ENDOCRINE PCCN EXAM | QUESTIONS
& ANSWERS (VERIFIED) | LATEST
UPDATE | GRADED A+
Imbalances in which of the following hormones will MOST DIRECTLY impact fluid
PR
balance:
A. Aldosterone and cortisol.
B. Thyroxin and ADH.
O
C. Aldosterone and ADH.
D. Cortisol and epinephrine.
FD
Correct Answer: C. Aldosterone is a mineral corticoid that regulates extracellular fluid
volume by increasing reabsorption of sodium and chloride, which causes water to be
retained. Aldosterone is released by the adrenal cortex through activation of the renin
O
angiotensin aldosterone system.
C
Antidiuretic hormone (ADH) is secreted from the posterior lobe of the pituitary gland.
ADH regulates the osmotic pressure of extracellular fluid by regulating the amount of
water reabsorbed in the renal tubules. ADH release is stimulated by an increase in
osmotic pressure.
Cortisol is the major glucocorticoid and is responsible for metabolism and utilization of
carbohydrates, proteins, and fats. It also has anti-inflammatory effects. Cortisol plays an
1
,indirect role in fluid balance but is known as the stress hormone that has the primary
effects of increasing circulating glucose and decreasing the immune response.
Thyroxine is produced by the thyroid gland under the influence of thyroid stimulating
hormone (TSH). Thyroxine stimulates metabolism in many tissues but is not related to
fluid balance.
The anterior pituitary releases which of these hormones:
A. Aldosterone.
PR
B. Antidiuretic hormone (ADH).
C. Thyroxine.
D. ACTH (adrenocorticotropic hormone).
O
Correct Answer: D. Anterior pituitary hormones include growth hormone (also called
FD
somatotropin), adrenocorticotropic hormone (ACTH), thyroid stimulating hormone
(TSH), gonadotropins (follicle stimulating hormone and luteinizing hormone), and some
other hormones that affect pregnancy and lactation. All of the hormones from the
O
anterior pituitary except growth hormone affect other glands and cause them to
C
synthesize and release specific hormones. ACTH affects the adrenal cortex to control
synthesis and release of cortisol. TSH causes the thyroid gland to synthesize and
release thyroid hormones. Growth hormone affects metabolism of many tissues and
stimulates hormone production by the liver.
The major posterior pituitary hormone of significance in critically ill patients is:
A. Cortisol.
2
,B. Epinephrine.
C. Aldosterone.
D. Antidiuretic hormone (ADH).
Correct Answer: D. ADH (also called vasopressin) is formed in the hypothalamus and
stored in the posterior pituitary. ADH works on the distal convoluted tubule and
collecting ducts in the kidney to make them more permeable to water, thus causing the
kidney to reabsorb water. The major stimuli to ADH secretion are hyperosmolality and
volume depletion. The water retention induced by ADH will both lower the plasma
PR
osmolality and raise the extracellular volume toward normal. ADH also causes
vasoconstriction of arterioles to support blood pressure.
Cortisol is the major glucocorticoid released by the adrenal cortex. Cortisol affects
O
metabolism in all cells of the body and regulates utilization of carbohydrates, proteins,
FD
and fats. It also has anti-inflammatory effects. Excess cortisol production causes
Cushing's syndrome; a deficiency of cortisol is adrenal insufficiency which is common in
critically ill patients. Chronic adrenal insufficiency is called Addison's disease and
O
involves a deficiency of both cortisol and aldosterone.
C
Aldosterone is the most important mineralocorticoid produced by the adrenal cortex. It's
most important function is to regulate Na+ and K+ movement through the renal tubules.
Aldosterone causes the kidney to retain Na+ and excrete K+.
Epinephrine (or adrenalin) is a catecholamine produced by the adrenal medulla. It works
by stimulating alpha receptors in peripheral vessels to cause vasoconstriction in all
vascular beds except heart, brain, and certain skeletal muscles (the "fight or flight"
3
, response) and by stimulating beta receptors in the heart to increase heart rate and
contractility.
Your patient was admitted following a closed head injury 2 days ago. He is awake but
confused, complaining of severe thirst, and drinking as much water as he can get. His
urine output has been 4 liters in the last 8 hours. Urinalysis reveals a urine osmolality of
250 mOsm/kg and specific gravity of 1.002. His serum Na+ level = 150 mEq/L, K+ = 3.6
mEq/L, glucose = 100 mg/dl. Based on his symptoms and labs, what is the most likely
PR
diagnosis:
A. SIADH.
B. HHNS (hyperglycemic hyperosmolar nonketotic state).
O
C. New onset diabetes mellitus.
FD
D. Diabetes insipidus.
Correct Answer: D. Diabetes insipidus (DI) is impaired renal conservation of water due
to either inadequate secretion of ADH (central DI) or an insufficient renal response to
O
ADH (nephrogenic DI). Common causes of DI are hypothalamic or pituitary tumor,
C
closed head injury with damage to the hypothalamus, and neurosurgery. Decreased
amounts of ADH cause the kidney tubules to become impermeable to water, resulting in
massive diuresis of dilute urine that can lead to dehydration. If the thirst mechanism is
functional, polydipsia (drinking excessive amounts of water) occurs in an effort to
balance large water losses. Lab work shows increased plasma osmolality and
hypernatremia, with decreased urine osmolality (normal = above 500mOsm/kg) and low
urine specific gravity due to the large water content of urine. To quickly calculate plasma
4
& ANSWERS (VERIFIED) | LATEST
UPDATE | GRADED A+
Imbalances in which of the following hormones will MOST DIRECTLY impact fluid
PR
balance:
A. Aldosterone and cortisol.
B. Thyroxin and ADH.
O
C. Aldosterone and ADH.
D. Cortisol and epinephrine.
FD
Correct Answer: C. Aldosterone is a mineral corticoid that regulates extracellular fluid
volume by increasing reabsorption of sodium and chloride, which causes water to be
retained. Aldosterone is released by the adrenal cortex through activation of the renin
O
angiotensin aldosterone system.
