Chapter 23

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 82) What are the three common causes of hypercortisolism?

: 1. adrenal tumor autonomously secretes cortisol (primary hypercortisolism) 2. pituitary tumor autonomously secretes ACTH (secondary hypercortisolism) 3. iatrogenic hypercortisolism (physician-caused) Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 66) List four factors that affect normal body growth.

: 1. growth hormone and other hormones 2. adequate diet 3. absence of stress 4. genetics Section Title: Growth Hormone Learning Outcome: 23.11

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 69) Name four physiological functions of calcium.

: 1. signal molecule 2. part of intercellular cement that holds cells together at tight junction 3. cofactor in the coagulation cascade 4. affects the excitability of neurons See Figure 23.11b in the chapter. Section Title: Calcium Balance Learning Outcome: 23.18

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 10) CRH stimulates the release of A) ACTH. B) cortisol. C) DHEA. D) MSH. E) None of these answers are correct.

: A Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 9) Cortisol secretion peaks between ________ and ________. A) early morning, noon B) midnight, early morning C) noon, early evening D) early evening, midnight

: A Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 44) may be an autoimmune disease

: A Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 32) Elevated levels of calcium ion in the blood stimulate the secretion of the hormone A) calcitonin. B) thyroid hormone. C) parathyroid hormone. D) growth hormone. E) testosterone.

: A Section Title: Calcium Balance Learning Outcome: 23.20

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 73) Increased blood calcium levels result in increased A) secretion of calcitonin. B) secretion of parathyroid hormone. C) retention of calcium by the kidneys. D) osteoclast activity. E) excitability of neural membranes.

: A Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the condition with its description. A. giantism B. kyphosis C. moon face D. myxedema E. goiter 52) caused by growth hormone excess in childhood

: A Section Title: Growth Hormone Learning Outcome: 23.14

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 49) caused by growth hormone excess in adulthood

: A Section Title: Growth Hormone Learning Outcome: 23.14

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 21) The pituitary hormone that triggers the release of thyroid hormone from the thyroid gland is A) TSH. B) ACTH. C) FSH. D) TRH E) CRH.

: A Section Title: Thyroid Hormones Learning Outcome: 23.9

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 28) Mature, less active bone cells are termed A) osteocytes. B) osteoblasts. C) osteoclasts. D) chondrocytes. E) osteons.

: A Section Title: Tissue and Bone Growth Learning Outcome: 23.17

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 86) Bill does not begin puberty until he is 16. What effect would you predict this will have on his stature? A) Bill will probably be taller than if he had started puberty earlier. B) Bill will probably be shorter than if he had started puberty earlier. C) Bill will probably be a dwarf. D) Bill will have bones that are denser than normal. E) The late onset of puberty will have no effect on Bill's stature.

: A Section Title: Tissue and Bone Growth Learning Outcome: 23.5

: Level III: Problem Solving (Bloom's Taxonomy: Synthesis) 91) Carmen has just given birth to her third child, and as with the first two, she stayed home and used the services of a nurse-midwife. While her recovery from the births of the first two children was normal and she was able to breast-feed both for two years, she is not lactating this time and is experiencing other difficulties. Her symptoms also include vomiting, fatigue, cold intolerance, and myxedema, which worsen over the coming weeks. She ignored her midwife's suggestion to see her doctor the day after giving birth, but has finally gone to an Ob-Gyn during the third week postpartum. Her newborn baby is healthy and thriving on human breast milk purchased from a milk bank. Diagnostic tests indicate decreased amounts of several hormones, as well as edema and poor blood flow into the pituitary. What do her symptoms indicate? Which hormones are likely decreased? What may be the root cause?

