Endocrine Practical

Question 1

What is Cushing’s syndrome? Name the hormone involved and clinical effects.

Answer 1

Cause: Cortisol-secreting tumours

Hormone involved: Cortisol

Clinical effects: Central obesity, hypertension, muscle wasting, skin changes, menstrual irregularities

Question 2

What is Conn’s syndrome? Name the hormone involved and clinical effects.

Answer 2

Cause: Aldosterone-secreting tumours

Hormone involved: Aldosterone

Clinical effects: Hypertension, hypokalemia, metabolic alkalosis

Question 3

What is adrenogenital syndrome? Name the hormone involved and clinical effects.

Answer 3

Cause: Excess androgen production by adrenal tumours or hyperplasia

Hormone involved: Androgens

Clinical effects: Virilization, hirsutism, menstrual irregularities

Question 4

Describe the aetiology of adrenal cortical hyperplasia.

Answer 4

Prolonged ACTH stimulation from:

Pituitary ACTH-producing adenoma (Cushing’s disease)

Ectopic ACTH production by non-pituitary tumors (Cushing’s syndrome)

Question 5

What are the common clinical features of Cushing’s syndrome?

Answer 5

Central obesity (moon facies, buffalo hump)

Abdominal striae

Muscle wasting

Hypertension

Hirsutism, menstrual irregularities, decreased libido

Question 6

How does long-term exogenous steroid use cause adrenal atrophy?

Answer 6

Negative feedback → Suppression of hypothalamic-pituitary axis → ↓ ACTH → Adrenal cortex shrinks due to lack of stimulation.

Question 7

Why does pituitary or hypothalamic damage cause adrenal atrophy?

Answer 7

Decreased production of ACTH → Adrenal cortex under-stimulated → Atrophy of cortex (especially zona fasciculata and reticularis).

Question 8

Name IHC markers positive in pheochromocytoma.

Answer 8

Chromogranin

Synaptophysin

Immunohistochemistry (IHC) markers

Question 9

Describe the cell pattern and histology of pheochromocytoma.

Answer 9

Zellballen pattern: nests of polygonal or spindle-shaped chromaffin (chief) cells, surrounded by sustentacular cells and rich vascular network

Question 10

Define Waterhouse-Friderichsen Syndrome.

Answer 10

Acute adrenal insufficiency due to adrenal hemorrhage in sepsis (e.g. Neisseria meningitidis)

Question 11

Describe the pathogenesis of multinodular goitre.

Answer 11

Chronic stimulation of the thyroid by TSH (due to iodine deficiency or other factors) →

Repeated cycles of follicular hyperplasia and involution →

Initially diffuse gland enlargement →

Over time, fibrosis and irregular nodularity develop →

Formation of multinodular goitre with areas of colloid accumulation, haemorrhage, and calcification.

Question 12

What are the microscopic features of multinodular goitre?

Answer 12

Variably sized, colloid-rich follicles

Question 13

Describe the microscopic features of follicular adenoma.

Answer 13

Encapsulated glandular tumour

Follicles of varying size, may contain colloid

Question 14

Is follicular adenoma benign or malignant?

Answer 14

Benign

Question 15

What is the key feature to differentiate follicular adenoma from carcinoma?

Answer 15

Capsular invasion

Question 16

What are the macroscopic features of follicular thyroid carcinoma?

Answer 16

Haemorrhage, necrosis

Ill-defined borders, infiltration

Question 17

Describe the characteristic microscopic features of papillary thyroid carcinoma.

Answer 17

Orphan Annie eye nuclei (clear nuclei)

Papillary structures

Psammoma bodies

Question 18

Why does a pituitary adenoma cause visual symptoms?

Answer 18

Compression of optic chiasm

Question 19

Is pituitary adenoma benign or malignant, functional or non-functional?

Answer 19

Benign adenoma

Usually non-functional

Question 20

What hormones are produced by thyrotroph adenoma and corticotroph adenoma?

Answer 20

Thyrotroph adenoma: TSH

Corticotroph adenoma: ACTH

Question 21

Describe the macroscopic features of parathyroid adenoma.

Answer 21

Well-circumscribed, no haemorrhage/necrosis

Functional → secretes PTH → hyperparathyroidism → hypercalcemia

Question 22

What hormone do parathyroid adenomas produce?

Answer 22

Functional → secretes PTH → hyperparathyroidism → hypercalcemia

Question 23

Are pancreatic neuroendocrine tumours benign or malignant?

Answer 23

Can be both

Question 24

Are neuroendocrine tumours functional or non-functional?

Answer 24

Can be either

Question 25

What syndromes are most commonly associated with pancreatic neuroendocrine tumours?

Answer 25

Insulinoma → hyperinsulinism, hypoglycemia Gastrinoma → Zollinger-Ellison syndrome, peptic ulcers

Question 26

What associated syndrome is linked to pancreatic neuroendocrine tumours?

Answer 26

MEN-1 (Werner syndrome) Can cause tumors in the parathyroid, pancreas (insulinoma, gastrinoma), pituitary (the 3 Ps), and duodenum (gastrinoma).

Question 27

What type of necrosis occurs in pancreatitis?

Answer 27

Fat necrosis

Question 28

What is the pathogenesis of fat necrosis in pancreatitis?

Answer 28

Pancreatic injury → enzyme activation → fat necrosis by lipase and phospholipase [also proteolysis, inflammation + oedema and haemorrhage].

Question 29

What does the mnemonic I GET SMASHED stand for in pancreatitis?

Answer 29

Causes of pancreatic injury: I – Idiopathic G – Gallstones E – Ethanol (Alcohol) T – Trauma S – Steroids M – Mumps (and other infections) A – Autoimmune S – Scorpion sting H – Hyperlipidemia/Hypercalcemia E – ERCP (Endoscopic retrograde cholangiopancreatography) D – Drugs (e.g., azathioprine, thiazides)