Week 3: Endocrine - Pancreas and Thyroid Gland

Question 1

ID

Answer 1

normal pancreas

Question 2

ID

Answer 2

Question 3

Name 1 product that is secreted from the Islets of Langerhan?

Answer 3

Glucagon, Insulin, Somatostatin, Pancreatic Polypeptide, and Ghrelin

Question 4

What do alpha cells secrete

Answer 4

glucagon

Question 5

what do beta cells secrete

Answer 5

insulin

Question 6

what do delta cells secrete

Answer 6

somatostatin

Question 7

what do PP cells secrete

Answer 7

pancreatic polypeptide

Question 8

what is an islet cell tumor called

Answer 8

pancreatic neuroendocrine tumors (PanNETs)

Question 9

ID

Answer 9

Insulinoma (PanNETs)

Question 10

ID

Answer 10

Gastrinoma (Zollinger-Ellison Syndrome ZES)

Question 11

What do ductal cells secrete?

Answer 11

Bicarbonate (HCO3-)

Question 12

What is the embryology of the pancreas?

Answer 12

Endoderm (Dorsal and Ventral Pancratic buds)

Question 13

What do the acinar cells have a receptor for?

Answer 13

cholecystokinin and acetylcholine

Question 14

what are the acinar cells of the exocrine pancreas stimulated by?

Answer 14

secretin

Question 15

where can gastrinomas occur?

Answer 15

Duodenum
Peripancreatic soft tissue
Pancreas

Question 16

ID

Answer 16

Question 17

What is the embryology of the thyroid gland?

Answer 17

Endoderm

Foramen caecum on pharynx floor between 1st and 2nd arch

Question 18

ID

Answer 18

Thyroid Gland

Principle cells are also called Follicular Cells

Question 19

ID

Answer 19

Septa

divides lobules of thyroid gland

Question 20

Hyperthyroidism signs

Answer 20

Increased BMR and weight loss, heat intolerance, sweating, palpitations, tachycardia, overactive sympathetic nervous system

Question 21

Hypothyroidism signs

Answer 21

fatigue, apathy, mental sluggishness, cold interolance, weight gain

Question 22

most common cause of hypothyroidism worldwide

Answer 22

iodine deficiency

Question 23

most common cause of hypothyroidism where iodine levels are sufficient

Answer 23

Hashimoto thyroiditis

Question 24

What causes Hashimoto Thyroiditis

Answer 24

Autoantibodies against thyroglobulin and thyroid peroxidase (autoimmune condition - more likely to develop others)

Question 25

What are the expected lab values for Hashimoto Thyroiditis

Answer 25

Low T4, T3;  elevated TSH

Question 26

ID

Answer 26

Hashimoto Thyroiditis | Cut surface is pale, yellow-tan, firm, and somewhat nodular

Question 27

ID

Answer 27

Hashimoto Thyroiditis | Cut surface is pale, yellow-tan, firm, and somewhat nodular

Question 28

ID

Answer 28

Hashimoto Thyroiditis ## Footnote germinal center formation (black arrows)

Question 29

ID

Answer 29

Hurthle cell metaplasia ## Footnote cuboidal epithelial cells of the follicle around the colloid (yellow arrow) appear larger and pinker (orange arrow).

Question 30

What is Grave's Disease

Answer 30

Hyperthyroidism w/ diffuse enlargement Thyroid-Stimulating Immunoglobulin antibody (TSI)  Exophthalmos

Question 31

Typical lab values for Grave's Disease

Answer 31

Elevated T4, T3; Low TSH 

Question 32

What causes exophthalmos in Grave's Disease?

Answer 32

cytokines that stimulates fibroblasts and synthesis of extracellular matrix proteins that increase the volume of retro-orbital connective tissue and extraocular muscles.

Question 33

ID

Answer 33

Grave's Disease | Diffusely enlarged gland (hypertrophy/hyperplasia) looks like muscle

Question 34

ID

Answer 34

Grave's Disease | Irregular follicles and papillary hyperplasia

Question 35

**ID**

Answer 35

Graves Disease ## Footnote **scalloping of colloid (open black arrows)** from actively reabsorbing the colloid and papillary hyperplasia (black arrow)

Question 36

ID

Answer 36

Graves Disease

Question 37

ID

Answer 37

Multinodular Goiter

Question 38

ID

Answer 38

Multinodular Goiter

Question 39

ID

Answer 39

Multinodular Goiter

Question 40

Signs and Symptoms of Goiter

Answer 40

Airway obstruction, dysphagia, SVC Syndrome

Question 41

What are four neoplasms of the Thyroid gland?

Answer 41

Follicular Adenoma Follicular Carcinoma Papillary Thyroid Cancer Medullary Thyroid Carcinoma

Question 42

What are defining features of Follicular Adenoma

Answer 42

Intact Capsule (Can't use Fine Needle Aspiration [FNA] to distinguish from a Carcinoma) benign mass

Question 43

ID

Answer 43

Follicular Adenoma | looks like a fig

Question 44

ID

Answer 44

Follicular Adenoma ## Footnote **intact capsule** (no colloids in it, but some purple cells are normal)

Question 45

ID

Answer 45

Follicular Adenoma

Question 46

What are defining features of Follicular Carcinoma

Answer 46

Distinction requires capsular invasion or vascular invasion Prefers hematogenous spread (bone, liver, lungs)

Question 47

ID

Answer 47

Follicular Carcinoma

Question 48

ID

Answer 48

Follicular Carcinoma ## Footnote Capsular Invasion

Question 49

ID

Answer 49

Follicular Carcinoma ## Footnote capsular invasion (yellow arrow)

Question 50

What are defining features of Papillary Thyroid Carcinoma

Answer 50

Branching papillae with fibrovascular stalk Psammoma bodies (concentrically calcified structures Orphan Annie eye nuclei -nuclei are optically clear Prefers lymphatic spread

Question 51

ID

Answer 51

Papillary Thyroid Carcinoma ## Footnote Branching papillae (papa) with fibrovascular stalk Psammoma (moma) bodies adopted orphan annie

Question 52

ID

Answer 52

Papillary Thyroid Carcinoma

Question 53

What are defining features of Medullary Carcinoma

Answer 53

3 C's: C-cells Secrete Calcitonin Congo-Red stain (apple-green birefringence amyloid deposits)

Question 54

ID

Answer 54

Medullary Carcinoma ## Footnote trabeculae/spindle shaped cells (orange), and amyloid (yellow)

Question 55

ID

Answer 55

Medullary Carcinoma

Question 56

ID

Answer 56

amyloid on polarized light on Congo red stain