: A lack of several pituitary hormones is apparent: PRH stimulates prolactin secretion and lactation, vomiting and fatigue could indicate lack of ACTH and consequent cortisol, and cold intolerance and myxedema indicate lack of TSH and consequent thyroid hormone. Abnormal function of the anterior pituitary can result from lack of hypothalamic-releasing hormones, pituitary adenoma, or pituitary infarction related to pregnancy (Sheehan syndrome; this syndrome is not described in the text, but the student may be able to reason decreased pituitary function due to decreased blood flow). Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 77) What is a permissive hormone effect? Provide an example, explaining what would result if the permissive hormone was absent.

: A permissive hormone effect is the dependence of one hormone on the presence of another in order to fully exert its effects. An example is that cortisol is required for full glucagon effect. Without cortisol, glucagon cannot adequately perform its role in glucose regulation, and death results. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 90) Precocious puberty in girls can result from hypersecretion of nongonadal steroids. In such girls, there is early breast development, onset of menses, and ovulation of viable eggs. This can occur by age 7 or even earlier. Which hormone(s) and nongonadal endocrine gland(s) may be responsible? Can the responsible gland(s) be safely removed? Explain. How might this condition be treated without surgery? What permanent nonsexual consequences may result from not treating this condition?

: Adrenal sex hormones include estrogens. Hypersecretion of estrogen would stimulate puberty. The adrenal glands can be removed, if cortisol and aldosterone are replaced. Drugs such as aromatase inhibitors, which block estrogen production, may be appropriate. An effect of estrogen is stimulation then cessation of skeletal growth, which after precocious puberty could result in shorter final stature due to premature closure of growth plates in long bones. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 3) All of the hormones secreted by the adrenal gland play a major role in growth and metabolism. A) True B) False

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 6) The precursor chemical for ACTH synthesis is A) CRH. B) POMC. C) beta-endorphin. D) MSH. E) TRH.

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 12) Without cortisol's permissive effect on ________, an animal would die. A) insulin B) glucagon C) thyroid hormone D) parathyroid hormone E) aldosterone

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 41) Some symptoms mimic diabetes mellitus.

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 45) may result from adrenal tumor

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 46) may result from a pituitary tumor

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 51) This condition results from excess androgens in females.

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the disease with the description. A. Addison's disease B. Cushing's disease C. Graves' disease D. Paget's disease 38) hypercortisolism

: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 31) The parathyroid glands produce a hormone that A) stimulates the formation of white blood cells. B) increases the level of calcium ions in the blood. C) increases the level of sodium ions in the blood. D) increases the level of potassium ions in the blood. E) increases the level of glucose in the blood.

: B Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 34) Calcium reabsorption at the kidneys is promoted by the hormone A) calcitonin. B) calcitriol. C) aldosterone. D) cortisol. E) ADH.

: B Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 53) hunchback appearance associated with osteoporosis

: B Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 33) A condition that produces a reduction in bone mass or density sufficient to compromise normal function is A) cretinism. B) osteoporosis. C) osteomyelitis. D) osteitis. E) acromegaly.

: B Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 22) Hyperthyroidism A) decreases oxygen consumption. B) increases protein catabolism. C) decreases protein synthesis. D) slows heart rate. E) causes cold intolerance.

: B Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 17) Iodine accumulation in thyroid cells involves symport with A) hydrogen. B) sodium. C) potassium. D) chloride.

: B Section Title: Thyroid Hormones Learning Outcome: 23.7

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 19) The Thyroid hormones T3 and T4 are lipophilic so they do not require transporters to cross cell membranes. A) True B) False

: B Section Title: Thyroid Hormones Learning Outcome: 23.8

: Level III: Problem Solving (Bloom's Taxonomy: Application) 100) Todd is in the emergency room, complaining of severe back pain and pain when trying to urinate. The physician has ordered blood tests and urinalysis to measure levels of parathyroid hormone (PTH) and phosphates. What possible reason would the physician have for doing this? What would the physician conclude if the results of the blood test show high levels of PTH and calcium and the urinalysis shows high levels of phosphate? How are calcium and phosphates related?

