Get me 100 mcqs in conn cushing addison adrenal gland and its ohysio .. not much understood and remembering but let me try

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Here are 100 MCQs on Conn's syndrome, Cushing's syndrome, Addison's disease, and adrenal gland physiology - crafted to test real understanding, not just recall.

100 MCQs: Adrenal Gland, Conn's, Cushing's & Addison's

SECTION 1: Adrenal Gland Anatomy & Physiology (Q1-20)

Q1. The adrenal cortex is divided into three zones. Which zone produces aldosterone?

A) Zona fasciculata
B) Zona reticularis
C) Zona glomerulosa ✅
D) Adrenal medulla

Mnemonic: GFR - Salt (glomerulosa), Sugar (fasciculata), Sex (reticularis)

Q2. Which enzyme is found exclusively in the zona glomerulosa and is responsible for aldosterone synthesis?

A) 17α-hydroxylase
B) 11β-hydroxylase
C) Aldosterone synthase (CYP11B2) ✅
D) 21-hydroxylase

Q3. Cortisol secretion follows a diurnal rhythm. When is cortisol at its PEAK?

A) Midnight
B) Early morning (6-8 AM) ✅
C) Noon
D) Late evening

Q4. What is the primary stimulus for aldosterone secretion?

A) ACTH
B) High sodium
C) Angiotensin II ✅
D) Low potassium

Q5. Cortisol is transported in blood primarily bound to:

A) Albumin
B) Transcortin (cortisol-binding globulin) ✅
C) Alpha-1 glycoprotein
D) It circulates freely

Q6. Which of the following is NOT a glucocorticoid effect of cortisol?

A) Gluconeogenesis
B) Lipolysis
C) Increased aldosterone secretion ✅
D) Protein catabolism

Q7. The adrenal medulla is a modified:

A) Endocrine gland
B) Sympathetic ganglion ✅
C) Parasympathetic ganglion
D) Neural crest derivative unrelated to ganglia

Q8. What percentage of adrenal medulla secretion is epinephrine vs norepinephrine?

A) 20% epinephrine, 80% norepinephrine
B) 80% epinephrine, 20% norepinephrine ✅
C) 50% each
D) 100% epinephrine

Q9. ACTH acts primarily on which zone?

A) Zona glomerulosa
B) Zona fasciculata ✅
C) Zona reticularis
D) Both B and C ✅ (ACTH acts on fasciculata predominantly for cortisol; also stimulates reticularis for androgens)

Best answer: D

Q10. Aldosterone acts on the kidney to:

A) Retain Na+, retain K+
B) Retain Na+, excrete K+ ✅
C) Excrete Na+, retain K+
D) Excrete both Na+ and K+

Q11. Which receptor does aldosterone act through?

A) Glucocorticoid receptor
B) Mineralocorticoid receptor ✅
C) Androgen receptor
D) Membrane-bound G-protein receptor

Q12. Cortisol suppresses immunity by:

A) Increasing IL-1 and IL-6
B) Inhibiting phospholipase A2 (reducing prostaglandins) ✅
C) Stimulating mast cell degranulation
D) Increasing neutrophil migration

Q13. Which of the following best describes the "stress response" of cortisol?

A) Anabolic, anti-inflammatory
B) Catabolic, anti-inflammatory ✅
C) Anabolic, pro-inflammatory
D) Catabolic, pro-inflammatory

Q14. The zona reticularis produces mainly:

A) Aldosterone
B) Cortisol
C) DHEA and androgens ✅
D) Epinephrine

Q15. Which of the following correctly describes the HPA axis feedback?

A) Low cortisol → decreased CRH → decreased ACTH
B) High cortisol → increased CRH → increased ACTH
C) High cortisol → decreased CRH and ACTH (negative feedback) ✅
D) ACTH directly inhibits CRH

Q16. Mineralocorticoid receptors have equal affinity for cortisol and aldosterone. What prevents cortisol from constantly activating them?

