Structure and functions of adrenal gland MCQs With Answer

Structure and functions of adrenal gland MCQs With Answer

The adrenal glands are paired endocrine organs vital to B.Pharm students studying pharmacology and physiology. This concise guide focuses on the structure and functions of adrenal gland MCQs with answer, covering adrenal cortex zones (zona glomerulosa, fasciculata, reticularis), adrenal medulla, hormone synthesis (aldosterone, cortisol, DHEA, catecholamines), regulatory axes (ACTH, RAAS), key enzymes (CYP11A1, 21‑hydroxylase, 11β‑hydroxylase), and pharmacologic modulators (spironolactone, ketoconazole, metyrapone). Questions emphasize clinical correlations—Addison’s, Cushing’s, congenital adrenal hyperplasia, pheochromocytoma—and diagnostic tests useful for pharmacy practice. Clear, exam-focused items will strengthen understanding of adrenal physiology, pathophysiology, and drug actions. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which anatomical layer of the adrenal gland directly surrounds the gland as a fibrous covering?

• Adrenal cortex
• Adrenal capsule
• Zona glomerulosa
• Medulla

Correct Answer: Adrenal capsule

Q2. The three classic zones of the adrenal cortex from outermost to innermost are:

• Fasciculata, reticularis, glomerulosa
• Glomerulosa, fasciculata, reticularis
• Reticularis, glomerulosa, fasciculata
• Capsule, medulla, cortex

Correct Answer: Glomerulosa, fasciculata, reticularis

Q3. Which zone of the adrenal cortex primarily synthesizes mineralocorticoids such as aldosterone?

• Zona fasciculata
• Zona reticularis
• Zona glomerulosa
• Adrenal medulla

Correct Answer: Zona glomerulosa

Q4. Which hormone is the principal glucocorticoid produced by the adrenal cortex?

• Aldosterone
• Cortisol
• DHEA
• Epinephrine

Correct Answer: Cortisol

Q5. The adrenal medulla secretes which class of hormones?

• Steroid hormones
• Peptide hormones
• Catecholamines
• Thyroid hormones

Correct Answer: Catecholamines

Q6. Which enzyme is responsible for converting cholesterol to pregnenolone, the first step in steroidogenesis?

• Tyrosine hydroxylase
• 11β‑Hydroxylase
• Cholesterol side‑chain cleavage enzyme (CYP11A1/P450scc)
• Aromatase

Correct Answer: Cholesterol side‑chain cleavage enzyme (CYP11A1/P450scc)

Q7. Deficiency of which enzyme is the most common cause of congenital adrenal hyperplasia (CAH)?

• 21‑Hydroxylase
• 17α‑Hydroxylase
• Aromatase
• 11β‑Hydroxylase

Correct Answer: 21‑Hydroxylase

Q8. Which regulatory system is the main physiological controller of aldosterone secretion?

• Hypothalamic‑pituitary‑adrenal (HPA) axis via ACTH
• Renin‑angiotensin‑aldosterone system (RAAS)
• Thyroid stimulating hormone
• Insulin signaling

Correct Answer: Renin‑angiotensin‑aldosterone system (RAAS)

Q9. ACTH primarily regulates secretion of which adrenal product?

• Aldosterone
• Cortisol
• Epinephrine
• Renin

Correct Answer: Cortisol

Q10. Cortisol is transported in blood mainly bound to which protein?

• Albumin only
• Corticosteroid‑binding globulin (CBG, transcortin)
• Thyroxine‑binding globulin
• Sex hormone‑binding globulin

Correct Answer: Corticosteroid‑binding globulin (CBG, transcortin)

Q11. Which enzyme converts active cortisol to inactive cortisone in mineralocorticoid‑sensitive tissues?

• 11β‑Hydroxylase
• 11β‑Hydroxysteroid dehydrogenase type 2 (11β‑HSD2)
• 17α‑Hydroxylase
• 3β‑Hydroxysteroid dehydrogenase

Correct Answer: 11β‑Hydroxysteroid dehydrogenase type 2 (11β‑HSD2)

Q12. Adrenal medullary chromaffin cells are derived embryologically from which tissue?