: Based on the symptoms that Todd is experiencing, the physician is likely considering kidney stones to be the cause of severe back pain. If there is a problem with hypersecretion of parathyroid hormone, this would cause increased calcium levels in the blood, and cause the kidneys to exchange more phosphates for calcium, leading to high urine levels of phosphates. If calcium levels in the blood are very high, the kidney will not be able to reabsorb all of the calcium, leading to the formation of kidney stones out of calcium phosphate. Section Title: Calcium Balance Learning Outcome: 23.20

: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 87) Describe the endocrine regulation of bone growth.

: Bone growth is regulated by many hormones, including growth hormone, insulin-like growth factor, sex steroids, and hormones that regulate calcium metabolism. Section Title: Tissue and Bone Growth Learning Outcome: 23.17

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 55) easily observable symptom of hypercortisolism

: C Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 29) Transcellular transport of intestinal calcium is accomplished by entry into the epithelial enterocytes via A) a sodium-iodide transporter. B) osteoclasts. C) apical calcium channels (TRPV6 = ECaC). D) CaSR (calcium sensing receptor). E) an amino acid transporter (MCT8).

: C Section Title: Calcium Balance Learning Outcome: 23.19

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 35) A hormone that can lower blood levels of calcium ion is A) parathyroid hormone. B) thyroxine. C) calcitonin. D) glucagon. E) oxytocin.

: C Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 26) Somatostatin is another name for A) growth hormone. B) growth hormone-releasing hormone. C) growth hormone-inhibiting hormone. D) thyroid hormone. E) parathyroid hormone.

: C Section Title: Growth Hormone Learning Outcome: 23.12

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 50) mental retardation associated with infantile hypothyroidism

: C Section Title: Growth Hormone Learning Outcome: 23.14

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 23) The effects of thyroid hormone on peripheral tissue include A) decreased oxygen consumption. B) decreased heart rate. C) increased sensitivity to sympathetic stimulation. D) increased activity of osteoclasts. E) All of these answers are correct.

: C Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 39) hyperthyroidism

: C Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 40) involves endocrine stimulation by antibodies

: C Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 15) The C cells of the thyroid gland produce A) only thyroxine. B) only TSH. C) only calcitonin. D) only parathyroid hormone. E) thryoxine and TSH.

: C Section Title: Thyroid Hormones Learning Outcome: 23.6

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 72) Premature closure of the epiphyseal plates could be caused by A) high levels of vitamin D3. B) too much calcium in the diet. C) elevated levels of sex hormones. D) too little thyroxine. E) an excess of growth hormone.

: C Section Title: Tissue and Bone Growth Learning Outcome: 23.17

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 64) What are the two distinct endocrine cell types that comprise the thyroid gland, and what do they secrete?

: C cells secrete calcitonin, and follicle cells secrete thyroid hormones. Section Title: Thyroid Hormones Learning Outcome: 23.6

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 81) Which hormones of growth and metabolism have a permissive effect on other hormones of growth and metabolism?

: Cortisol is required for glucagon to be fully effective against a hypoglycemic challenge. In children, thyroid hormone is necessary for the full expression of growth hormone. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 78) Explain how cortisol suppresses the immune system, and why this is sometimes a useful therapy. What are some negative side effects of cortisol therapy? Why do doctors prescribe cortisol in doses that taper off at the end of the therapy period? Why do doctors sometimes prefer to prescribe nonsteroidal anti-inflammatory drugs?

