WBR0732

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Physiology
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A researcher is studying the role of the hypothalamic-pituitary-adrenal (HPA) axis in lifestyle stresses. She enrolls 120 healthy volunteers for the study and measures plasma concentrations of adrenal hormones during several activities. She notes that the main secretory product of the zona fasciculata of the adrenal gland may fluctuate according to the type of activity. Which of the following molecular changes occurs in response to the increased plasma concentration of the compound secreted from the zona fasciculata?]]
Answer A	AnswerA::Accumulation of cyclic AMP (cAMP)
Answer A Explanation	[[AnswerAExp::Cortisol upregulates adrenergic receptors to increase the sensitivity of norepinephrine and thus increase blood pressure. The mechanism by which cortisol or glucocorticoids achieve such permissive effect is by coupling the adrenergic receptors and the G-protein receptors to stimulate adenylate cyclase, which is sensitive to catecholamines, leading to cAMP accumulation.]]
Answer B	AnswerB::Increase in plasma norepinephrine levels
Answer B Explanation	AnswerBExp::Plasma levels of norepinephrine are unchanged with cortisol; but cortisol increases the sensitivity of norepinephrine and potentiate their effect by increasing the alpha-1 receptors on arterioles.
Answer C	AnswerC::Decrease in plasma neutrophil count
Answer C Explanation	AnswerCExp::Cortisol is associated with neutrophilia
Answer D	AnswerD::Increase in plasma eosinophil count
Answer D Explanation	AnswerDExp::Cortisol is associated with low eosinophil counts.
Answer E	AnswerE::Increase in insulin sensitivity
Answer E Explanation	AnswerEExp::Cortisol is associated with insulin resistance.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Cortisol upregulates adrenergic receptors to increase the sensitivity of norepinephrine and thus increase blood pressure. The mechanism by which cortisol or glucocorticoids achieve such permissive effect is by coupling the adrenergic receptors and the G-protein receptors to stimulate adenylate cyclase, which is sensitive to catecholamines, leading to cAMP accumulation. As such, it it believed that the target for cortisol to achieve its action is are adrenergic receptors. Following the administration of cortisol, the activity of adrenergic receptors increases to as much as 3 times its baseline value. Thyroid hormones are another example of permissive hormones that allow activity of other hormones that act through the cAMP pathway. Educational Objective: Cortisol and glucocorticoids are permissive hormones that regulate the action of other hormones that act through cAMP pathway by targeting the adrenergic receptors. Reference: Hadcock JR, Malbon CC. Regulation of beta-adrenergic receptors by "permissive" hormones: glucocorticoids increase steady-state levels of receptor mRNA. Proc Natl. Acad. Sci. USA. 1988;85:8415-8419. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::cortisol, WBRKeyword::norepinephrine, WBRKeyword::function, WBRKeyword::blood, WBRKeyword::pressure, WBRKeyword::receptor, WBRKeyword::adrenergic, WBRKeyword::zona, WBRKeyword::fasciculata
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::