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NBME 20 Answers

nbme20/Block 2/Question#30

A 78-year-old man is brought to the emergency ...


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submitted by hayayah(525),

He's not eating enough.

One of cortisol's functions is to increase gluconeogenesis, lipolysis, and proteolysis.

IGF-1 is produced primarily by the liver as an endocrine hormone as well as in target tissues in a paracrine/autocrine fashion. Production is stimulated by growth hormone (GH) and can be retarded by undernutrition, growth hormone insensitivity, lack of growth hormone receptors, or failures of the downstream signaling pathway post GH receptor including SHP2 and STAT5B.

From wikipedia; sourced to: https://academic.oup.com/endo/article-abstract/135/1/472/3036057?redirectedFrom=fulltext

 +1  upvote downvote
submitted by youssefa(37),

From Faid 2019 new figure: IGF-1 mainly functions as an anabolic hormone on muscles and bones (pretty much like insulin-> decreases serum glucose). GH acts separately by promoting insulin resistance (increasing serum glucose). Therefore, IGF-1 is not the answer. If GH was among the answers it would have got really confusing.

charcot_bouchard  Can anyone take a little time to curse on that daughter? +3  
dbg  Sure, charcot. Just wished on her to get a couple of charcots (the triad, your aneuryms, marie tooth, etc). +  
noorahsaahir  Charcot_bouchard and dbg best comments .... 不不不不不 +  

Anyone know why IGF-1 wouldn't be increased as well? GHRH is stimulated in hypoglycemic states.

nala_ula  Honestly, it's something that has confused me for a while. Why is it that GH secretion is stimulated by hypoglycemia? I mean, it's literally called growth hormone (for growth!), and hypoglycemia, which is basically a "starvation" state, will stimulate this hormone? +  
shaeking  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529368/ This might help answer your question. I basically didn't pick IGF-1 because it would increase the uptake of glucose leading to a worsen hypoglycemic state. Didn't have a true reason otherwise. +  
temmy  IGF-1 is regulated by insulin. so it will be decreased because insulin levels are also low. +2  
nala_ula  thank you @shaeking! +  
nwinkelmann  I found this and it also explains to a more genetic/cellular level. Essentially, it says that starvation induces some factors that cause GH resistance and IGF1 suppression. +1  
nwinkelmann  Sorry forgot the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575072/ +  

 +0  upvote downvote
submitted by rio19111(6),

I think a lot of you missed the point. The answer is Cortisol because it helps maintain blood pressure even in the setting where he is malnourished.

rio19111  FA 2019, Pg. 329 +1  
pakimd  according to pathoma, cortisol is the hormone neccessary for life. in a condition like the one presented in the Q-stem the most important hormone will be cortisol. +1