1.
Which of the following is a distinguishing feature of secondary adrenal
insufficiency compared to primary adrenal insufficiency?
A) Hyperpigmentation of the skin
B) Low ACTH levels
C) Hyperkalemia
D) Elevated renin levels
Correct Answer: B) Low ACTH levels
Rationale: Secondary adrenal insufficiency occurs due to inadequate production of ACTH by
the pituitary, leading to low cortisol levels but normal aldosterone levels. Low ACTH
distinguishes secondary from primary adrenal insufficiency, where ACTH levels are elevated.
Hyperpigmentation, hyperkalemia, and elevated renin are associated with primary adrenal
insufficiency.
2. A patient is diagnosed with Addison’s disease. Which of the following
symptoms is most characteristic of this condition?
A) Weight gain
B) Hypertension
C) Hyperpigmentation
D) Hyperglycemia
Correct Answer: C) Hyperpigmentation
Rationale: Hyperpigmentation is a hallmark of primary adrenal insufficiency (Addison’s
disease) and results from increased ACTH production, which stimulates melanocyte receptors.
The other options are inconsistent with Addison's disease, which typically causes weight loss,
hypotension, and hypoglycemia.
3. Which electrolyte imbalance is least likely to occur in secondary adrenal
insufficiency?
A) Hyponatremia
B) Hyperkalemia
C) Hypoglycemia
D) Low bicarbonate
Correct Answer: B) Hyperkalemia
Rationale: Hyperkalemia is not seen in secondary adrenal insufficiency because aldosterone
production remains intact (regulated by the renin-angiotensin system). In contrast, primary
adrenal insufficiency affects aldosterone, leading to hyperkalemia. Both primary and secondary
adrenal insufficiency may cause hyponatremia and hypoglycemia due to cortisol deficiency.
4. What is the most appropriate initial treatment for a patient in acute adrenal
crisis?
A) Hydrocortisone and IV fluids
B) Fludrocortisone and oral fluids
C) Spironolactone and oral sodium
D) ACTH injections and bed rest
Correct Answer: A) Hydrocortisone and IV fluids
Rationale: The management of an acute adrenal crisis requires immediate administration of
intravenous hydrocortisone and IV fluids to replace cortisol and correct hypotension and
electrolyte imbalances. Fludrocortisone, a mineralocorticoid, may be used later in chronic
management but is not the first-line treatment in a crisis.
5. Which of the following is the best test to differentiate between primary and
secondary adrenal insufficiency?
A) Serum cortisol
B) Plasma renin activity
C) ACTH stimulation test
D) Serum ACTH level
Correct Answer: D) Serum ACTH level
Rationale: Measuring serum ACTH levels helps differentiate between primary and secondary
adrenal insufficiency. In primary adrenal insufficiency, ACTH is elevated due to the lack of
negative feedback from cortisol. In secondary adrenal insufficiency, ACTH levels are low
because the pituitary is unable to produce sufficient ACTH.