A) Cortisol doesn't enter renal cells
B) 11β-hydroxysteroid dehydrogenase type 2 converts cortisol to inactive cortisone ✅
C) Cortisol is rapidly degraded in plasma
D) Aldosterone is present in much higher concentrations

Q17. Which electrolyte abnormality is most expected in primary adrenal insufficiency?

A) Hypernatremia, hypokalemia
B) Hyponatremia, hyperkalemia ✅
C) Hypernatremia, hyperkalemia
D) Hyponatremia, hypokalemia

Q18. Adrenal androgens are responsible for which feature in females?

A) Breast development
B) Pubic and axillary hair ✅
C) Menstrual cycle
D) Lactation

Q19. What is the precursor for ALL adrenal steroid hormones?

A) Tyrosine
B) Arachidonic acid
C) Cholesterol ✅
D) Tryptophan

Q20. The renin-angiotensin-aldosterone system (RAAS) is activated by:

A) Hypervolemia
B) High sodium intake
C) Decreased renal perfusion pressure ✅
D) Hyperkalemia alone

SECTION 2: Cushing's Syndrome (Q21-45)

Q21. The MOST COMMON cause of Cushing's syndrome overall is:

A) Adrenal adenoma
B) Ectopic ACTH
C) Exogenous glucocorticoid use ✅
D) Pituitary adenoma

Q22. Cushing's DISEASE (specifically) refers to:

A) Any cause of hypercortisolism
B) Hypercortisolism due to pituitary adenoma secreting ACTH ✅
C) Adrenal adenoma causing cortisol excess
D) Ectopic ACTH production

Q23. Which is the most common endogenous cause of Cushing's syndrome?

A) Adrenal carcinoma
B) Ectopic ACTH from small cell lung cancer
C) Pituitary adenoma (Cushing's disease) ✅
D) Adrenal adenoma

Q24. A patient with Cushing's syndrome has low ACTH levels. The most likely cause is:

A) Pituitary adenoma
B) Ectopic ACTH production
C) Adrenal adenoma or carcinoma ✅
D) Hypothalamic CRH excess

Q25. Classic features of Cushing's include all EXCEPT:

A) Central obesity
B) Purple striae
C) Hyperpigmentation ✅
D) Moon face

Hyperpigmentation occurs in ACTH-excess states (Addison's, ectopic ACTH) - NOT in adrenal Cushing's where ACTH is suppressed

Q26. Which test is the BEST initial screening test for Cushing's syndrome?

A) Morning serum cortisol
B) 24-hour urinary free cortisol ✅ (or late-night salivary cortisol)
C) ACTH stimulation test
D) Insulin tolerance test

Q27. The overnight 1mg dexamethasone suppression test - in a NORMAL individual:

A) Cortisol remains >550 nmol/L
B) Cortisol suppresses to <50 nmol/L ✅
C) ACTH doubles
D) There is no change in cortisol

Q28. In Cushing's DISEASE (pituitary), what happens with high-dose dexamethasone (8mg) suppression test?

A) No suppression
B) Cortisol suppresses by >50% ✅
C) ACTH rises paradoxically
D) Complete suppression to undetectable

Q29. In ectopic ACTH syndrome, the high-dose dexamethasone suppression test shows:

A) >50% suppression of cortisol
B) No suppression ✅
C) Paradoxical cortisol rise
D) ACTH suppression

Q30. Which of the following is characteristic of Cushing's syndrome on imaging?

A) Bilateral adrenal hyperplasia in adrenal cause
B) Bilateral adrenal hyperplasia in ACTH-dependent causes ✅
C) Adrenal atrophy in pituitary cause
D) Normal adrenals always

Q31. A patient with Cushing's has markedly elevated ACTH (>200 pg/mL), hypokalemic alkalosis, and minimal cushingoid features. Most likely cause?