: Cortisol prevents cytokine release and antibody production by white blood cells and decreases leukocyte mobility and migration; cortisol is thus an effective anti-inflammatory and antirejection drug for transplant patients. Cortisol weakens the skeleton and alters brain function, in addition to suppressing the immune system. Because cortisol suppresses ACTH production by negative feedback, the adrenal cortex atrophies during cortisol therapy. Tapering off of dosing allows adrenal cortex function to return gradually. Nonsteroidal anti-inflammatories avoid the negative side effects of cortisol therapy and are therefore more appropriate for minor inflammation. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level III: Problem Solving (Bloom's Taxonomy: Synthesis) 92) In an effort to impress her physiology instructor, your roommate did an Internet search on cortisol. In her exuberance, she failed to read the book chapter, the instructor has not yet lectured on this chapter, and frankly she knows next to nothing about this hormone. She discovers such seemingly unrelated therapeutic effects as treatment for bee stings and rejection of transplanted organs. You, however, completed your physiology course last semester, and she turns to you for enlightenment. What can you tell her about some other therapeutic uses for cortisol, and what functional connections do these illustrate? What are some of the negative side effects?

: Cortisol suppresses the immune system by preventing cytokine release, inhibiting antibody production, and inhibiting the inflammatory response. Allergic reactions to bee stings, poison ivy, and pollen involve the immune system; thus cortisol can be used to suppress these responses. Rejection of a transplanted organ is also an immune response. Negative feedback from the exogenous hormone inhibits ACTH production, which can result in atrophy of the adrenal cortex. Hypercortisolism can also result, with symptoms similar to diabetes mellitus, and extra fat deposition leading to "moon face," and changes in mood and cognition. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.5

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 65) ________ is a result of deficient thyroid hormone secretion in infancy.

: Cretinism Section Title: Growth Hormone Learning Outcome: 23.10

: Level III: Problem Solving (Bloom's Taxonomy: Application) 96) An adult with cretinism has incomplete manifestation of puberty (e.g., scant pubic hair), abnormal facial features, dwarfism, and mental retardation. Explain what causes these symptoms. How is cretin dwarfism different from pituitary dwarfism? How could cretinism be prevented?

: Cretinism results from lack of thyroid hormones during early childhood. Thyroid hormones are permissive for growth hormones and play an important role in the development of the nervous system. The incomplete puberty may be related to lack of thyroid hormone and growth hormone effects on the sexual tissues. Pituitary dwarfism results from lack of growth hormone, unrelated to thyroid hormones. Prevention of thyroid cretinism is aimed at adequate prenatal care (especially dietary iodine) and administration of exogenous thyroid hormones to the infant. Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 83) What are the symptoms and causes of Cushing's disease? How do they compare and contrast with symptoms and causes of Addison's disease?

: Cushing's disease is hypercortisolism, which can arise from adrenal or pituitary tumors or exogenous administration of cortisol. Symptoms include gluconeogenesis and consequent hyperglycemia, tissue wasting (especially in the limbs) from breakdown of protein and fat, excess fat deposition in trunk and face, mood elevation followed by depression, and difficulty with learning and memory. Addison's disease, far less common, is hyposecretion of cortisol as well as other adrenal steroids. It is usually caused by autoimmune destruction. Symptoms include darkening of the skin due to effects of ACTH on melanocytes. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 70) Damage to cells of the zona fasciculata of the adrenal cortex would result in A) the disappearance of axillary and pubic hair. B) increased volume of urine formation. C) decreased levels of sodium ion in the blood. D) decreased ability to convert lipids to glucose. E) increased water retention.

: D Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 7) The adrenal medulla produces A) androgens. B) glucocorticoids. C) mineralocorticoids. D) catecholamines. E) corticosteroids.

: D Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 5) Crossover effects are sometimes seen among A) most hormones. B) all hormones. C) peptide/protein hormones. D) steroid hormones.

: D Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 43) Calcitonin may be an appropriate treatment.

: D Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 36) Parathyroid hormone is A) a lipid. B) dissolved in plasma. C) bound to a carrier. D) an amine hormone. E) the cause of Graves' disease.

: D Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 37) Vitamin D (calcitriol) A) is formed by sunlight only. B) is bound to plasma protein for transport only. C) synthesis is stimulated by high calcium levels. D) is formed by sunlight and bound to plasma protein for transport. E) is formed by sunlight and synthesis is stimulated by high calcium levels.

