TUTORIAL QUIZ: NEUROHORMONES

MPHARM YEAR 2 CNS, MENTAL HEALTH, GUT & SKIN (PY5050)

You have 15 minutes to answer all questions
NAME:
STUDENT NUMBER:
1. Which of the following hormone receptors only binds to its endogenous
ligand once it passes through the cell’s plasma membrane? (1 mark)
A. ACTH receptor
B. oxytocin receptor
C. thyroid hormone receptor
D. thyroid stimulating hormone (TSH) receptor
E. vasopressin receptor
Answer: C
Thyroid and steroid hormones can cross the cell membrane and bind to
intracellular nuclear receptors. The receptor-hormone complex (thyroid or
steroid hormone receptor) will then migrate to the nucleus and bind to DNA to
increase gene transcription.
ACTH, vasopressin, thyroid stimulating hormone (TSH) and oxytocin receptors
are GPCR receptors, with seven transmembrane domains, and are located on
the cell membrane. As such, answer “C” is correct.

2. A 61-year-old male, has been feeling unwell and has been reviewed by his
GP and
diagnosed with hyperthyroidism.
Which of the following symptoms has he most likely been experiencing? (1
mark)
A. depression
B. irritability
C. low heart rate
D. slowed mental functioning
E. weight gain
Answer: B
Symptoms of hyperthyroidism (high level of thyroxine) include increased basal
metabolic rate and all symptoms associated with that such as weight loss,
anxiety, increased heart rate, irritability. Hypothyroidism symptoms (low
plasma
level of thyroxine) include low basal metabolic rate and all symptoms
associated
with that such as low heart rate (bradycardia), weight gain, myxoedema,
depression, slow mental functioning. As such, answer “B” is correct.
3. Which of the following hormones is synthesised in the pituitary? (1 mark)
A. corticotropin–releasing hormone (CRH)
B. oxytocin
C. prolactin
D. thyrotropin–releasing hormone (TRH)
E. vasopressin
Answer: C
Oxytocin and vasopressin are hyptothalamic neurohormones synthesised in
the paraventricular and supraoptic nuclei of the hypothalamus and released in
the blood circulation in the posterior pituitary. They are synthesised in cell
bodies of magnocellular neurons which project from the hypothalamus to the
posterior pituitary where the neurohormones are released.CRH and TRH are
both hypothalamic hormones. They are synthesised in the
hypothalamus and are released in the portal system in the hypothalamus.
Once
released in the portal capillary system, they travel to the anterior pituitary
where
they stimulate the release of ACTH and TSH, respectively. Dopamine however,
can be released from the hypothalamus. It can then travel along the portal
capillary system to the anterior pituitary. There, it can inhibit prolactin release
in the blood circulation. As such, prolactin is synthesised in the anterior
pituitary, so answer “C” is correct.

4. You need to assess the risk of the following patients on developing

Cushing’s
syndrome.
Which of the following patients would be more at risk of developing Cushing’s
syndrome? (1 mark)
A. Dr A. who has been taking corticosteroids for 5 weeks to manage his
rheumatoid arthritis
B. Mr B. who has had his adrenal glands removed after an operation
C. Mr D. who has been suffering from clinical depression
D. Ms C. who has had part of her pituitary removed causing low levels of ACTH
to be
secreted
E. Ms E. who has been given thyroxine to treat a thyroid conditionAnswer: A
Cushing’s syndrome is a disorder caused by excessive production or
administration of glucocorticoid hormones, typically resulting in conditions
such as obesity, high blood pressure, diabetes and osteoporosis. Cortisol is
synthesised and released from adrenal glands. If those are removed, then one
would expect lower levels of cortisol NOT higher, so “B” cannot be correct.
High
levels of cortisol during Cushing’s syndrome could lead to depression but less
likely that depression could lead to Cushing’s syndrome, so “C” cannot be
correct. ACTH release from the pituitary in the blood circulation, would bind to
ACTH receptors in the adrenal gland to induce cortisol release. If the pituitary
is
removed causing low levels of ACTH to be secreted, that would cause less
(not
more) secretion of cortisol, so “D” is not correct. Cushing’s syndrome is often
triggered by long term treatment with cortisol in autoimmune conditions and
inflammatory conditions such as rheumatoid arthritis. It has nothing to do with
thyroxine, so “E” is NOT correct. As such, answer “A” is correct.
5. A 60-year-old man presents himself with complaints of fatigue, decreased
appetite, weight loss, low blood glucose and characteristic darkened skill on
the face,
neck and back of the hands. His GP diagnoses Addison’s disease.
Which one of the following sets of laboratory results is most consistent with
that clinical presentation? (1 mark)
A. results A
B. results B
C. results C
D. results D
E. results E
Answer: B
Addison’s disease is characterised by adrenal insufficiency. Adrenal gland
thus
secretes lower levels of adrenal gland hormones including cortisol and
mineralocorticoids such as aldosterone. Cortisol exerts negative feedback on
the pituitary and hypothalamus. As such, low levels of cortisol would result in
increase ACTH release from the anterior pituitary because of HPA negative
feedback mechanism. As such, answer “B” is correct.
Results A Results B Results C Results D Results E
Cortisol Decreased Decreased Elevated Elevated Decreased
Aldosterone Elevated Decreased Decreased Elevated Elevated
ACTH Elevated Elevated Decreased Decreased Decreased