A) Pituitary adenoma
B) Adrenal adenoma
C) Ectopic ACTH (e.g., small cell lung cancer) ✅
D) Adrenal hyperplasia

Q32. Cushing's syndrome causes diabetes mellitus through:

A) Pancreatic beta cell destruction
B) Decreased insulin secretion
C) Peripheral insulin resistance and increased gluconeogenesis ✅
D) Increased renal glucose reabsorption

Q33. Which psychiatric manifestation is MOST common in Cushing's syndrome?

A) Schizophrenia
B) Mania
C) Depression ✅
D) Obsessive-compulsive disorder

Q34. Osteoporosis in Cushing's syndrome occurs because cortisol:

A) Increases calcium absorption from gut
B) Inhibits osteoblasts and reduces calcium absorption ✅
C) Stimulates parathyroid hormone
D) Increases urinary calcium retention

Q35. The "buffalo hump" in Cushing's syndrome is due to:

A) Muscle hypertrophy
B) Fat redistribution - dorsocervical fat pad deposition ✅
C) Spinal osteoporosis
D) Lymph node enlargement

Q36. Which investigation best LOCALIZES the source in Cushing's after biochemical diagnosis?

A) Random serum cortisol
B) Inferior petrosal sinus sampling (IPSS) for distinguishing pituitary vs ectopic ✅
C) 24-hour UFC
D) Low-dose dexamethasone test

Q37. Nelson's syndrome occurs after:

A) Adrenalectomy for adrenal Cushing's
B) Bilateral adrenalectomy for Cushing's disease ✅
C) Pituitary irradiation
D) Ectopic ACTH treatment

Nelson's = pituitary adenoma enlargement + hyperpigmentation after bilateral adrenalectomy removes negative feedback

Q38. Proximal muscle weakness in Cushing's is due to:

A) Hypercalcemia
B) Glucocorticoid-induced protein catabolism in muscle ✅
C) Peripheral neuropathy
D) Hypokalemia alone

Q39. Which skin finding is SPECIFIC to Cushing's (vs simple obesity)?

A) Acanthosis nigricans
B) Wide (>1cm), violaceous (purple) striae ✅
C) Thin striae
D) Xanthomas

Q40. In a child, the most common cause of Cushing's syndrome is:

A) Pituitary adenoma
B) Ectopic ACTH
C) Exogenous steroids ✅
D) Adrenal carcinoma

Q41. The drug of choice to control cortisol excess in preparation for surgery in Cushing's:

A) Spironolactone
B) Metyrapone or ketoconazole ✅
C) Dexamethasone
D) Fludrocortisone

Q42. Hypertension in Cushing's syndrome is due to:

A) Only mineralocorticoid effects of cortisol
B) Cortisol activating mineralocorticoid receptors (when 11β-HSD2 is overwhelmed) + other vasoactive effects ✅
C) Direct cardiac stimulation
D) Renin suppression

Q43. A patient undergoes successful pituitary surgery for Cushing's disease. Post-operatively, they need:

A) High-dose mineralocorticoids only
B) Glucocorticoid replacement until HPA axis recovers ✅
C) No replacement - cortisol normalizes immediately
D) Lifelong ACTH injections

Q44. Which tumor marker is associated with ectopic ACTH from carcinoid tumors?

A) CEA
B) AFP
C) Chromogranin A ✅
D) CA-125

Q45. Pseudo-Cushing's state is seen in:

A) Hypothyroidism
B) Chronic alcoholism and severe depression ✅
C) Acromegaly
D) Type 2 diabetes alone

SECTION 3: Conn's Syndrome (Primary Hyperaldosteronism) (Q46-65)

Q46. Conn's syndrome is characterized by:

A) Low aldosterone, high renin
B) High aldosterone, high renin
C) High aldosterone, low renin ✅
D) Low aldosterone, low renin

Q47. The MOST COMMON cause of primary hyperaldosteronism is:

A) Unilateral adrenal adenoma (Conn's adenoma) - historically thought most common
B) Bilateral idiopathic adrenal hyperplasia ✅ (now recognized as most common ~60-70%)
C) Adrenal carcinoma
D) Familial hyperaldosteronism

Q48. The classic triad of Conn's syndrome is:

A) Hypertension, hypokalemia, metabolic acidosis
B) Hypertension, hypokalemia, metabolic alkalosis ✅
C) Hypotension, hyperkalemia, metabolic acidosis
D) Hypertension, hyperkalemia, metabolic alkalosis

Q49. Why does Conn's syndrome cause metabolic alkalosis?