• Endoderm
• Paraxial mesoderm
• Neural crest
• Lateral plate mesoderm

Correct Answer: Neural crest

Q13. Which is the rate‑limiting enzyme in catecholamine biosynthesis?

• Phenylethanolamine N‑methyltransferase (PNMT)
• Dopamine β‑hydroxylase
• Tyrosine hydroxylase
• Monoamine oxidase

Correct Answer: Tyrosine hydroxylase

Q14. Which enzyme converts norepinephrine to epinephrine in the adrenal medulla and is upregulated by cortisol?

• Tyrosine hydroxylase
• DOPA decarboxylase
• Phenylethanolamine N‑methyltransferase (PNMT)
• Monoamine oxidase

Correct Answer: Phenylethanolamine N‑methyltransferase (PNMT)

Q15. A patient with primary adrenal insufficiency (Addison’s disease) typically shows which laboratory abnormality?

• Hypertension and hypokalemia
• Hyponatremia and hyperkalemia
• Hypernatremia and hypokalemia
• Normal electrolytes

Correct Answer: Hyponatremia and hyperkalemia

Q16. Which drug is a competitive antagonist at the mineralocorticoid receptor and has antiandrogenic side effects?

• Fludrocortisone
• Spironolactone
• Hydrocortisone
• Metyrapone

Correct Answer: Spironolactone

Q17. Fludrocortisone is best classified pharmacologically as which of the following?

• Synthetic glucocorticoid with no mineralocorticoid activity
• Synthetic mineralocorticoid with potent sodium‑retaining effects
• Adrenal steroid synthesis inhibitor
• Adrenergic agonist

Correct Answer: Synthetic mineralocorticoid with potent sodium‑retaining effects

Q18. Metyrapone is used diagnostically and therapeutically because it inhibits which adrenal enzyme?

• 3β‑Hydroxysteroid dehydrogenase
• 11β‑Hydroxylase
• Aromatase
• Cholesterol side‑chain cleavage enzyme

Correct Answer: 11β‑Hydroxylase

Q19. Which clinical test is most appropriate to assess primary adrenal insufficiency by measuring cortisol response to exogenous ACTH?

• Dexamethasone suppression test
• ACTH stimulation test (short cosyntropin test)
• Oral glucose tolerance test
• Renin activity test

Correct Answer: ACTH stimulation test (short cosyntropin test)

Q20. A low‑dose dexamethasone suppression test is primarily used to screen for which condition?

• Addison’s disease
• Cushing’s syndrome
• Pheochromocytoma
• Primary aldosteronism

Correct Answer: Cushing’s syndrome

Q21. Which of the following drugs is known to inhibit multiple cytochrome P450 enzymes in adrenal steroid synthesis and can reduce cortisol production?

• Ketoconazole
• Fludrocortisone
• Epinephrine
• Spironolactone

Correct Answer: Ketoconazole

Q22. In primary hyperaldosteronism (Conn’s syndrome), the typical laboratory finding is:

• Hypokalemia and hypertension with low renin activity
• Hyperkalemia and hypotension with high renin activity
• Hyponatremia and hyperkalemia with high ACTH
• Normal electrolytes with low blood pressure

Correct Answer: Hypokalemia and hypertension with low renin activity

Q23. Which imaging finding is most specific for pheochromocytoma?

• Adrenal cortical hyperplasia on CT
• Enhancing adrenal medullary mass on CT/MRI with increased metanephrines
• Diffuse adrenal atrophy
• Renal adenoma

Correct Answer: Enhancing adrenal medullary mass on CT/MRI with increased metanephrines

Q24. The classic symptomatic triad of pheochromocytoma includes:

• Weight gain, cold intolerance, constipation
• Headache, sweating, tachycardia
• Polyuria, polydipsia, polyphagia
• Muscle weakness, hyperpigmentation, salt craving

Correct Answer: Headache, sweating, tachycardia

Q25. Which test measures catecholamine metabolites useful for diagnosing pheochromocytoma?

• Serum cortisol level
• Plasma or urinary fractionated metanephrines
• Plasma renin activity only
• ACTH stimulation test

Correct Answer: Plasma or urinary fractionated metanephrines

Q26. Which receptor type mediates most genomic effects of glucocorticoids inside target cells?

