![COMPREHENSION QUESTIONS
[1] Which of the following statements best describes
the pathomechanism involved in producing
secondary hyperparathyroidism in an individual with
chronic renal failure?
A. Decreased PTH levels increase serum calcium.
B. Elevated serum phosphorus levels increase PTH
levels.
C. Increased PTH levels decrease serum calcium.
D.Loss of calcium increases PTH levels.
E. Retention of calcium increases PTH levels.](https://image.slidesharecdn.com/endocrinepathologytutorial-250407094447-90c9d05c/85/Endocrine-Pathology-cases-in-Tutorial-pdf-5-320.jpg)
![[2] In what organs are tumors
characteristically found in individuals with
MEN type 1?
A. Adrenal, thyroid, and parathyroid
B. Kidneys, adrenal, and liver
C. Liver, pancreas, and small intestines
D. Parathyroid, pineal, and pancreas
E. Pituitary, parathyroid, and pancreas](https://image.slidesharecdn.com/endocrinepathologytutorial-250407094447-90c9d05c/85/Endocrine-Pathology-cases-in-Tutorial-pdf-6-320.jpg)
![[3]Which of the following enzymes is
necessary for the final biochemical reaction
involved in the activation of vitamin D?
A. 1-α-Hydroxylase in the kidney
B. 7-α-Hydroxylase in the liver
C. 17-Hydroxylase in the adrenal cortex
D. 11-Hydroxylase in the adrenal cortex
E. 25-Hydroxylase in the skin](https://image.slidesharecdn.com/endocrinepathologytutorial-250407094447-90c9d05c/85/Endocrine-Pathology-cases-in-Tutorial-pdf-7-320.jpg)
![COMPREHENSION QUESTIONS
[1] A 41-year-old woman with a history of rheumatoid
arthritis presents with increasing weakness and cold
intolerance. Physical examination finds a goiter, and
laboratory evaluation finds her thyroid function tests to
be consistent with primary hypothyroidism. Which of
the following histologic findings is most consistent with
a diagnosis of Hashimoto thyroiditis in this individual?
A. Amyloid deposition
B. Granulomatous inflammation
C. Lymphoid infiltrate with Hürthle cells
D. Parafollicular hyperplasia
E. Scalloping of colloid](https://image.slidesharecdn.com/endocrinepathologytutorial-250407094447-90c9d05c/85/Endocrine-Pathology-cases-in-Tutorial-pdf-14-320.jpg)
![[2] A 35-year-old woman presents with increasing
fatigue, slight weight gain, and a low-grade fever.
Approximately 3 weeks before developing these
symptoms she had a 4-day upper respiratory viral
infection. At present a physical examination finds a
tender enlarged thyroid gland. If a biopsy specimen
reveals granulomatous inflammation with giant cells,
which of the following is the correct diagnosis?
A. De Quervain thyroiditis
B. Graves disease
C. Hashimoto thyroiditis
D. Plummer disease
E. Schmidt syndrome](https://image.slidesharecdn.com/endocrinepathologytutorial-250407094447-90c9d05c/85/Endocrine-Pathology-cases-in-Tutorial-pdf-15-320.jpg)
![[3] The clinical combination of
hyperthyroidism, exophthalmos, and
pretibial myxedema is most likely to be
seen in an individual with which of the
following types of autoantibodies?
A. Antimitochondrial antibodies
B. Antineutrophil cytoplasmic antibodies
C. Antismooth muscle antibodies
D. TSH-receptor-blocking antibodies
E. TSH-receptor-stimulating antibodies](https://image.slidesharecdn.com/endocrinepathologytutorial-250407094447-90c9d05c/85/Endocrine-Pathology-cases-in-Tutorial-pdf-16-320.jpg)
Endocrine Pathology cases in Tutorial.pdf
- 1. Endocrine Pathology Tutorial Dr. Emad Ibrahim Osman
- 3. ❖ CASE 1 A 30-year-old woman presents to the emergency department with acute abdominal pain that is colicky in nature. She has hematuria and bone pain. Physical examination reveals her to be dehydrated. Plain x-ray of the abdomen reveals a radiopaque renal calculus on the right side. Serum calcium is found to be elevated. The patient’s past medical history is significant for an islet cell tumor of the pancreas (insulinoma). ◆ What is the most likely diagnosis? ◆ What is the reason for her dehydration? ◆ What syndrome does this patient most likely have?
- 4. ◆ Most likely diagnosis: Primary hyperparathyroidism caused by an adenoma. ◆ Reason for dehydration: Primary hyperparathyroidism results in hypercalcemia. This causes impairment of the action of antidiuretic hormone (ADH) at the collecting ducts. This is thus an example of nephrogenic diabetes insipidus. These patients are expected to have polyuria and may become dehydrated, especially if water intake is not maintained. ◆ Most likely syndrome: Multiple endocrine neoplasia (MEN) type 1.
- 5. COMPREHENSION QUESTIONS [1] Which of the following statements best describes the pathomechanism involved in producing secondary hyperparathyroidism in an individual with chronic renal failure? A. Decreased PTH levels increase serum calcium. B. Elevated serum phosphorus levels increase PTH levels. C. Increased PTH levels decrease serum calcium. D.Loss of calcium increases PTH levels. E. Retention of calcium increases PTH levels.
