Endocrine Pathology Practice Questions

Q: In diseases, cell death of growth hormone cells occurs by which mechanism?

Apoptosis. The correct answer is **Apoptosis**. **Why Apoptosis is correct:** In the context of endocrine pathology, the regulation of hormone-secreting cells is a highly controlled process. When the physiological demand for a hormone decreases or when specific pathological triggers occur (such as the withdrawal of trophic hormones or specific feedback inhibition), the corresponding cells undergo **programmed cell death**, or **apoptosis** [1]. Specifically, in the anterior pituitary, the loss of growth hormone-secreting cells (somatotrophs) in various disease states or physiological shifts is mediated by the activation of caspases, leading to cell shrinkage and fragmentation without an inflammatory response [2]. **Why other options are incorrect:** * **Aging:** While aging leads to a functional decline in the somatotropic axis (somatopause), it is a chronological process rather than the primary *mechanism* of acute or disease-induced cell death [3]. * **Necrosis:** Necrosis is accidental, uncontrolled cell death resulting from severe external injury (e.g., ischemia in Sheehan’s syndrome) [3]. While it occurs in pituitary infarction, it is not the standard mechanism for the selective loss of specific cell types like growth hormone cells in general disease states. * **All of the above:** Since apoptosis is the specific programmed mechanism for selective cell deletion in endocrine regulation, this option is incorrect. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 63-64. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 64-65. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 45.

Q: A patient presents with secondary malignancy in the adrenal glands. What is the most common primary site for such metastases?

Lung. **Explanation:** The adrenal glands are highly vascular organs, making them a frequent site for hematogenous metastasis. In fact, metastatic disease is the most common cause of a non-functioning adrenal mass. **1. Why Lung is Correct:** Carcinoma of the **Lung** is the most common primary source of adrenal metastasis [1]. This is attributed to the rich sinusoidal blood supply of the adrenal cortex, which traps circulating tumor cells. In clinical practice, when a patient with a known lung malignancy presents with an adrenal mass, it is statistically more likely to be a secondary deposit than a primary adrenal cortical carcinoma. **2. Analysis of Incorrect Options:** * **Kidney (B):** While Renal Cell Carcinoma (RCC) can spread to the adrenals due to anatomical proximity and venous drainage, it is less frequent than lung primaries. * **Breast (C):** Breast cancer is the second most common primary site for adrenal metastasis, particularly in females, but it trails behind lung cancer in overall incidence. * **Stomach (D):** Gastric carcinomas typically metastasize to the liver, peritoneum, or Virchow’s node; adrenal involvement is rare compared to thoracic malignancies. **3. High-Yield Pearls for NEET-PG:** * **Order of Frequency:** Lung > Breast > Stomach > Pancreas > Colon. * **Clinical Presentation:** Most adrenal metastases are asymptomatic and discovered incidentally ("incidentalomas"). They rarely cause adrenal insufficiency (Addison’s disease) unless >90% of the gland is destroyed bilaterally. * **Imaging:** On CT/MRI, metastases typically show lower lipid content and slower contrast washout compared to benign adrenal adenomas. * **Primary vs. Secondary:** Metastatic disease is significantly more common than primary Adrenocortical Carcinoma (ACC). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725.

Question 1

All of the following are features of medullary carcinoma of thyroid, except:

Accepted Answer

RAS gene mutations play an important role in its tumourigenesis

Answer

Arises from parafollicular cells or C-cells

Answer

Known association with MEN-2A or MEN-2B syndromes

Answer

Tumour cells secrete calcitonin

Question 2

What is the commonest cause of Cushing's syndrome?

Accepted Answer

Adrenal hyperplasia

Answer

Adrenal adenoma

Answer

Adrenocortical carcinoma

Answer

Adrenal atrophy

Question 3

A 58-year-old patient presents with increased "fullness" in her neck. Examination reveals non-tender, diffuse enlargement of her thyroid gland. Clinically, she is euthyroid. Microscopic examination of her thyroid gland reveals numerous, mainly enlarged follicles filled with abundant colloid material. There are areas of fibrosis, hemorrhage, and cystic degeneration. No papillary structures are identified, and neither colloid scalloping nor Hurthle cells are present. What is the most likely diagnosis?

Accepted Answer

Multinodular goiter

Answer

Colloid carcinoma

Answer

Diffuse toxic goiter

Answer

Graves disease

Question 4

Gs-alpha mutation may lead to which of the following conditions?

Accepted Answer

All of the above

Answer

McCune-Albright syndrome

Answer

Pseudohypoparathyroidism

Answer

Pseudopseudohypoparathyroidism

Question 5

Autoimmune thyroiditis is commonly associated with which of the following conditions?

Accepted Answer

Down syndrome

Answer

Marfan syndrome

Answer

Lowe syndrome

Answer

Edwards syndrome

Question 6

In diseases, cell death of growth hormone cells occurs by which mechanism?

Accepted Answer

Apoptosis

Answer

Aging

Answer

Necrosis

Answer

All of the above

Question 7

A biopsy from a mass shows parafollicular cells. What is the tumor marker?

Accepted Answer

Calcitonin

Answer

T4

Answer

Thyroxine

Answer

Thyroglobulin

Question 8

A patient presents with secondary malignancy in the adrenal glands. What is the most common primary site for such metastases?

Accepted Answer

Lung

Answer

Kidney

Answer

Breast

Answer

Stomach

Question 9

A patient presents with a pituitary tumor, pheochromocytoma, and a thyroid nodule. Which type of thyroid cancer is most likely to occur?

Accepted Answer

Medullary carcinoma

Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Question 10

A 45-year-old male was evaluated for secondary hypertension and diagnosed with pheochromocytoma. MRI abdomen revealed a 3 cm mass in the left adrenal gland. He underwent a left adrenalectomy, after which his hypertension is well controlled. How will you decide whether his pheochromocytoma was malignant?

Accepted Answer

The presence or absence of distant metastases is the primary determinant of malignancy.

Answer

Approximately 50% of pheochromocytomas are malignant.

Answer

Cellular atypia and invasion of blood vessels on pathology define malignancy for pheochromocytoma.

Answer

123I-metaiodobenzylguanidine scans are not useful in locating distant metastases.

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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