Endocrine Pathology

Question 1

A lack of cortisol from primary adrenal failure can lead to what disease?

Answer 1

Addison Disease

Question 2

A nodule in the adrenal cortex that has zona glomerulosa cells produces what condition? If it has zona fasciculata cells?

Answer 2

Primary hyperaldosteronism

Cushing Syndrome

Question 3

If a patient does not have detectable C peptide, what does this indicate?

Answer 3

There is no endogenous insulin production.

Question 4

What is the most common cause of hypoparathyroidism?

Answer 4

Removal of or damage to the parathyroid glands during surgery can cause hypocalcemia secondary to hypoparathyroidism.

Question 5

What is Conn Syndrome?

Answer 5

Adrenal cortical adenoma that secretes aldosterone. Hyperaldosteronism reduces the synthesis of renin by the JGM apparatus in the kidney. Aldosterone does NOT exhibit feedback suppression of the anterior pituitary. Patients with hyperaldosteronism have low serum potassium levels and sodium retention. No effect on blood glucose!

Question 6

Follicular carcinomas are much ____ likely than papillary carcinomas to involve the lymph nodes, but they are ____ likely to metastasize to distant sites, such as bone, lung and liver

Answer 6

Less; More

Question 7

Bilateral adrenal cortical atrophy is typically seen in what cases?

Answer 7

Addison’s Disease

Exogenous glucocorticoid therapy

Question 8

In a patient with Graves Disease, what will the microscopic appearance of the patient’s thyroid gland look like?

Answer 8

Papillary projections in thyroid follicles and lymphoid aggregates in the stroma. The thyroid stimulating immunoglobulins that appear in this condition result in diffuse thyroid enlargement and hyperfunction, papillary projections lined by tall columnar epithelial cells.

Question 9

Hashimoto thyroiditis

Microscopic appearance?

Answer 9

Destruction of thyroid follicles with lymphoid aggregates and Hurthle cell metaplasia.

Question 10

Granulomatous thyroiditis

Microscopic appearance

Answer 10

Follicular destruction and presence of giant cells.

Question 11

Medullary Carcinoma:
Microscopic Appearance
Can medullary carcinoma be multifocal?

Answer 11

Nests of cells in a Congo red-positive hyaline stroma

It can be multifocal but is not diffuse and does not lead to hyperthyroidism

Question 12

Goiter

Microscopic Appearance

Answer 12

Enlarged follicles and flattened epithelial cells

Question 13

When low dose and high dose dexamethasone suppression tests fail to suppress cortisol secretion, what diagnosis is unlikely?

Answer 13

A pituitary corticotropin-secreting adenoma

Question 14

If dexamethasone test fails to suppress cortisol secretion, how do you distinguish between an ectopic source of corticotropin or a tumor of the adrenal cortex that is secreting glucocorticoids?

Answer 14

Plasma corticotropin levels.
Corticotropin levels are HIGH if there is an ectopic source.
Glucocorticoid secretion from an adrenal neoplasm suppresses corticotropin production, leading to ATROPHY of the contralateral adrenal cortex.

Question 15

Why does an adrenal cortical adenoma that secretes aldosterone not cause atrophy of the contralateral adrenal cortex?

Answer 15

Because aldosterone does not have a negative feedback to the pituitary gland.

Question 16

Secondary hyperparathyroidism, most commonly resulting from _____ ______, is excluded when the serum ______ level is low because it is retained during this disease process.

Answer 16

renal failure;

inorganic phosphate

Question 17

What is the most common cause of diffuse nontoxic goiter?

Answer 17

Iodine deficiency.
Condition is endemic in regions of world where there is a deficiency of iodine.
Patients are typically euthyroid

Question 18

Plummer syndrome (toxic multinodular goiter) occurs when there is a ______ nodule in a goiter

Answer 18

hyperfunctioning

Question 19

Many causes of de Quervain thyroiditis are preceded by what?

Answer 19

Upper respiratory infection.

Question 20

Transient hyperthyroidism in de Quarvains thyroiditis results from what?

Answer 20

Transient hyperthyroidism results from inflammatory destruction of the thyroid follicles and release of thyroid hormone. Released colloid acts as a foreign body, producing florid granulomatous inflammation in the thyroid.

Question 21

Medullary carcinoma is derived from what cell type?

Answer 21

C-cells

Question 22

What is Wermer Syndrome?

Answer 22

MEN Type 1

PANcreas, PITuitary, PARathyroid

Question 23

What pancreatic abnormalities would be found in a patient with DM Type I?

Answer 23

Insulitis caused by T-cell infiltration. Assoc. with increase expression of Class I MHC molecules and aberrant expression of class II MHC molecules on B cells of the islets.

Question 24

Mutations in the RET proto-oncogene occur in what thyroid carcinoma?

Answer 24

Papillary carcinoma of the thyroid

Medullary Carcinoma of the thyroid

Question 25

Most common predisposing factor for papillary carcinoma?

Answer 25

Irradiation of the neck

Question 26

How are Schwann cells injured in a patient that has autonomic neuropathy caused by long standing DM Type II?

Answer 26

Nerve cells do not require insulin for uptake
Excess glucose diffused into cell cytoplasm, converted to sortbitol and fructose by aldose reductase
Increased amt of carbs increases cell osmolarity and free water influx injuring the cell. This injury could lead to peripheral neuropathy

Question 27

Describe acute addisonian crisis.

Answer 27

Long term corticosteroid therapy shuts off corticotropin stimulation to the adrenal glands leading to adrenal atrophy. When patient is not continued on corticosteroid therapy, and there is a stressful situation a crisis ensues

Question 28

Hemorrhagic necrosis bilaterally of adrenal glands suggests what?

Answer 28

Waterhouse-Friderichsen syndrome

Question 29

What are the two common mutations for parathyroid tumors?

Answer 29

Cyclin D1

MEN1

Question 30

What is a common mutation in somatotroph (GH-producing) pituitary adenomas?

Answer 30

GNAS1

Question 31

What is the most common thyroid malignancy?

Answer 31

Papillary carcinoma

Question 32

How is papillary carcinoma of the thyroid often detected?

Answer 32

Initially with metastasis, and local lymph nodes are the most common site. The primary site may not be detectable as a palpable nodule.

Question 33

How does a patient with a malignancy get hypercalcemia?

Answer 33

Hypercalcemia from a malignancy can be caused by osteolytic metastases or paraneoplastic syndrome from secretion of parathyroid hormone-related protein by the tumor.