: D Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 42) associated with overactive osteoclasts

: D Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 27) Excess growth hormone prior to puberty would result in A) osteoporosis. B) cretinism. C) rickets. D) giantism. E) dwarfism.

: D Section Title: Growth Hormone Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 25) Excess secretion of growth hormone during adulthood will cause A) goiter. B) exophthalmus. C) giantism. D) acromegaly. E) diabetes.

: D Section Title: Growth Hormone Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 24) GH A) is secreted by the anterior pituitary. B) is secreted by the posterior pituitary. C) binds to a plasma protein. D) is secreted by the anterior pituitary and binds to a plasma protein. E) is secreted by the posterior pituitary and binds to a plasma protein.

: D Section Title: Growth Hormone Learning Outcome: 23.11

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 48) caused by growth hormone deficiency in childhood

: D Section Title: Growth Hormone Learning Outcome: 23.14

Human Physiology: An Integrated Approach, 6e (Silverthorn) Chapter 23 Endocrine Control of Growth and Metabolism 1) The action of a hormone on a target cell involves effects on A) receptor proteins. B) nonreceptor proteins. C) lipids. D) receptor and nonreceptor proteins. E) receptor proteins and lipids.

: D Section Title: Review of Endocrine Principles Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 54) puffy appearance associated with hypothyroidism

: D Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 14) Thyroid hormone contains the mineral A) sodium. B) thallium. C) iron. D) iodine. E) zinc.

: D Section Title: Thyroid Hormones Learning Outcome: 23.7

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 18) Thyroid hormones A) are lipophilic. B) are hydrophilic. C) must bind to plasma proteins for transport to target cells. D) are lipophilic and must bind to plasma proteins for transport to target cells. E) are hydrophilic and must bind to plasma proteins for transport to target cells.

: D Section Title: Thyroid Hormones Learning Outcome: 23.8

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 20) Which of the following transporters are known to transport thyroid hormones into target cells? A) CaSR (calcium sensing receptor) B) TRPV6 C) Sodium-iodide symporter D) MCT8 E) Mineralocorticoid receptor

: D Section Title: Thyroid Hormones Learning Outcome: 23.8

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 2) The endocrine gland that is a modified sympathetic ganglion is the A) thyroid. B) anterior pituitary. C) posterior pituitary. D) adrenal cortex. E) adrenal medulla.

: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 4) Cholesterol is a precursor for the synthesis of A) progesterone. B) aldosterone. C) estradiol. D) calcitonin. E) progesterone, aldosterone, and estradiol.

: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 8) Which of the following could describe the function of 11 Beta-hydroxysteroid dehydrogenase? A) An enzyme located in renal tubules that acts on cortisol . B) It converts cortisol to a less active form. C) It aids in preventing crossover effects from cortisol. D) It converts cortisol to a form with a lower specificity for mineralocorticoid receptors there. E) All of these answers are correct.

: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 11) Cortisol has the following effects: A) suppresses the immune system. B) causes positive calcium balance. C) influences brain function. D) suppresses the immune system and causes positive calcium balance. E) suppresses the immune system and influences brain function.

: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 13) Melanocortins includes one or more of the following: A) ACTH B) cortisol C) growth hormone D) MSH E) ACTH and MSH

: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 71) A rise in cortisol would cause each of the following except one. Identify the exception. A) enhanced rate of glucose synthesis by the liver B) increased rate of glycogen usage by the liver C) higher levels of fatty acids in the blood D) suppression of the immune system E) increased ACTH levels

: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 30) Parathyroid hormone A) stimulates osteoclast activity. B) increases the rate of calcium absorption. C) decreases the rate of calcium excretion. D) raises the level of calcium ion in the blood. E) All of these answers are correct.

: E Section Title: Calcium Balance Learning Outcome: 23.20

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the condition with the description. A. acromegaly B. adrenogenital syndrome C. cretinism D. dwarfism E. exophthalmus 47) associated with Graves' disease

: E Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 56) caused by elevation of TSH

: E Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 16) Pendrin is an anion transporter important in the production of A) parathyroid hormone. B) calcitonin. C) TRH. D) TSH. E) thyroid hormone.

