1.

Cortisol is a naturally occurring glucocorticoid released by the adrenal gland in

response to a wide variety of stressful events, including fear & other forms of
psychological stress, vigorous exercise, acute trauma, surgery, or severe
infection. The responses produced by cortisol can be divided into metabolic
effects and anti-inflammatory effects that are mediated primarily by changes in
gene expession. Which of the following is a metabolic effect produced by
elevated levels of this hormone?

A. hyperglycemia

B. increased insulin sensitivity

C. reduced lipolysis

D. reduced muscle catabolism

1. Glucocorticoid-mediated suppression of the inflammatory response has important

pharmacologic implications for the treatment of conditions such as organ
transplantation, asthma, rheumatoid arthritis & other autoimmune disorders such
as lupus. The anti-inflammatory effects of glucocorticoids are known to be
mediated by multiple mechanisms. Which of the following is one such
mechanism?

A. ? Decreased production of Annexin A1

B. ? Decreased release of cytokines by monocytes & macrophages

C. ? Increased COX-1 expression

D. ? Increased production of eicosanoids

E. ? Stimulation of phosopholipase A2

2. Greg is a 14 year old patient who was started on a high dose of oral prednisone
(40 mg qd) to control a severe asthma flair-up related to a severe head cold.
After five weeks of prednisone therapy, his asthma symptoms begin to dissipate,
and his pediatrician decides to change his medications from oral predisone to
inhaled fluticasone to minimize the development of severe side effects. However,
rather than abruptly switching Greg from one medication to another, his
 pediatrician decides to slowly taper the dose of oral prednisone (lowering its dose
by 5 mg per week) over the next 2 months, while simultaneously initiating the use
of inhaled fluticasone. What was the main reason why the pediatrician didn't
simply have Greg switch from one medication to the other, and have him stop
taking prednisone "cold turkey"?

A. ? Because the onset of action of the inhaled drug is very slow

B. ? To allow the hypothalamic-pituitary axis time to regain full activity

C. ? To avoid a rebound of his asthma

D. ? To avoid causing a rebound surge in cortisol release by the adrenal

gland

3. Regina is a 56 year-old woman that has been on long term treatment for a
chronic health condition. Her recent health check up indicated that compared to
her baseline health status a few years ago, she has developed increased
hypertension, hyperglycemia, and osteoporosis. Which of the following is MOST
LIKELY responsible for causing her symptoms?

A. ? inhaled fluticasone for asthma

B. ? oral fludrocortisone for Addison's disease

C. ? oral prednisone for SLE

D. ? hydrocortisone po twice daily for Addison's disease

4. A 32 year old woman suffering from weight gain, hirsutism, fatigue, hypertension,
diabetes and premature osteoporosis is found to have elevated plasma cortisol
levels. To determine if her cortisol production is under pituitary control, you
attempt to suppress pituitary ACTH production by administering a potent & long-
acting synthetic glucocorticoid. Which glucocorticoid would you use for this
purpose?

A. ? cortisone
 B. ? dexamethasone

C. ? fludrocortisone

D. ? methylprednisolone

E. ? prednisolone

5. Patients who are on long-term therapy with glucocorticoids can experience a

number of significant side effects. Most side effects are reversible when drug
therapy is tapered to levels physiologically equivalent to normal corisol. Which
effect, if it developed, would NOT be reversible?

A. ? avascular necrosis of femoral heads

B. ? fatigue & weakness

C. ? increased blood pressure

D. ? increased likelihood for infections

E. ? moon face appearance

6. Some drugs have multiple clinical indications that are unrelated because drugs
can effect more than one type of receptor. One drug that fits this description is an
antagonist of both progesterone & glucocorticoid steroid receptors. As a result it
can be used for two completely different uses: 1) termination of pregnancy and 2)
reducing hyperglycemia in patients with inoperable Cushing's disease. The drug
that fits this description is:

A. ? Fludocortisone

B. ? Methylpredisolone

C. ? Metyrapone

D. ? Mifepristone

E. ? Triamcinolone
 7. Normal physiological levels of circulating cortisol have a minimal effect on
mineralocorticoid receptors expressed in the distal collecting duct of the kidney. If
this were not the case, normal levels of cortisol would produce salt & water
retention, leading to the development of hypertension. This insensitivity of cells in
the collecting duct results from:

A. ? conversion of cortisol to cortisone by kidney cells

B. ? impermeability of kidney cells to cortisol

C. ? renal expression of a mineralocorticoid splice variant that is

insensitive to cortisol

D. ? renal expression of a P-glycoprotein that effluxes cortisol

1 Correct! Cortisol increases nutrient availability for the brain and vital organs in times of stress
by raising blood glucose, amino acids & triglyceride levels.

Elevated blood sugar is achieved by a combination of increased glucose production by the liver
(gluconeogenesis) & antagonizing insulin's action to lower plasma glucose.

Increased breakdown of muscle protein provides fuel for hepatic gluconeogenesis, and
increased activity of hormone-sensitive lipase produces increased fatty acid release, which
increases insulin resistance.

2 Correct! Glucocorticoids downregulate the expression of genes for most inflammatory

cytokines (including IL-1 thru IL-6 & TNF-alpha).

Which of the following statements about the hippocampal glucocorticoid receptor is correct?

A) The glucocorticoid receptor is absent in the hippocampus.

B) The hippocampal glucocorticoid receptor is primarily involved in olfaction.

C) Activation of the hippocampal glucocorticoid receptor is associated with stress response regulation.
D) The hippocampal glucocorticoid receptor is exclusive to motor control.

Which of the following is a function of the hippocampal glucocorticoid receptor?

A) Regulation of blood sugar levels

B) Control of muscle contractions

C) Modulation of the stress response

D) Synthesis of neurotransmitters

What is the role of the hippocampal glucocorticoid receptor in memory formation?

A) Inhibiting memory consolidation

B) Enhancing long-term potentiation

C) Controlling visual perception

D) Regulating motor coordination

https://www.youtube.com/watch?v=E3kB78zVFXo

https://www.youtube.com/watch?v=4ngvviSqdvo

https://myendoconsult.com/learn/quizzes/pituitary-gland-pathology-mcqs/