Pituitary, Parathyroid and Pancreas MCQs

MEN-I, or Wermer syndrome, characterized by abnormalities involving the parathyroid (Primary hyperparathyroidism resulting in renal stones), pancreas, and pituitary glands (prolactinoma) ; thus the mnemonic device, the 3Ps. Reference: Robbins & Cotran Pathologic Basics of Diseases 9 th edition, pg 1136

Prolactinomas are more common than other hormonesecreting pituitary adenomas. In addition to her galactorrhea and infertility, this patient also may have decreased libido, and her amenorrhea is secondary to the excessive prolactin secretion. Microadenomas might not have pressure effects on surrounding structures such as optic chiasm, but they can be discovered because of their hormonal effects. Acromegaly results from a growth hormone-secreting pituitary adenoma in an adult. Cushing disease occurs when there is an ACTH-secreting pituitary adenoma. A thyroid-stimulating hormone (TSH)-secreting pituitary adenoma is uncommon, but it could account for elevated levels of T4 and TSH in a hyper-thyroid patient. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, chapter 24, pg 1066

In T2DM, amyloid is often present within the islets of Langerhans, particularly in patients over 60 years of age. This type of amyloid derives from a polypeptide molecule known as amylin, which is secreted with insulin by the β-cell. As many as 20% of aged nondiabetic persons also have amyloid deposits in the pancreas, which is a finding that has been attributed to the aging process itself. None of the other choices show Congo red staining and apple-green birefringence under polarized light. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, chapter 24, pg 1097

The histologic pattern in pheochromocytoma shows tumor cells composed of clusters of polygonal to spindle shaped chromaffin cells or chief cells that are surrounded by supporting sustentacular cells, creating small nests or alveoli called zellballen. These are supplied by a rich vascular network. Reference: Robbins 9th ed. Pg. 1135

Pheochromocytoma is a rare tumor of chromaffin cells of the adrenal medulla that secretes catecholamines. Such tumors also originate in extra-adrenal sites, in which case they are termed paragangliomas. The clinical features associated with pheochromocytoma are caused by the release of catecholamines. Patients with pheochromocytoma come to medical attention because of (1) asymptomatic hypertension discovered on a routine physical examination, (2) symptomatic hypertension that is resistant to antihypertensive therapy; (3) malignant hypertension (e.g., encephalopathy, papilledema, proteinuria), (4) myocardial infarction or aortic dissection, or (5) convulsions. The other choices do not include tumors that lead to episodic hypertension. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, chapter 24, pg 1127