: E Section Title: Thyroid Hormones Learning Outcome: 23.6

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 80) List and explain the effects of cortisol.

: Effects include promoting gluconeogenesis, breakdown of skeletal muscle proteins and lipolysis, immune suppression, negative calcium balance, alteration of cerebral function. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level III: Problem Solving (Bloom's Taxonomy: Application) 93) Therapeutic surgical removal of the thyroid gland was documented more than 1000 years ago. In the 19th century, a surgeon performing that procedure had only about 50% patient survival, and patient death was often unrelated to nonspecific complications such as infection or bleeding. What condition of the thyroid is so easily diagnosed that ancient surgeons would think to remove it? What hormonal problem unrelated to thyroid hormones may account for the 50% mortality of thyroidectomy patients in the 19th century (and probably throughout history)? Why didn't the surgeons anticipate this problem? Why wasn't the mortality closer to 100%?

: Goiters develop from lack of iodine in the diet or from Graves' disease, producing an obvious enlargement in the neck. Loss of parathyroid hormone following thyroidectomy with inadvertent parathyroidectomy caused death in patients due to lack of calcium for excitable cells such as heart and nerve cells. The role of the parathyroid glands was not fully understood in the 19th century. Mortality was not 100% because the amount of parathyroid tissue varies in individuals, and some had parathyroid tissue that was not removed by thyroidectomy. Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 85) Define hypertrophy and hyperplasia, and describe their hormone regulation.

: Hypertrophy is increase in cell size, and hyperplasia is increase in cell number. Both are regulated by growth hormone, thyroid hormone, and insulin. Section Title: Growth Hormone Learning Outcome: 23.11

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 79) Billy has been serving in a noncombat position in the army for two years and has just been informed that he is leaving on a combat mission tomorrow. Billy is feeling very stressed. How has his endocrine system responded to this bad news? Which hormones are involved, and what effects do they have?

: Increased cortisol secretion by the adrenal cortex is stimulated via corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH). Cortisol generally has catabolic effects, to protect against hypoglycemia. These effects include gluconeogenesis in the liver, breakdown of skeletal muscle proteins, enhanced lipolysis, immune suppression, and bone loss. Additionally, this discouraging news may be accompanied by a fight-or-flight reaction, in which increased sympathetic activity will result in increased heart and respiratory rates, increased perfusion of skeletal musculature, and decreased digestive activity. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 88) Describe the sources, targets, and primary effects of the hormones of calcium metabolism.

: Parathyroid hormone, calcitonin, and calcitriol are the primary hormones. See Table 23.1 and Figures 23.12 and 23.13 in the chapter. Section Title: Calcium Balance Learning Outcome: 23.20

: Level III: Problem Solving (Bloom's Taxonomy: Application) 99) Rani has read how important Ca2+ ions are to muscle contraction and neuron function. Rani, age 25, hates milk and most dairy products, and doesn't think she eats many foods that are sources of calcium, nor does she take supplements. Why don't Rani's muscles and nerves show problems related to calcium deficiency? What problems might Rani encounter later in life if she continues this lifestyle?

: Rani's skeleton contains enough Ca2+ to, under the influence of PTH, release Ca2+ to maintain normal blood levels. The muscles, nerves, and other cells are thus able to obtain sufficient Ca2+. It is also likely that Rani consumes at least small amounts of Ca2+ in her diet. Rani will eventually lose enough bone density to be prone to fractures. Section Title: Calcium Balance Learning Outcome: 23.20

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 75) Draw a map of steroid hormone synthesis.

: See Figure 23.1 in the chapter. Section Title: Review of Endocrine Principles Learning Outcome: 23.1

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 76) Describe the hypothalamic-pituitary-endocrine organ pathways for the adrenal cortex and thyroid gland. Do releasing and/or trophic hormones exert effects outside this pathway? Explain.

