lesions. Multiple causes of hypercalcemia include the following: Sarcoidosis and other granulomatous diseases. In patients who have been exposed preoperatively to glucocorticoid excess, the maintenance dose may be as high as 100 mg/d for several months. Lastly, MCT is found as a component of the MEN IIb syndrome without or without bilateral adrenal medullary disease and always with the facies and autonomic nervous system dysplasia expressed as ganglioneuromatosis from the lips to the anus. Aldosteronism that is ACTH insensitive and posture sensitive is likely caused by idiopathic adrenal hyperplasia, which is best managed medically with spironolactone, triamterene, amiloride, or nifedipine. Mithramycin has proved useful in patients with hypercalcemia of malignancy, but it has a substantial cumulative toxicity (thrombocytopenia, hepatotoxicity, and nephrotoxicity). Because of the high failure rate of long-term treatment with thionamides, the use of these drugs as definitive treatment has decreased. Follicular carcinomas are rarely multicentric. Diabetes insipidus is diagnosed by a combination of high plasma osmolality and low urine osmolality following water deprivation. Omoikane. For these reasons, careful postoperative monitoring of serum calcium levels is essential. Magnetic resonance imaging of the adrenal gland, c. MIBG (131I-Methaiodobenzylguanidine) scintigraphy, d. Measurement of catecholamines and their degradation products in a 24-hour urine specimen. Formerly, the anterior approach was preferred for adrenalectomy as it facilitated complete abdominal exploration and search for extra-adrenal pheochromocytoma. They may be useful in patients whose surgery must be delayed. Choose the pair of hormones that have agonistic effects on blood sugar levels: c) Plasma Because of the lower radiation exposure, cost and easy use, 99mTc is preferentially used. peptide hormones. a) Hypothalamus DISCUSSION: Analysis of multiple series in which patients with thyroid nodules have undergone FNAB has demonstrated a false-negative rate of 2.4% and a false-positive rate of 3.3%. Answer: C. 2. Approximately 10% of insulinomas and approximately 15% or more of gastrinomas in patients with MEN 1 are malignant. Propranolol is the most widely used of these drugs. b. Subtotal thyroid lobectomy and resection of the isthmus, c. Total extracapsular thyroid lobectomy, resection of the isthmus, and modified unilateral neck dissection, d. Total extracapsular thyroid lobectomy and resection of the isthmus. In performing total lobectomy, both parathyroid glands are carefully preserved with their blood supply. Both fiction and non-fiction are covered, spanning different genres (e.g. Choose from 500 different sets of multiple choice quiz endocrine system flashcards on Quizlet. Furthermore, incidentally discovered adrenal masses larger than 6 cm. Most patients undergoing operation on the thyroid experience some alteration in serum calcium. Plain skull X-rays are not needed generally. Possibility of using radioactive iodine postoperatively to identify and treat metastases. Multiple Choice Questions And Answers Endocrine System Multiple Choice Questions And Answers When somebody should go to the books stores, search instigation by shop, shelf by shelf, it is in point of fact problematic This is why we give the book Pheochromoctyoma requires definitive surgical resection although the preoperative pharmacologic preparation with catecholamine blockade is required. Pituitary insufficiency, as well as the accompanying secondary adrenal insufficiency, may cause hypotension and shock. Stress dose steroids are inadequate once adrenal crisis has occurred, and exogenous mineralocorticoids are given when the patient resumes oral intake. Prolactinomas may enlarge during pregnancy and can produce symptoms requiring treatment with either bromocriptine or surgery. There is no evidence that this patient has a postoperative surgical problem such as a cervical hematoma. on CT since tumors of this size harbor carcinoma in more than 90% of cases. 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