A) Aldosterone directly stimulates bicarbonate production
B) Aldosterone increases H+ excretion in collecting duct alongside K+ ✅
C) Hypernatremia causes alkalosis
D) Elevated cortisol causes alkalosis

Q50. Conn's syndrome does NOT typically cause edema because of:

A) Increased oncotic pressure
B) "Aldosterone escape" - ANP and pressure natriuresis prevent continued Na+ retention ✅
C) Decreased aldosterone effect over time
D) Increased protein intake

Q51. The best SCREENING test for primary hyperaldosteronism in a hypertensive patient is:

A) Plasma aldosterone alone
B) Plasma renin alone
C) Aldosterone-to-renin ratio (ARR) ✅
D) 24-hour urinary aldosterone

Q52. What ARR value is generally considered a positive screen?

A) >10
B) >20-30 (depending on units) ✅
C) >5
D) >100

Q53. Which drug used for hypertension can FALSELY elevate renin, potentially masking Conn's?

A) Beta-blockers
B) ACE inhibitors and ARBs ✅
C) Calcium channel blockers
D) Alpha-blockers

Q54. Which antihypertensive drug is preferred while investigating possible Conn's syndrome (least interference with ARR)?

A) Amlodipine (calcium channel blocker) ✅
B) Lisinopril
C) Spironolactone
D) Atenolol

Q55. After a positive ARR, confirmatory testing includes:

A) Repeat ARR
B) Salt loading test (oral or IV saline) - failure to suppress aldosterone confirms diagnosis ✅
C) Dexamethasone suppression test
D) ACTH stimulation test

Q56. To distinguish unilateral adenoma from bilateral hyperplasia in Conn's, the gold standard is:

A) CT scan of adrenals
B) MRI adrenals
C) Adrenal vein sampling (AVS) ✅
D) Scintigraphy with NP-59

Q57. Treatment for unilateral adrenal adenoma (Conn's) is:

A) Lifelong spironolactone
B) Bilateral adrenalectomy
C) Laparoscopic unilateral adrenalectomy ✅
D) Fludrocortisone suppression

Q58. Treatment for bilateral idiopathic hyperaldosteronism is:

A) Bilateral adrenalectomy
B) Unilateral adrenalectomy
C) Spironolactone (mineralocorticoid receptor antagonist) ✅
D) Corticosteroid therapy

Q59. A patient with Conn's develops painful gynecomastia on treatment. The responsible drug is:

A) Enalapril
B) Spironolactone ✅
C) Amlodipine
D) Atenolol

Spironolactone is anti-androgenic → gynecomastia; switch to eplerenone (more selective)

Q60. Familial hyperaldosteronism type I (glucocorticoid-remediable aldosteronism) is caused by:

A) KCNJ5 gene mutation
B) Chimeric CYP11B1/CYP11B2 gene - aldosterone synthase under ACTH control ✅
C) Pheochromocytoma association
D) MEN2 mutation

Q61. In glucocorticoid-remediable aldosteronism, hypertension is treated with:

A) Spironolactone only
B) Low-dose dexamethasone (suppresses ACTH, thereby suppressing aldosterone) ✅
C) Surgical adrenalectomy
D) Fludrocortisone

Q62. Hypokalemia in Conn's causes which cardiac complication?