: See Figures 23.2 and 23.5 in the chapter. CRH and ACTH receptors have been identified in cells of the immune system and are thought to mediate the association between stress and the immune system. Section Title: Review of Endocrine Principles Learning Outcome: 23.2

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 84) Explain how the mutant agouti mouse is proving useful as a model for obesity-related disease.

: See the "Emerging Concepts: Melanocortins and the Agouti Mouse" section of the chapter. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2

: Level III: Problem Solving (Bloom's Taxonomy: Application) 98) Juan has great hopes that his 12-year-old son will play professional basketball and wants to do anything that might be helpful. He has heard that the administration of testosterone or other androgens might increase his son's height. Alarmed, you tell him that this may be a treatment that would actually limit his future athletic potential. Why?

: The administration of sex hormones may cause a quick increase in height, but could also contribute to the premature closure of the epiphyseal plates, limiting the final height this child may attain. Section Title: Tissue and Bone Growth Learning Outcome: 23.17

: Level III: Problem Solving (Bloom's Taxonomy: Application) 95) Carl is suffering from hypothyroidism. How could his physician determine if his symptoms result from problems at the level of the hypothalamus and pituitary or at the level of the gland itself?

: The physician could order blood tests to determine the levels of TSH, T3, and T4 in the blood. If the condition is due to disease of the thyroid gland, you would expect to see elevated levels of TSH because of a lack of feedback inhibition by thyroid hormones. If, on the other hand, the problem is due to problems at the level of the hypothalamus or pituitary, you would expect to see decreased levels of TSH. Section Title: Thyroid Hormones Learning Outcome: 23.10

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 74) Pick one hormone from Chapter 23 and design a concept map showing the feedback pattern, types of hormone receptors and how this relates to normal cellular / tissue responses, and areas in the map which could be the cause of pathologies (i.e., hyposecretion, hyperresponsiveness, ...).

: The primary hormones covered are adrenal glucocorticoids (Fig. 23.2), thyroid hormones (Fig. 23.5) and calcitonin (Tbl. 23.1), growth hormone (Fig. 23.8), parathyroid hormone (Fig. 23.12), and calcitriol (Fig. 23.13). If the hormone uses a cell membrane receptor, then the effects should be fairly rapid and short-lived. If the hormone uses an intracellular or nuclear receptor, then the effects will take longer and be longer lasting, as this will typically involve gene transcription. (See Chapter 6, Signal Pathways.) Section Title: Review of Endocrine Principles Learning Outcome: 23.1

: Level III: Problem Solving (Bloom's Taxonomy: Application) 94) A diagnosis of thyroid cancer may be treated with removal of the thyroid gland. Which hormone or hormones may now be deficient? Considering each hormone individually, which ones should be restored and why? Explain any age-related considerations. Which nonthyroid hormone may be affected by careless thyroidectomy? Explain your answer, indicating whether or not it is critical to maintain this hormone.

: The thyroid gland is the source of thyroid hormones and calcitonin. Thyroid hormones should be replaced in children to maintain normal growth and in adults to maintain quality of life. Calcitonin replacement is not necessary in adults, because parathyroid hormone and calcitriol should be unaffected, and they are sufficient to maintain normal calcium balance. It is unclear how important calcitonin replacement may be in children. Careless thyroidectomy could result in removal of parathyroid glands. If parathyroid hormone is not restored, death results. Section Title: Calcium Balance Learning Outcome: 23.20

: Level III: Problem Solving (Bloom's Taxonomy: Application) 97) The approach to treating patients who secrete abnormal amounts of hormone sometimes depends upon the age of the patient. List the hormones of growth and metabolism for which this statement is true, and explain in each case how and why the approach would differ for a prepubertal patient compared to a postpubertal patient.

