Block 6 - Endocrinology

Question 1

What is bottle A87-157?

Answer 1

A87-157 Pituitary: Adenoma with hypopituitarism

Question 2

What is bottle 855?

Answer 2

**855 Thyroid: Multinodular goitre
**
This diffusely enlarged thyroid gland is somewhat nodular. This patient was euthyroid. This represents the most common cause for an enlarged thyroid gland and the most common disease of the thyroid–a nodular goiter.

Question 3

What is bottle 851/858?

Answer 3

851 Thyroid: atrophy & 858 Thyroid: Hashimoto’s disease
This symmetrically small thyroid gland demonstrates atrophy. This patient was hypothyroid. This is the end result of Hashimoto’s thyroiditis. Initially, the thyroid is enlarged and there may be transient hyperthyroidism, followed by a euthyroid state and then hypothyroidism with eventual atrophy years later. Hashimoto’s thyroiditis results from abnormal T cell activation and subsequent B cell stimulation to secrete a variety of autoantibodies.
Hypothyroidism is most often due to thyroid gland failure (primary hypothyroidism) best diagnosed with measurement of thyroid stimulating hormone (TSH), which will be high. For secondary hypothyroidism from pituitary failure, both TSH and T4 will be low. Measurement of T3 is rarely of value.

Question 4

What is bottle 877?

Answer 4

877 Thyroid: adenoma
Here is a surgical excision of a small mass from the thyroid gland that has been cut in half. A rim of slightly darker rim normal surrounding thyroid parenchyma is seen at the left. The mass is well-circumscribed. On physical examination it felt firm. By scintigraphic scan it was “cold.” This is a follicular adenoma.

Question 5

What is bottle 2077?

Answer 5

**2077 Thyroid: papillary adenocarcinoma
**
Sectioning through a lobe of excised thyroid gland reveals a papillary carcinoma. This neoplasm can be multifocal, as seen here, because of the propensity of this neoplasm to invade lymphatics within thyroid, and lymph node metastases are also common. The larger mass shown here is cystic and contains papillary excresences. These tumors most often arise in middle-aged women. [Image contributed by John Nicholls, MD, Hong Kong University]

Question 6

What is bottle 896?

Answer 6

**896 Parathyroid: Hyperplasia.
**Parathyroid hyperplasia is shown here. Three and one-half glands have been removed (only half the gland at the lower left is present). Parathyroid hyperplasia is the second most common form of primary hyperparathyroidism, with parathyroid carcinoma the least common form.

Question 7

893 Parathyroid: adenoma

Answer 7

893 Parathyroid: adenoma

Question 8

What is bottle 859 Parathyroid?

Answer 8

**859 Parathyroid: carcinoma
**
This is the gross appearance of a parathyroid carcinoma. The serum calcium can be quite high. Note the large size and irregular cut surface. These carcinomas have a tendency to invade surrounding tissues in the neck, complicating their removal.

Question 9

837 Adrenal: atrophy

Answer 9

**837 Adrenal: atrophy
**
The pair of adrenals in the center are normal. Those at the top come from a patient with adrenal atrophy (with either Addison’s disease or long-term corticosteroid therapy). The adrenals at the bottom represent bilateral cortical hyperplasia. This could be due to a pituitary adenoma secreting ACTH (Cushing’s disease), or Cushing’s syndrome from ectopic ACTH production, or idiopathic adrenal hyperplasia.

Question 10

What is bottle 801?

Answer 10

801 Adrenal: Bilateral haemorrhage

Question 11

What is bottle 822?

Answer 11

822 Adrenal: cortical adenoma (Conn’s syndrome)

Here is a 1.3 cm left adrenal adenoma found in a patient with hypertension. She had hypokalemia on a routine chemistry panel. Further workup revealed a high serum aldosterone and a low serum renin, findings consistent with an aldosterone secreting adrenal adenoma (Conn’s syndrome). This lesion accounts for about two-thirds of cases of primary hyperaldosteronism (PHA), while bilateral adrenal hyperplasia accounts for about 30% of PHA. Such adenomas are typically less than 2 cm in size and yellow on cut surface.

Question 12

What is bottle 831 Adrenal?

Answer 12

831 Adrenal: cortical adenoma (Cushing’s syndrome)
This adrenal gland, removed surgically from a patient with Cushing syndrome, has been sectioned in half to reveal a cortical adenoma. Some remaining atrophic adrenal is seen at the right. The adenoma is composed of yellow firm tissue, just like adrenal cortex. This neoplasm is well-circumscribed. Histologically, it is composed of well-differentiated cells resembling the normal cortical fasciculata zone. It is benign.

Question 13

899 Adrenal: Adrenocortical carcinoma

Answer 13

**899 Adrenal: Adrenocortical carcinoma
**
This is a large adrenal cortical carcinoma which is displacing the left kidney downward. Such neoplasms are usually functional (secreting corticosteroids or sex steroids). They have a poor prognosis, because they are often diagnosed at a high stage, since there is room for them to enlarge in the retroperitoneum before detection.

Question 14

What is bottle 800 Adrenal?

Answer 14

**800 Adrenal: Phaeochromocytoma
**
This large adrenal neoplasm has been sectioned in half. Note the grey-tan color of the tumor compared to the yellow cortex stretched around it and a small remnant of remaining adrenal at the lower right. This patient had episodic hypertension. This is a tumor arising in the adrenal medulla–a pheochromocytoma.

Question 15

803 Adrenal: Ganglioneuroma

Answer 15

803 Adrenal: Ganglioneuroma