C
Antidiuretic hormone (ADH) is secreted from the posterior lobe of the pituitary gland.
ADH regulates the osmotic pressure of extracellular fluid by regulating the amount of
water reabsorbed in the renal tubules. ADH release is stimulated by an increase in
osmotic pressure.
Cortisol is the major glucocorticoid and is responsible for metabolism and utilization of
carbohydrates, proteins, and fats. It also has anti-inflammatory effects. Cortisol plays an
1
,indirect role in fluid balance but is known as the stress hormone that has the primary
effects of increasing circulating glucose and decreasing the immune response.
Thyroxine is produced by the thyroid gland under the influence of thyroid stimulating
hormone (TSH). Thyroxine stimulates metabolism in many tissues but is not related to
fluid balance.
The anterior pituitary releases which of these hormones:
A. Aldosterone.
PR
B. Antidiuretic hormone (ADH).
C. Thyroxine.
D. ACTH (adrenocorticotropic hormone).
O
Correct Answer: D. Anterior pituitary hormones include growth hormone (also called
FD
somatotropin), adrenocorticotropic hormone (ACTH), thyroid stimulating hormone
(TSH), gonadotropins (follicle stimulating hormone and luteinizing hormone), and some
other hormones that affect pregnancy and lactation. All of the hormones from the
O
anterior pituitary except growth hormone affect other glands and cause them to
C
synthesize and release specific hormones. ACTH affects the adrenal cortex to control
synthesis and release of cortisol. TSH causes the thyroid gland to synthesize and
release thyroid hormones. Growth hormone affects metabolism of many tissues and
stimulates hormone production by the liver.
The major posterior pituitary hormone of significance in critically ill patients is:
A. Cortisol.
2
,B. Epinephrine.
C. Aldosterone.
D. Antidiuretic hormone (ADH).
Correct Answer: D. ADH (also called vasopressin) is formed in the hypothalamus and
stored in the posterior pituitary. ADH works on the distal convoluted tubule and
collecting ducts in the kidney to make them more permeable to water, thus causing the
kidney to reabsorb water. The major stimuli to ADH secretion are hyperosmolality and
volume depletion. The water retention induced by ADH will both lower the plasma
PR
osmolality and raise the extracellular volume toward normal. ADH also causes
vasoconstriction of arterioles to support blood pressure.
Cortisol is the major glucocorticoid released by the adrenal cortex. Cortisol affects
O
metabolism in all cells of the body and regulates utilization of carbohydrates, proteins,
FD
and fats. It also has anti-inflammatory effects. Excess cortisol production causes
Cushing's syndrome; a deficiency of cortisol is adrenal insufficiency which is common in
critically ill patients. Chronic adrenal insufficiency is called Addison's disease and
O
involves a deficiency of both cortisol and aldosterone.
C
Aldosterone is the most important mineralocorticoid produced by the adrenal cortex. It's
most important function is to regulate Na+ and K+ movement through the renal tubules.
Aldosterone causes the kidney to retain Na+ and excrete K+.
Epinephrine (or adrenalin) is a catecholamine produced by the adrenal medulla. It works
by stimulating alpha receptors in peripheral vessels to cause vasoconstriction in all
vascular beds except heart, brain, and certain skeletal muscles (the "fight or flight"
3
, response) and by stimulating beta receptors in the heart to increase heart rate and
contractility.
Your patient was admitted following a closed head injury 2 days ago. He is awake but
confused, complaining of severe thirst, and drinking as much water as he can get. His
urine output has been 4 liters in the last 8 hours. Urinalysis reveals a urine osmolality of
250 mOsm/kg and specific gravity of 1.002. His serum Na+ level = 150 mEq/L, K+ = 3.6
mEq/L, glucose = 100 mg/dl. Based on his symptoms and labs, what is the most likely
PR
diagnosis:
A. SIADH.
B. HHNS (hyperglycemic hyperosmolar nonketotic state).
O
C. New onset diabetes mellitus.
FD
D. Diabetes insipidus.
Correct Answer: D. Diabetes insipidus (DI) is impaired renal conservation of water due
to either inadequate secretion of ADH (central DI) or an insufficient renal response to
O
ADH (nephrogenic DI). Common causes of DI are hypothalamic or pituitary tumor,
C
closed head injury with damage to the hypothalamus, and neurosurgery. Decreased
amounts of ADH cause the kidney tubules to become impermeable to water, resulting in
massive diuresis of dilute urine that can lead to dehydration. If the thirst mechanism is
functional, polydipsia (drinking excessive amounts of water) occurs in an effort to
balance large water losses. Lab work shows increased plasma osmolality and
hypernatremia, with decreased urine osmolality (normal = above 500mOsm/kg) and low
urine specific gravity due to the large water content of urine. To quickly calculate plasma
4