: Thyroid hormone and growth hormone are the main hormones of growth and development with differing roles in childhood compared to adulthood. Students may wish to discuss calcitonin as well, but there is little detail in the text and incomplete understanding of its role, especially in adults. 1. Thyroid hormone is essential for normal growth and development in children, although this hormone is not essential for living, regardless of age. Thyroid imbalances must be promptly corrected in children, or else the patients will be developmentally delayed. Thyroid hormone has a permissive effect for growth hormone, is anabolic in children, and is required for normal neural development. These effects are not seen with thyroid hormone imbalance in adulthood, but to maintain a normal quality of life, amount of circulating thyroid hormone should be corrected in adults as well. 2. Children cannot grow normally without adequate amounts of growth hormone, and imbalances should be corrected promptly. Secretion of GH peaks during the teens. Excess GH in childhood can lead to giantism, while lack of GH leads to pituitary dwarfism. Lack of GH in adulthood is not problematic, but excess production stimulates the growth of cartilage, causing acromegaly. Section Title: Growth Hormone Learning Outcome: 23.11

: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 89) Describe differences in effects of hormones of growth and metabolism in children compared to effects in adults.

: While all the hormones discussed in this chapter will have effects on adults and children, some have very specific effects at different stages of life. 1. Cortisol provides a catabolic protective effect against hypoglycemia, enhancing the effectiveness of glucagon, important in response to stress. In children, excess cortisol released due to stress can result in stunted growth or a failure to thrive 2. Thyroid hormone provides substrates for oxidative metabolism in adults, but has the additional effect of providing for full expression of growth hormone and mental development in infants and young children. In adults, Thyroid hormones cause protein catabolism while it has anabolic effects in children. Thyroid hormone deficiency in children will be developmentally delayed and short in stature and may have mental retardation. In adults, hypothyroidism may cause cold-intolerance, slow reflexes, fatigue, slow heart rate, and many other conditions. 3. Growth hormone is anabolic, essential for tissue growth and maintenance. Its effects are most dramatically seen in children (rapid growth spurts). Growth hormone deficiency causes dwarfism and excess causes giantism in children. Acromegaly characterizes GH excess in adults. 4. Calcitonin's primary role is likely in providing normal skeletal growth in children. In adults it is important when net bone deposition is needed, such as during pregnancy. Section Title: Review of Endocrine Principles Learning Outcome: 23.2

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 58) Cortisol secretion shows a ________ pattern of secretion, normally peaking in the ________.

: circadian, morning Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 59) The hypothalamic-pituitary-adrenal pathway begins with secretion of ________ into the ________ and transported to the ________.

: corticotropin-releasing-hormone (CRH), hypothalamic-hypophyseal portal system, anterior pituitary (See Figure 23.2 in the chapter.) Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 60) The most important metabolic effect of ________ is protection against ________, crucial to surviving significant stress.

: cortisol, hypoglycemia Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 57) Structurally similar steroids sometimes bind to the same receptor, producing ________ effects.

: crossover Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 68) In bone, the calcium phosphate forms crystals of ________.

: hydroxyapatite Section Title: Tissue and Bone Growth Learning Outcome: 23.16

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 67) GH stimulates the secretion of ________ from the liver and other tissue. This hormone has ________ feedback effect on growth hormone secretion.

: insulin-like growth factor; negative Section Title: Growth Hormone Learning Outcome: 23.13

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 63) ACTH is synthesized from a large glycoprotein called ________, which also produces ________ in the pituitary.

: pro-opiomelanocortin (POMC), beta endorphin Section Title: Adrenal Glucocorticoids Learning Outcome: 23.5

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 61) The thyroid gland is composed of many ________ that produce and store thyroid hormones.

: thyroid follicles Section Title: Thyroid Hormones Learning Outcome: 23.6

: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 62) Thyroid hormones are structural derivatives of the amino acid ________.

: tyrosine Section Title: Thyroid Hormones Learning Outcome: 23.6