Endocrine: adrenal steroid synthesis: practice question

A Physiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Physiology · Endocrine: adrenal steroid synthesis

Sample item

A girl born with virilised genitalia is found in early childhood to have hypertension and hypokalaemia, with raised 11-deoxycortisol and low renin. What causes the hypertension?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Accumulation of 11-deoxycorticosterone, which has mineralocorticoid activity

Deficiency of 11-beta hydroxylase blocks cortisol synthesis, raising ACTH, and the precursors 11-deoxycorticosterone and 11-deoxycortisol build up. Deoxycorticosterone has mineralocorticoid action, causing sodium retention, hypertension and hypokalaemia with suppressed renin and aldosterone. Androgen excess produces virilisation.

Option by option

  • A. Accumulation of 17-hydroxyprogesterone, a potent vasoconstrictor

    17-hydroxyprogesterone is the marker of 21-hydroxylase deficiency and is not a vasoconstrictor.

  • B. Excess aldosterone secretion from high ACTH

    Aldosterone is low here, as indicated by suppressed renin.

  • C. Deficient cortisol causing loss of vascular tone

    Cortisol deficiency alone would tend to lower blood pressure.

  • D. Accumulation of 11-deoxycorticosterone, which has mineralocorticoid activity (correct)

    Correct. Deoxycorticosterone acts on the mineralocorticoid receptor and retains salt.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is D, Accumulation of 11-deoxycorticosterone, which has mineralocorticoid activity. Deficiency of 11-beta hydroxylase blocks cortisol synthesis, raising ACTH, and the precursors 11-deoxycorticosterone and 11-deoxycortisol build up.

Why is "Accumulation of 17-hydroxyprogesterone, a potent vasoconstrictor" not the answer?

17-hydroxyprogesterone is the marker of 21-hydroxylase deficiency and is not a vasoconstrictor.

Why is "Excess aldosterone secretion from high ACTH" not the answer?

Aldosterone is low here, as indicated by suppressed renin.

Why is "Deficient cortisol causing loss of vascular tone" not the answer?

Cortisol deficiency alone would tend to lower blood pressure.

What concept does this question test?

It tests Endocrine: adrenal steroid synthesis in Physiology. Deoxycorticosterone has mineralocorticoid action, causing sodium retention, hypertension and hypokalaemia with suppressed renin and aldosterone. Androgen excess produces virilisation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine: adrenal steroid synthesis?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.