A) Heart block
B) Ventricular arrhythmias ✅
C) Pericarditis
D) Aortic stenosis

Q63. A patient with Conn's syndrome has a serum K+ of 2.8 mEq/L. They are also likely to have:

A) Respiratory acidosis
B) Muscle cramps, weakness, polyuria (nephrogenic DI from hypokalemia) ✅
C) Hyperpigmentation
D) Hypoglycemia

Q64. In Conn's syndrome, plasma renin activity is low because:

A) Aldosterone inhibits renin via juxtaglomerular cells (volume expansion suppresses renin) ✅
B) Hyperkalemia suppresses renin
C) Cortisol directly inhibits renin
D) ACTH suppresses renin

Q65. Secondary hyperaldosteronism differs from primary in that:

A) Aldosterone is low
B) Renin is HIGH (driven by renal hypoperfusion, heart failure, cirrhosis, etc.) ✅
C) Blood pressure is always low
D) It never causes hypokalemia

SECTION 4: Addison's Disease (Primary Adrenal Insufficiency) (Q66-85)

Q66. The most common cause of primary adrenal insufficiency (Addison's disease) in developed countries is:

A) Tuberculosis
B) Autoimmune adrenalitis ✅
C) Metastatic malignancy
D) Waterhouse-Friderichsen syndrome

Q67. The most common cause of Addison's disease WORLDWIDE (including developing countries) historically has been:

A) Autoimmune
B) Tuberculosis ✅
C) Fungal infections
D) HIV

Q68. Classic hyperpigmentation in Addison's occurs due to:

A) Increased cortisol → MSH
B) Increased ACTH → stimulates MC1R (melanocortin-1 receptor) on melanocytes ✅ (ACTH shares precursor POMC with MSH)
C) Hemosiderin deposition
D) Increased estrogen

Q69. Hyperpigmentation in Addison's disease is most prominent at:

A) Trunk
B) Sun-exposed areas, skin creases, mucous membranes, scars ✅
C) Face only
D) Palms only

Q70. The biochemical hallmark of primary adrenal insufficiency is:

A) Low cortisol, low ACTH
B) Low cortisol, HIGH ACTH ✅
C) High cortisol, low ACTH
D) Normal cortisol, high ACTH

Q71. The gold standard diagnostic test for Addison's disease is:

A) Basal morning cortisol
B) Short Synacthen test (250μg ACTH stimulation test) ✅
C) Insulin tolerance test
D) Overnight dexamethasone suppression test

Q72. In a SHORT Synacthen test, adrenal insufficiency is diagnosed when 30-min cortisol is:

A) <500 nmol/L ✅ (typically, peak <500 nmol/L indicates insufficiency)
B) >550 nmol/L
C) <200 nmol/L only
D) Any value below baseline

Q73. An Addisonian crisis is precipitated by:

A) Excess steroid intake
B) Stress (infection, surgery, trauma) without dose adjustment ✅
C) High salt diet
D) Hypertension treatment

Q74. The treatment of Addisonian crisis includes:

A) Oral hydrocortisone + fludrocortisone
B) IV hydrocortisone 100mg stat + IV normal saline ✅
C) IV dexamethasone alone
D) IV aldosterone replacement

Q75. Why is dexamethasone preferred over hydrocortisone in suspected Addison's BEFORE Synacthen testing?

A) Dexamethasone has more mineralocorticoid activity
B) Dexamethasone does NOT interfere with cortisol assay, allowing the Synacthen test to be performed ✅
C) Dexamethasone is less immunosuppressive
D) Hydrocortisone causes adrenal suppression

Q76. Maintenance replacement in Addison's disease requires:

A) Glucocorticoid only (hydrocortisone)
B) Mineralocorticoid only (fludrocortisone)
C) Both glucocorticoid (hydrocortisone) AND mineralocorticoid (fludrocortisone) ✅
D) Cortisone and spironolactone

Q77. Secondary adrenal insufficiency differs from Addison's because:

A) Cortisol is high
B) ACTH is HIGH
C) Mineralocorticoid function is PRESERVED (aldosterone is primarily RAAS-regulated) ✅
D) Hyperpigmentation is more pronounced

Q78. Which autoantibody is associated with autoimmune Addison's disease?

