200 Essentials of Biochemistry

c. Progesterone to produce the expected increase in TSH. Which

d. Estriol of the following is the most likely cause of the
Answer is d. Plasma levels of maternal patient’s hypothyroidism?
estrogens during pregnancy are dependent on a. Secondary hypothyroidism
a functioning fetus. The fetal adrenal cortex b. Hashimoto’s thyroiditis
and liver produce the weak androgens, DHEA-S c. Iodine deficiency
and 16-OH DHEA-S, which are carried to the d. Tertiary hypothyroidism
placenta by the fetal circulation. The placenta Answer is a. A decrease in both serum T4
then desulfates the androgens and aromatizes and TSH could result from either a pituitary
them to estrogens (16-OH DHEA-S, estriol) defect or a hypothalamic defect. In the case of
prior to delivery to the maternal circulation. the hypothalamic defect, decreased secretion
Estradiol and estrone increase approximately of TRH leads to decreased TSH secretion and,
50 fold during pregnancy, but estriol increases hence, decreased T4 secretion. In secondary
about 1000 fold. When estriol is assayed daily, a hypothyroidism, a decrease in TSH secretion
significant drop may be a sensitive early indicator due to a pituitary defect is responsible for
of fetal jeopardy. the decreased T4. The TRH stimulation test
10. A patient with signs and symptoms consistent can be used to distinguish between these two
with hypothyroidism exhibits a decrease in both possibilities. Failure of TSH to increase after
serum TSH and serum T4. Injection of TRH fails injection of TRH indicates a pituitary defect.

Multiple Choice Questions

1. Binding of hormones to receptor activates: c. Its secretion is stimulated by TRH

a. Glycoprotein d. Its secretion is repressed by dopamine
b. G protein 6. Vasopressin:
c. M protein a. Is secreted from anterior pituitary gland
d. Lipoproteins b. Deficiency results in diabetes mellitus
2. The hormonal action on the target organs c. Deficiency occurs due to basal skull fractures
depends on all the following factors except: d. Deficiency leads to oliguria
a. Cyclic AMP 7. Which one of the following is NOT a hypothyroid
b. Adenylate cyclase disease?
c. Receptor a. Cretinism
d. ADP b. Myxedema
3. Which of the following is NOT an anterior c. Graves’s disease
pituitary hormone: d. Goiter
a. Prolactin 8. Concerning the hypothyroidism, one of the
b. Follicular stimulating hormone following is incorrect:
c. Antidiuretic hormone a. Sensitivity to heat
d. Alpha-Melanocyte stimulating hormone b. Rapid heart rate
4. Human growth hormone is also called as: c. Increased BMR
a. Cortisol d. Reduced TSH
b. Somatomammotropin 9. Concerning calcium homeostasis by PTH, all of
c. a-melanocyte stimulating hormone the following statements are true except:
d. Somatotropin a. It increases the resorption bone
5. Concerning prolactin, all of the following b. It reduces renal clearance or excretion of
statements are true except: calcium during hypocalcemia
a. Hypoprolactinemia is a cause of infertility in c. It acts upon the intestine to increase Ca2+
females absorption
b. It is a protein of 198 amino acids d. It increases renal phosphate clearance
 Hormones 201
10. Concerning the glucocorticoids all of the c. Catecholamine
following statements are true except: d. Cortisol
a. It stimulates glycolysis 19. The maximum number of hormone secreting
b. It has anti-inflammatory effect cells of anterior pituitary are:
c. It prevents the rejection of transplanted organs a. Thyrotropes
d. It is used to control asthma. b. Corticotropes
11. Cushing’s syndrome: c. Lactotropes
a. Results from deficiency of glucocorticoids d. Somatotropes
b. Present with low blood glucose 20. Which of the following is rapid acting?
c. Sensitive to infection a. T4
d. Patients have obesity b. TBG
12. Cohn’s syndrome results from the deficiency c. T3
of: d. Thyroglobulin
a. Elevated aldosterone 21. In myxedema, serum findings are all except:
b. Elevated cortisol a. Low T3, T4
c. Reduced mineralocorticoids b. High TSH
d. Reduced dopamine c. Low cholesterol
13. Concerning the adrenal gland hormones, one d. Normal creatinine
of the following statements is incorrect: 22. Conversion of Vit D3 to 1-25 dihydroxycholecal-
a. They are derived from tyrosine ciferol occurs in:
b. They rise the blood pressure a. Kidney
c. Elevated BMR b. Adrenal cortex
d. Reduced ACTH secretion from the anterior c. Bone
pituitary d. Intestine
14. Insulin: 23. Thyroid hormone:
a. Stimulates gluconeogenesis a. Decrease the absorption of carbohydrate from
b. Is synthesized directly the intestine
c. Inhibits lipolysis b. Exerts a positive feedback action on TSH
d. Increases the uptake of glucose from the production
peripheral cells c. Indirectly increases the nitrogen excretion
15. Concerning the estrogen, all of the following d. Has a does not have any action on the cardiac
are true except: muscle
a. Stimulates the mammary gland 24. Concerning aldosterone one of the following
b. Increases the adipose tissue fat statements is incorrect:
c. Participate in pregnancy if it occurs a. Deficiency results in hypotension
d. Broadening the pelvis b. Increases sodium reabsorption from urine
16. All of the following are the adrenal gland c. Release is stimulated by an increase in
hormones except: angiotensin II
a. Epinephrine d. Is secreted by the zona fasciculata
b. ADH 25. Concerning insulin, all the following are true
c. Mineralocorticoids except:
d. Glucocorticoids a. Stimulate glycolysis in liver
17. Which one of the following does not secret b. Stimulate lipogenesis in liver and fat tissues
steroid hormones? c. Is synthesized in the endoplasmic reticulum of
a. Ovary the beta cells
b. Testes d. Receptors are increased in the presence of
c. Adrenal medulla uremia
d. Placenta 26. Calcitonin:
18. Receptors within cell cytoplasm are specific to: a. Is produced by the parafollicular cells outside
a. Peptide hormones the thyroid glands
b. Protein hormones b. Is a steroid hormone
 202 Essentials of Biochemistry

c. Is decreased in the presence of hypercalcemia 28. Amyloidosis:

d. Increases incorporation of calcium into bone a. The protein stained with eosin
matrix b. The deposition is intracellular
27. Parathyroid hormone: c. Has a polymorphous structure
a. Is not a peptide hormone d. AL type is seen in 15 percent of patients with
b. Is released in response to hypocalcemia multiple myeloma.
c. Increases phosphate reabsorption in the kidneys
d. Increases calcium excretion in the kidneys

Answers
1. b 2. d 3. c 4. d 5. a 6. c 7. c 8. b
9. d 10. a 11. d 12. a 13. d 14. c 15. a 16. b
17. c 18. d 19. d 20. c 21. c 22. a 23. c 24. d
25. d 26. d 27. b 28. d