Hypophysitis Research Center

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Please select an answer for every question.

1) Imagine a lesion that interrupts the pituitary stalk just above the diaphragma sellae. The patient is expected to show all of the following changes EXCEPT:
a) GH, TSH, ACTH, FSH and LH will decrease because the lesion interrupts the major control that the hypothalamus exerts on the adenohypophysis, that is a "stimulatory" control
b) PRL increases because the lesion interrupts the major control that the hypothalamus exerts on the adenohypophysis: dopamine, which is a "inhibitory" control
c) The synthesis of ADH and oxytocin is usually not affected because these hormones are made above the lesion
d) The synthesis of ADH and oxytocin increases because the lesion stimulates the hypothalamic synthesis of these hormones as a compensatory feedback mechanism
2) Remembering the anatomic relationships, you can predict that an enlarged pituitary gland will cause all of the following symptoms, EXCEPT:
a) Headache, because the upward extension of the enlarged gland stretches the diaphragma sellae, which is innervated
b) Visual field defects (typically bitemporal hemianopsia) because the upward extension of the gland compresses, once the diaphragma is passed, the optic chiasma
c) Exophthalmia because the enlarged pituitary blocks the lymphatic drainage from the orbit, and thus pushes the eye globe forward
d) Impaired mobility of the eye globes. In fact a pituitary mass can expand laterally into the cavernous sinus where it can compress the oculomotor nerve (III cranial nerve that controls medial glaze), more rarely the trochlear (VI) and abducent (VI) cranial nerves
e) Hypopituitarism because the pituitary mass when compresses the normal adjacent cells of the pituitary. The first normal cells to be affected are the lactotropes and the somatotropes, but their loss of function does not cause clear symptoms in the adult. Next are affected the gonadotropes (thus hypogonadism appears), then the thyreotropes (hypothyroidism), and finally the corticotropes (adrenal insufficiency).
3) Somatostatin has all of the following effects, EXCEPT:
a) inhibits gastric secretion from the parietal cells of the stomach
b) inhibits TSH release
c) inhibits insulin release
d) increases glucagon secretion
e) inhibits gallbladder contractility
4) A 60 yr-old man, heavy smoker, presents with fatigue, slight weight increase, and hemophtysis (spotting of blood derived from the lungs). Physical exam shows edema around the ankles, enlargement of the liver, and enlargement of supraclavicular lymph nodes. A chest X-ray shows a large mass around the right hilus.

Analysis of the patient's serum shows:
- sodium 115 mEq/L (vn 135-154)
- potassium 2.3 mEq/L (vn 3.5-5.0)
- chloride 70 mEq/L (vn 95-110)
- osmolality: 230 mOsm/L (vn 285-295)

The urine osmolality was 500 mOsm/L (vn 400-800). Which of the following hormones would you expect to see increased in this patient's serum?
a) ADH
b) GH
c) PRL
d) Aldosterone
e) Cortisol
5) The adrenocortical insufficiency can cause decreased blood levels of sodium (hyponatremia). Which of the following mechanisms DOES NOT contribute to the hyponatremia?
a) the aldosterone deficit causes urinary loss of sodium
b) the cortisol deficit decreases the clearance of free water (by antagonizing the action of ADH on the renal tubuli). The end-result is that more water is absorbed
c) the cortisol deficit decreases ADH release from the neurohypophysis
d) the aldosterone and cortisol deficits cause reduced blood volume (hypovolemia), and thus reduced blood pressure and cardiac output
6) All of the following hormones share their alpha subunit with TSH, EXCEPT:
a) LH
b) GH
c) FSH
d) hCG
7) Which of the following statements describing the actions of GnRH and estradiol on the gonadotropes in women is/are CORRECT?
a) GnRH induces synthesis and storage of gonadotropins (reserve pool)
b) estradiol induces synthesis of gonadotropins, but inhibits their release
c) GnRH stimulates the synthesis of its own receptors from the gonadotropes (self-priming). Thus the response of gonadotropes to identical pulses of GnRH increases over time
d) at midcycle, GnRH has induced sufficient number of its own receptors that GnRH stimulatory actions overcome the inhibition that estradiol exerts on gonadotropins release, thus causing the mid-cycle gonadotropin peak
e) none of these
f) all of these
8) ONLY ONE of the following statements regarding the secretion of hormones produced by the anterior hypophysis is correct:
a) The main hypothalamic factor that controls prolactin secretion is stimulatory in nature
b) A single blood sample is sufficient to study and assess the function of the anterior hypophysis
c) A lesion that interrupts the pituitary stalk causes an increase in the serum concentrations of ACTH, TSH and GH
d) The main hypothalamic factor that control prolactin secretion is dopamine, which has an inhibitory effect on prolactin
9) After a very severe decrease in the extracellular volume, without a change in osmolality, the body responds by increasing:
a) Aldosterone and atrial natriuretic factor
b) Calcitonin and antidiuretic hormone
c) Aldosterone and renin
d) Aldosterone and anti-diuretic hormone
10) Indicate which of the following statements are True (T) and which are False (F):
T   F    a) Tanycytes may transport substances between the third ventricle and the gomitoli
T   F    b) The testosterone surge that human males experience at about 2 months of age is thought to "organize" the androgen-dependent tissues
T   F    c) Human chorionic gonadotropin (hCG), but not luteinizing hormone (LH), prevents the lysis of the corpus luteum during the menstrual cycle
T   F    d) Both the male and female pituitaries respond to inhibin
T   F    e) The hypothalamic neurons that produce gonadotropin-releasing hormone (GnRH) in females and males respond identically to their respective main steroid, estradiol and testosterone
11a) During pregnancy prolactin levels raise beginning at about 8 weeks and peaking at term. Prolactin is the major hormone in milk synthesis, however, during pregnancy lactation is inhibited by:
a) Estrogen
b) Progesterone
c) hCG
d) all of these
11b) Then, after delivery, the hormonal trigger for milk production is the rapid decline in the circulation of:
a) Estrogen
b) Progesterone
c) both of these
d) none of these
11c) During puerperium, breast suckling stimulates the release of:
a) Prolactin
b) Oxitocin
c) all of these
d) none of these