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Chapter 45. Adrenal Gland Disorders

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Which of the following is true regarding the hypothalamic-pituitary-adrenal (HPA) axis?

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A. Corticotropin-releasing hormone (CRH) is secreted by the hypothalamus to stimulate adrenocorticotropic hormone (ACTH) secretion from the anterior pituitary.

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B. The adrenal cortex stimulates the anterior pituitary to secrete cortisol.

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C. Cortisol exerts positive feedback on the hypothalamus to increase secretion of CRH.

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D. The adrenal medulla produces testosterone and estrogen under the control of the pituitary.

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E. Aldosterone is produced in the pituitary.

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Which of the following is the most common etiology of primary adrenal insufficiency?

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A. An autoimmune process

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B. Chronic glucocorticoid administration at supraphysiologic dose

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C. Infection

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D. Adrenalectomy

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E. Megestrol acetate

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The clinical presentation of primary adrenal insufficiency differs from that of secondary or tertiary adrenal insufficiency in the following way(s):

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A. Hyperpigmentation is commonly seen in secondary and tertiary adrenal insufficiency.

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B. Hyperkalemia is more commonly seen in primary adrenal insufficiency.

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C. Decreased aldosterone concentrations is most often seen in primary adrenal insufficiency.

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D. B and C

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E. A, B, and C

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A 43-year-old woman comes to the pharmacy asking for help selecting “iron pills.” She states that she has been feeling gradually more “tired and weak over the past couple of years.” Upon further questioning, she also complains of recurring dizziness, nausea, and diarrhea, and a 10-pound (4.5 kg) weight loss over the past year. She fills her prescriptions at the pharmacy, and a review of the medication profile reveals that fluticasone/salmeterol DPI 500/50 mcg one inhalation bid, albuterol MDI two puffs every 4 hours as needed, HCTZ 25 mg daily, and pantoprazole 40 mg daily have been prescribed. She also has a history of asthma exacerbations requiring hospitalization and prednisone taper treatment one or two times per year. Which of the following would be the most appropriate step to take?

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A. Refer for medical evaluation for possible hypocortisolism.

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B. Refer for medical evaluation for possible hypercortisolism.

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C. Help her select a B-complex vitamin product to treat fatigue.

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D. Help her select ...

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