- 6. [2] In what organs are tumors characteristically found in individuals with MEN type 1? A. Adrenal, thyroid, and parathyroid B. Kidneys, adrenal, and liver C. Liver, pancreas, and small intestines D. Parathyroid, pineal, and pancreas E. Pituitary, parathyroid, and pancreas
- 7. [3]Which of the following enzymes is necessary for the final biochemical reaction involved in the activation of vitamin D? A. 1-α-Hydroxylase in the kidney B. 7-α-Hydroxylase in the liver C. 17-Hydroxylase in the adrenal cortex D. 11-Hydroxylase in the adrenal cortex E. 25-Hydroxylase in the skin
- 8. Important Notes ❖ Calcium homeostasis is maintained by parathyroid hormone, 1,25-dihydroxycholecalciferol (activated vitamin D3), and calcitonin. ❖ Primary hyperparathyroidism and malignancies are the two most common causes (>90 percent of cases) of hypercalcemia. ❖ In primary hyperparathyroidism, there is autonomous spontaneous overproduction of PTH. The causes are an adenoma (>80 percent of cases) and hyperplasia of all glands. ❖ Primary hyperparathyroidism in some cases is associated with multiple endocrine neoplasia.
- 9. ❖ PTH levels are raised but serum calcium is not elevated in secondary hyperparathyroidism. ❖ After long-standing secondary hyperparathyroidism the parathyroids become autonomous and hyperactive, resulting in tertiary hyperparathyroidism. ❖ MEN syndromes are transmitted as autosomal dominant. ❖ The various types of hypoparathyroidism include primary hypoparathyroidism and pseudohypoparathyroidism. All forms are uncommon except transient hypoparathyroidism, which is seen after thyroid or parathyroid surgery.
- 10. Thyroid gland
- 11. ❖ CASE 2 A 45-year-old woman with a known history of rheumatoid arthritis presents to her primary care physician with fatigue, weight gain, and cold intolerance. Examination reveals an enlarged thyroid gland (goiter), coarse skin, and brady- cardia. Her thyroid function tests show elevated thyroid-stimulating hormone (TSH) levels and low levels of total triiodothyronine (T3) and thyroxine (T4). ◆ What is the most likely diagnosis? ◆ What is the most likely underlying etiology for this condition? ◆ What are the other symptoms and signs related to this condition? ◆ What tests would confirm the mechanism of this disorder?
- 12. ◆ Most likely diagnosis: Primary hypothyroidism ◆ Likely underlying etiology: An autoimmune process such as Hashimoto thyroiditis ◆ Symptoms of hypothyroidism: Fatigue, goiter, weight gain, cold intolerance, dry coarse skin, muscle weakness, constipation, and menorrhagia or oligomenorrhea ◆ Signs of hypothyroidism: Mental slowness, change in voice, dry thin hair and skin, loss of eyebrows, bradycardia, pericardial effusion, anemia, and slowing of the relaxation phase of reflexes ◆ Confirmation tests: Antithyroglobulin and antithyroid peroxidase assays
- 13. Definitions Goiter: Enlargement of the thyroid gland. Hypothyroidism: A clinical state resulting from underactivity of the thyroid gland. Primary hypothyroidism: Hypothyroidism caused by intrinsic pathology of the thyroid gland. Secondary hypothyroidism: A clinical state of hypothyroidism, but the thyroid gland is normal; the cause is usually hypopituitarism with low TSH secretion. Hyperthyroidism or thyrotoxicosis: A clinical state resulting from overactivity of the thyroid gland. Euthyroid: State of normal thyroid activity. Thyroid hormones: Triiodothyronine (T3) and thyroxine (T4). The thyroid gland synthesizes mostly T4, which in the periphery is converted to T3. T3 has tenfold higher biological activity than does T4.
- 14. COMPREHENSION QUESTIONS [1] A 41-year-old woman with a history of rheumatoid arthritis presents with increasing weakness and cold intolerance. Physical examination finds a goiter, and laboratory evaluation finds her thyroid function tests to be consistent with primary hypothyroidism. Which of the following histologic findings is most consistent with a diagnosis of Hashimoto thyroiditis in this individual? A. Amyloid deposition B. Granulomatous inflammation C. Lymphoid infiltrate with Hürthle cells D. Parafollicular hyperplasia E. Scalloping of colloid
- 15. [2] A 35-year-old woman presents with increasing fatigue, slight weight gain, and a low-grade fever. Approximately 3 weeks before developing these symptoms she had a 4-day upper respiratory viral infection. At present a physical examination finds a tender enlarged thyroid gland. If a biopsy specimen reveals granulomatous inflammation with giant cells, which of the following is the correct diagnosis? A. De Quervain thyroiditis B. Graves disease C. Hashimoto thyroiditis D. Plummer disease E. Schmidt syndrome
- 16. [3] The clinical combination of hyperthyroidism, exophthalmos, and pretibial myxedema is most likely to be seen in an individual with which of the following types of autoantibodies? A. Antimitochondrial antibodies B. Antineutrophil cytoplasmic antibodies C. Antismooth muscle antibodies D. TSH-receptor-blocking antibodies E. TSH-receptor-stimulating antibodies
- 17. Important Notes ❖ Alterations in levels of thyroxine-binding protein affect the total val- ues of T4 and T3. In such situations free T3 and free T4 should be measured. ❖ Most patients who present with thyroid disease present with a goi- ter, accompanied by a hyper- or hypothyroid state. ❖ Hashimoto thyroiditis, lymphocytic thyroiditis, and Graves disease are the principal autoimmune thyroid diseases. ❖Hashimoto thyroiditis is the most common cause of hypothyroidism in areas where iodine is sufficient. ❖ Individuals with Hashimoto thyroiditis are at risk for B-cell lymphomas.
- 18. ❖ Graves disease and nodular goiters are the common causes of hyperthyroidism. ❖ The eye changes seen in thyrotoxicosis are exclusive to Graves disease. ❖ Patients with long-standing Graves disease usually convert to a hypothyroid state. ❖De Quervain thyroiditis is a self-limiting condition. ❖ It is highly unlikely for a hot nodule to be neoplastic, whereas up to 10 percent of cold nodules are malignant.
- 19. The End Thanks