6. Answer the following extended matching question:

A. a drug that blocks cortisol synthesis like metyrapone
B. a drug that suppresses the synthesis of thyroid hormones like carbimazole
C. corticosteroid replacement therapy
D. intranasal oxytocin
E. intranasal vasopressin
F. levothyroxine therapy to replace thyroxin
G. synthetic growth hormone
H. synthetic somatostatin
For the five statements below, match the most likely treatment from the list
above. Each option may be used once, more than once or not at all.

1. a 58-year-old female presents symptoms of hair loss, hypertension and

complained that she has put on weight. Her legs are thin and slightly bruised,
and
she appears to have purple stretch marks. The GP looked at her history and
noticed that she had been put on a long-term steroid treatment for her
rheumatoid
arthritis. What would be an appropriate therapy for her condition? (Answer: A)
Thinning of skin, bruising, appearance of purple stretch marks,
hypertension, weight gain are all cardinal symptoms of Cushing’s syndrome.
It looks like the patient has been on long-term steroid treatment for her
rheumatoid arthritis which may have caused her Cushing’s syndrome –
Cushing’s is characterized by high levels of plasma cortisol. As such,
treatments which reduce cortisol may be appropriate for the management of
the condition. As such,
“A” is the only correct answer as all the other options
apart from “C” do not affect cortisol levels. It cannot be corticosteroid
replacement therapy – as this would increase corticosteroid levels even
further.
2. a 62-year-old female presents symptoms of weight loss, anxiety, diarrhea
and
intolerance to heat. She is diagnosed with a thyroid condition. What would be
the
first-line therapy? (Answer: B)
The fact that the patient has been diagnosed by a thyroid condition suggests
it may be either hypo- or hyper-thyroidism. Weight loss and anxiety and
increased basal metabolic rate are cardinal symptoms of hyper-thyroidism.
Hyper-thyroidism is characterized by high levels of plasma thyroxine. As
such, treatment which reduces thyroxine may be appropriate in this case. As
such,
“B” is correct. The other options, apart from “F”, would not affect
thyroxine levels and “F” would be appropriate for hypo-thyroidism
conditions. Levothyroxine is taken to replace the missing thyroid hormone
thyroxine.
3. a 35-year-old man visits his GP. He presents enlarged hands and feet and
enlarged facial features, including the facial bones, lips, nose and tongue.
After
several tests, he is diagnosed with acromegaly. What would be an appropriate
therapy for his condition? (Answer: H)Enlarged hands and feet and enlarged
facial features, including the facial bones,
lips, nose, and tongue are reminiscent of acromegaly a condition
characterised
by hypersecretion of growth hormone. As such, treatment which would reduce
growth hormone may be appropriate in this case. Somatostatin inhibits growth
hormone (as well as prolactin), as such “H” is correct. None of the other
treatments would affect growth hormone release per se.
4. a 60-year-old male presents symptoms of weight loss, low blood pressure,
fatigue,
nausea, depression, and diarrhea. He is diagnosed with an adrenal gland
condition. What would be an appropriate therapy? (Answer: C)
As the patient has an adrenal gland condition it is possible that it could be
either
Addison’s disease (hyposecretion of cortisol) or Cushing’s (hypersecretion of
cortisol). Weight loss, low blood pressure, fatigue, nausea, depression, and
diarrhea are symptoms linked to Addison’s rather than Cushing’s. So,
“C” is
correct. Corticosteroid replacement therapy would replace the missing adrenal
hormone. Other treatments listed associated with treatment of thyroid
dysfunction are not relevant as the patient is diagnosed with an adrenal
condition.
5. a 35-year-old female presents to the GP with symptoms of tiredness, weight
gain,
depression, slow movement and thoughts and muscle aches. She is
diagnosed
with a thyroid condition. What would be the first-line therapy? (Answer: F)
As the patient has a thyroid gland condition, it is possible that it could be
either
hyperthyroidism or hypothyroidism. Symptoms of tiredness, weight gain,
depression, slow movement and thoughts and muscle aches are characteristic
of hypothyroidism (low thyroxine), so treatment to increase thyroxine would
be
appropriate to manage the condition. So,
“F” – levothyroxine therapy to replace
thyroxin – would be appropriate. Levothyroxine is taken to replace the missing
thyroid hormone thyroxine. Other treatments listed associated with treatment
of adrenal dysfunction are not relevant as the patient is diagnosed with a
thyroid
condition.