A) Anti-TPO
B) 21-hydroxylase antibodies (anti-adrenal antibodies) ✅
C) Anti-dsDNA
D) Anti-CCP

Q79. Waterhouse-Friderichsen syndrome is associated with:

A) Autoimmune destruction of adrenals
B) Bilateral adrenal hemorrhage due to Neisseria meningitidis septicemia ✅
C) Adrenal tuberculosis
D) CMV adrenalitis in HIV

Q80. Addison's disease is associated with which other autoimmune conditions? (Most common association)

A) Systemic lupus erythematosus
B) Autoimmune thyroid disease (Hashimoto's, Graves') ✅ - part of Schmidt's syndrome / APS type 2
C) Rheumatoid arthritis
D) Psoriasis

Q81. Schmidt's syndrome (APS type 2) includes:

A) Addison's + Type 1 DM + Hypoparathyroidism
B) Addison's + Autoimmune thyroid disease ± Type 1 DM ✅
C) Addison's + Vitiligo + Pernicious anemia
D) Addison's + Hypoparathyroidism only

Q82. In Addison's disease, which ECG finding is associated with hyperkalemia?

A) Prolonged QT
B) Peaked T waves → widened QRS → sine wave pattern ✅
C) ST elevation
D) Delta waves

Q83. Hypoglycemia in Addison's occurs because cortisol:

A) Is needed for insulin secretion
B) Normally promotes gluconeogenesis and glycogenolysis - its absence causes hypoglycemia ✅
C) Inhibits glucose uptake
D) Stimulates ketone production

Q84. A patient with known Addison's is having elective surgery. Their steroid regimen should be:

A) Stopped 24 hours before surgery
B) Doubled for 3 days post-op
C) "Sick day rules" - stress dosing: hydrocortisone 25-50mg IV at induction, then 3x usual dose for 48-72hrs ✅
D) No change needed

Q85. Salt craving in Addison's disease is due to:

A) Cortisol deficiency causing psychological stress
B) Aldosterone deficiency → sodium loss → physiological craving for salt ✅
C) Elevated ACTH stimulating salt appetite centers
D) Hypoglycemia-induced cravings

SECTION 5: Mixed/Advanced & Clinical Scenarios (Q86-100)

Q86. A 35-year-old woman has hypertension, hypokalemia, and an adrenal mass on CT. Plasma renin is suppressed. The most likely diagnosis is:

A) Pheochromocytoma
B) Cushing's syndrome
C) Conn's syndrome (primary hyperaldosteronism) ✅
D) Adrenal metastasis

Q87. A patient presents with weight gain, purple striae, hypertension, and glucose intolerance. ACTH is elevated and NOT suppressed by high-dose dexamethasone. Most likely diagnosis:

A) Pituitary Cushing's disease
B) Adrenal adenoma
C) Ectopic ACTH syndrome ✅
D) Adrenal carcinoma

Q88. A 40-year-old man collapses during a routine infection. He is hypotensive, hypoglycemic, hyponatremic, and hyperkalemic. He has diffuse hyperpigmentation. Diagnosis:

A) Septic shock
B) Addisonian crisis ✅
C) Diabetic ketoacidosis
D) SIADH

Q89. Which of the following is a cause of LOW renin, LOW aldosterone hypertension?

A) Renovascular hypertension
B) Conn's syndrome
C) 11β-hydroxylase deficiency (congenital adrenal hyperplasia) ✅
D) Renal artery stenosis

11β-OH deficiency → 11-deoxycortisol and DOC accumulate → DOC has mineralocorticoid activity → hypertension, low renin, low aldosterone

Q90. Which CAH type presents with hypertension AND virilization?

