Endocrine pathology

Question 0

Thyroid cancer

Answer 0

Papillary carcinoma excellent prognosis, empty nuclei, increase risk with RET and BRAF mutation
Medullary carcinoma from para follicular c cells, produce calcitonin, sheets of cells in amyloid stroma. MEN 2A and 2B

Question 1

Cushing syndrome

Answer 1

Increased cortisol due to exogenous corticosteroids, 1ry adrenal adenoma, leading to decrease ACTH

Hypertension, weight gain, moon facies, turncal obesity, buffalo hump, amenorrhea, immunosupression

Screen by Dexamethasone suppression test and CRH stimulation test if ACTH is elevated

Question 2

Graves’ disease

Answer 2

Graves’ disease IgG stimulate TSH receptors, retro orbital fibroblasts and dermal fibroblasts

Question 3

Thyroid storm

Answer 3

Thyroid storm - stress induced catechu lamina surge, agitation, delirium, diarrhea, coma and tachyarythmia, increae alp, teases with 3 Ps, beta blockers propranolol, propylthiouracil and prednisone.

Question 4

Hashimoto thyroiditis (hypothyroidism )

Answer 4

Autoimmune disease, HLA DR5, maybe hyperthyroid at first
Histologic findings Hurthle cells, lumphoid aggregates
Moderately enlarged, non tender thyroid

Question 5

Congential hypothyroidism (cretinism)

Answer 5

Severe fetal hypothyroidism , iodine deficiency

6 Ps pain, pot belly, protruding tongue, pale face, puffy, poor brain development, protruding umbilicus

Question 6

Pheochromocytoma

Answer 6

Rule of 10% malignancy, bilateral, extra adrenal,calcify, kids
Episodic HTN due to secretion of epinephrine, norepinephrine and dopamine
5 Ps of pheochromocytoma Pain, Pallor, Pressure (BP), Palpitations, perspiration
Tx- irreversible alpha antagonists followed by beta blockers

Question 7

Neuroblastoma, it’s symptoms? What gene is over expressed? What products would you find in the blood? What other disease has a similar product? What markers are positive? Is he likely to develop hypertension?

Answer 7

Originates from NC cells, Homer Wright rosette,abdominal distension and firm irregular mass that can cross midline. Less likely to develop hypertension. 
Dancing eyes and dancing feet
HVA and VMA increased in urine
Over expression of n-myc oncogene
Bombesin and neuro specific enolase

Question 8

Adrenal insufficiency description

Answer 8

Weakness, fatigue, orthostatic hypotension, muscle aches
Metyrapone test blocks last step of cortisol synthesis, so cortisol should decrease in normal pt and ACTH should increase as feedback response

Question 9

Adrenal insufficiency types

Answer 9

Primary - aldosterone and cortisol deficiency - hypotension, pigmentation
Waterhouse-Frideerichsen syndrome - 1ry adrenal insufficiency due to adrenal hemorrhag with septicemia
Secondary - decreased ACTH,- no hyper pigmentation
Tertiary - chronic exogenous steroid tissues, precipitated by abrupt withdrawal, aldosterone not affected