• Membrane G‑protein coupled receptor
• Ion channel receptor
• Intracellular nuclear glucocorticoid receptor
• Toll‑like receptor

Correct Answer: Intracellular nuclear glucocorticoid receptor

Q27. Chronic exogenous glucocorticoid therapy commonly suppresses which of the following?

• Renin secretion permanently
• Pituitary ACTH secretion leading to adrenal atrophy
• Adrenal medullary catecholamine synthesis
• Thyroid stimulating hormone (TSH) secretion only

Correct Answer: Pituitary ACTH secretion leading to adrenal atrophy

Q28. Which enzyme deficiency leads to accumulation of 11‑deoxycortisol and can cause hypertension and virilization?

• 21‑Hydroxylase deficiency
• 11β‑Hydroxylase deficiency
• 17α‑Hydroxylase deficiency
• Aromatase deficiency

Correct Answer: 11β‑Hydroxylase deficiency

Q29. The adrenal venous drainage pattern is characterized by:

• Multiple veins draining each gland into the inferior mesenteric vein
• A single central adrenal vein draining each gland into the IVC on the right and the left renal vein on the left
• Drainage directly into the portal vein
• No venous drainage, only lymphatics

Correct Answer: A single central adrenal vein draining each gland into the IVC on the right and the left renal vein on the left

Q30. StAR protein is essential in steroidogenesis because it:

• Converts cholesterol to pregnenolone enzymatically
• Transports cholesterol into mitochondria for steroid synthesis
• Methylates steroids for excretion
• Inactivates cortisol to cortisone

Correct Answer: Transports cholesterol into mitochondria for steroid synthesis

Q31. Which adrenal enzyme deficiency typically results in hypertension and hypokalemia due to excess deoxycorticosterone production?

• 21‑Hydroxylase deficiency
• 17α‑Hydroxylase deficiency
• 11β‑Hydroxylase deficiency
• 3β‑Hydroxysteroid dehydrogenase deficiency

Correct Answer: 17α‑Hydroxylase deficiency

Q32. Cortisol increases gluconeogenesis primarily by inducing which hepatic enzyme?

• Glycogen synthase
• Phosphoenolpyruvate carboxykinase (PEPCK)
• Hexokinase
• Lipoprotein lipase

Correct Answer: Phosphoenolpyruvate carboxykinase (PEPCK)

Q33. Which synthetic glucocorticoid has minimal mineralocorticoid activity and is commonly used for anti‑inflammatory therapy?

• Fludrocortisone
• Dexamethasone
• Aldosterone
• Desoxycorticosterone

Correct Answer: Dexamethasone

Q34. Apparent mineralocorticoid excess (AME) can result from deficiency of which enzyme, causing hypertension and hypokalemia?

• 11β‑HSD2 deficiency
• 11β‑HSD1 deficiency
• Tyrosine hydroxylase deficiency
• PNMT deficiency

Correct Answer: 11β‑HSD2 deficiency

Q35. Which drug blocks adrenal steroid synthesis by inhibiting 3β‑hydroxysteroid dehydrogenase or related early steps and may be used experimentally?

• Metyrapone
• Trilostane
• Spironolactone
• Metoprolol

Correct Answer: Trilostane

Q36. Which statement best describes the diurnal rhythm of cortisol secretion?

• Cortisol is highest at midnight and lowest in the early morning
• Cortisol secretion is constant throughout the day
• Cortisol peaks in the early morning and is lowest at night
• Cortisol peaks only after meals

Correct Answer: Cortisol peaks in the early morning and is lowest at night

Q37. A biochemical hallmark of Cushing’s disease due to pituitary adenoma is:

• Low ACTH with high cortisol
• High ACTH with loss of normal suppression on low‑dose dexamethasone but suppression on high‑dose dexamethasone
• Normal ACTH and cortisol
• High renin activity with low aldosterone

Correct Answer: High ACTH with loss of normal suppression on low‑dose dexamethasone but suppression on high‑dose dexamethasone

Q38. Which adrenal pathology typically presents with hyperpigmentation due to increased ACTH and MSH production?