A) 21-hydroxylase deficiency
B) 11β-hydroxylase deficiency ✅
C) 17α-hydroxylase deficiency
D) 3β-HSD deficiency

Q91. Pheochromocytoma is associated with all of the following EXCEPT:

A) MEN2A and MEN2B
B) Von Hippel-Lindau disease
C) Neurofibromatosis type 1
D) MEN1 ✅

Pheochromocytoma = MEN2A, MEN2B, VHL, NF1. NOT MEN1 (which is parathyroid, pituitary, pancreas)

Q92. A patient on long-term oral prednisolone for rheumatoid arthritis abruptly stops the drug. They develop fatigue, nausea, and hypotension. This is due to:

A) Rebound autoimmune flare
B) Secondary adrenal insufficiency from HPA axis suppression ✅
C) Primary Addison's triggered by prednisolone
D) Cortisol receptor downregulation

Q93. The "rule of 2s" for adrenal incidentaloma management - which feature most suggests malignancy?

A) Lipid-rich appearance on unenhanced CT (<10 HU)
B) Size >4cm, high HU (>10 HU unenhanced), irregular borders ✅
C) Bilateral small nodules
D) Calcification

Q94. Which test is CONTRAINDICATED before ruling out pheochromocytoma in a patient with adrenal mass?

A) CT with contrast
B) Fine needle aspiration (FNA) biopsy ✅ (can precipitate hypertensive crisis)
C) Urine metanephrines
D) MRI

Q95. A patient with known Addison's disease develops new hypertension and hypokalemia. The most likely additional diagnosis is:

A) Essential hypertension
B) Excessive fludrocortisone replacement ✅
C) New Conn's adenoma
D) Renal artery stenosis

Q96. Which imaging finding is characteristic of Addison's disease due to tuberculosis?

A) Adrenal atrophy bilaterally
B) Bilateral adrenal enlargement with calcification ✅
C) Unilateral adrenal mass
D) Normal adrenals

Q97. The ACTH stimulation test uses synthetic ACTH (Synacthen). It tests:

A) Pituitary ACTH reserve
B) Adrenal cortex response to ACTH ✅
C) Hypothalamic CRH secretion
D) Adrenal medulla function

Q98. A patient has all features of Cushing's but all biochemical tests are normal. The most likely explanation is:

A) Factitious disorder
B) Pseudo-Cushing's state (alcohol, depression) ✅
C) Cushing's syndrome in remission
D) The tests were performed incorrectly

Q99. Eplerenone is preferred over spironolactone in some patients because:

A) It is cheaper
B) It is more selective for mineralocorticoid receptors (fewer anti-androgenic side effects) ✅
C) It can be used in bilateral adrenal hyperplasia only
D) It suppresses aldosterone synthesis

Q100. Which statement about cortisol is TRUE?

A) It increases eosinophil count
B) It causes neutrophilia and eosinopenia ✅ (demargination of neutrophils; eosinophil sequestration)
C) It stimulates lymphocyte proliferation
D) It has no effect on white blood cells

Quick Summary Mnemonics

Condition	Cortisol	ACTH	Aldosterone	Renin	K+	Na+
Cushing's (adrenal)	↑	↓	Normal	Normal	Normal	Normal
Cushing's disease (pituitary)	↑	↑	Normal	Normal	Normal/↓	Normal
Conn's	Normal	Normal	↑	↓	↓	↑
Addison's (primary)	↓	↑	↓	↑	↑	↓
Secondary AdI	↓	↓	Normal	Normal	Normal	Normal

Key Differentiators to Remember:

Hyperpigmentation = elevated ACTH (Addison's, ectopic ACTH, Nelson's) - NOT adrenal Cushing's
Hypokalemia + hypertension + low renin = Conn's syndrome
High-dose dex suppresses pituitary Cushing's but NOT ectopic ACTH or adrenal causes
Fludrocortisone needed in primary (Addison's) but NOT secondary adrenal insufficiency

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