• Secondary adrenal insufficiency due to pituitary failure
• Primary adrenal insufficiency (Addison’s disease)
• Pheochromocytoma
• Primary hyperaldosteronism

Correct Answer: Primary adrenal insufficiency (Addison’s disease)

Q39. In hypovolemic stress or severe infection, inadequate cortisol response can precipitate:

• Thyroid storm
• Adrenal crisis with refractory hypotension
• Hypoglycemia without other effects
• Primary hyperaldosteronism

Correct Answer: Adrenal crisis with refractory hypotension

Q40. The mineralocorticoid receptor in the kidney increases sodium reabsorption by upregulating which epithelial channel?

• CFTR chloride channel
• ENaC (epithelial sodium channel)
• GLUT2 glucose transporter
• Voltage‑gated calcium channel

Correct Answer: ENaC (epithelial sodium channel)

Q41. Which of the following is an immediate sympathetic effect of adrenal medullary epinephrine release?

• Decreased heart rate
• Bronchoconstriction via β2 receptors
• Increased cardiac output via β1 receptor stimulation
• Long‑term genomic changes only

Correct Answer: Increased cardiac output via β1 receptor stimulation

Q42. Which clinical measurement is used as a screening test for primary hyperaldosteronism?

• Plasma aldosterone concentration to plasma renin activity ratio (ARR)
• Serum cortisol alone
• Plasma metanephrines
• Thyroid function tests

Correct Answer: Plasma aldosterone concentration to plasma renin activity ratio (ARR)

Q43. Which adrenal disorder is characterized by cortical atrophy, hyperpigmentation, hyponatremia, hyperkalemia, and hypotension?

• Cushing’s syndrome
• Primary hyperaldosteronism
• Primary adrenal insufficiency (Addison’s disease)
• Pheochromocytoma

Correct Answer: Primary adrenal insufficiency (Addison’s disease)

Q44. POMC is the precursor polypeptide that yields ACTH and also produces which peptide that contributes to skin hyperpigmentation?

• Prolactin
• Melanocyte‑stimulating hormone (MSH)
• Thyrotropin‑releasing hormone
• Vasopressin

Correct Answer: Melanocyte‑stimulating hormone (MSH)

Q45. Which pharmacologic agent is a glucocorticoid receptor antagonist used experimentally for Cushing’s syndrome?

• Fludrocortisone
• Mifepristone
• Spironolactone
• Ketanserin

Correct Answer: Mifepristone

Q46. Which adrenal enzyme deficiency typically causes undervirilization in genetic males and ambiguous genitalia in genetic females due to impaired sex steroid synthesis?

• 17α‑Hydroxylase deficiency
• 21‑Hydroxylase deficiency
• Aromatase overactivity
• 11β‑Hydroxylase overactivity

Correct Answer: 21‑Hydroxylase deficiency

Q47. Which of the following best describes the blood supply pattern to the adrenal gland?

• Single arterial supply and multiple veins
• Rich arterial supply from three suprarenal arteries and a single central vein
• No arterial supply, only venous drainage
• Supply via portal circulation

Correct Answer: Rich arterial supply from three suprarenal arteries and a single central vein

Q48. Which steroid has the strongest mineralocorticoid activity among commonly used agents?

• Dexamethasone
• Prednisone
• Fludrocortisone
• Hydrocortisone

Correct Answer: Fludrocortisone

Q49. Which physiologic stimulus increases PNMT expression in the adrenal medulla, favoring epinephrine synthesis?

• High insulin levels
• Glucocorticoids from the adrenal cortex (cortisol)
• High thyroid hormones only
• Low ACTH levels

Correct Answer: Glucocorticoids from the adrenal cortex (cortisol)

Q50. Long‑term untreated primary hyperaldosteronism can lead to which cardiovascular consequence?

• Reduction in left ventricular mass
• Hypotension and bradycardia
• Left ventricular hypertrophy and increased cardiovascular risk
• Improved renal function and decreased blood pressure

Correct Answer: Left ventricular hypertrophy and increased cardiovascular risk

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

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