Endocrine Pathology
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University of Santo Tomas Faculty of Medicine and Surgery Department of Pathology
Situational Analysis
Endocrine Pathology SY 2005-2006
Antonio M. Cruz, MD Lorna B. Lioanag, MD
Case 1 Enlarging neck A 43 y/o female noted gradual neck enlargement every time she got pregnant. She had occasional irritability and palpitations; excessive sweating and easy fatigability. Since 1 year ago, she lost 15 kg despite eating adequately. Later, the patient developed exophthalmos, prompting consult. On PE, PR 105/min, regular; RR of 24/min; BP 130/80; T 37.2 C; BW 52.7 kg. Thyroid lobes are easily palpable, moves with deglutition, soft, nontender, no nodules noted. Chest and abdominal findings are normal.
A. Explain the signs and symptoms in this patient. B. Discuss the etiopathogenesis of exophthalmos and weight loss in this patient?
She has been diagnosed to have "diffuse toxic goiter ". A. Which laboratory and ancillary procedures are necessary to evaluate patient's condition? B. What would be the expected results?
Eventually, thyroidectomy was done. A. Which of the following histopathology is compatible with patient's history and physical examination findings? B. Differentiate the histopathologic findings as to: 4. morphology and etiopathogenesis 5. epidemiology 6. clinical manifestations 7. possible outcome / complications
Slide A
Slide B
Slide C
Slide D
Slide E
CASE 2 Firm mass on the neck A 34 y/o female noted “slight swelling” of the neck during pregnancy. After giving birth, the swelling persisted on one side. Consult revealed a palpable, non-tender, firm nodule on the swollen side that moves with deglutition. Aside from the “swollen neck”, the patient is apparently normal.
A. What are the salient features in the patient’s history? What is the significance of the palpable nodule in the neck? C. What diagnostic work-ups could be done to evaluate patient’s condition? What will be the expected results?
•Differentiate the following histopathologic pictures as to : 1. Morphology and etiopathogenesis 2. Epidemiology 3. Clinical manifestations 4. Possible outcomes/complications •Among the histopathologic pictures, which is the most likely compatible with patient’s condition?
Slide A
Slide B
Slide C
Slide D
Case 3 Body weakness A 65 y/o female complained of bone pains, recurrent abdominal cramps and constipation. She is also often lethargic and feeling weak. She had recurrent UTI due to presence of calcium oxalate stones in her urine. She has been told of possible parathyroid pathology.
Explain the salient features in the patient’s history that points to a possible parathyroid problem. What other conditions present the same way as the parathyroid problem of the patient? Which laboratory and ancillary work-ups are necessary to confirm the diagnosis? What will be the expected results?
Differentiate the following histopathologic pictures as to : 1. Morphology and etiopathogenesis 2. Epidemiology 3. Clinical manifestations 4. Possible outcome/complications Among the histopathologic pictures, which is most likely compatible with patient’s condition?
A
B
Case 4 Galactorrhea A tall voluptuous 24 y/o female experienced “double vision” upon waking up. Since adolescence, her menses were irregular menses but she has been amenorrheic for the past 3 months. Physical examination revealed large breasts, with minimal white secretions expressed from the nipples.
A. Explain the history and clinical findings in this patient. What are the possible causes? D. Which laboratory and ancillary work-ups are necessary to support the diagnosis? What will be the expected results?
•Differentiate the following histopathologic pictures as to : 1. Morphology 2. Epidemiology 3. Clinical manifestations 4. Possible outcome/complications •Among the histopathologic pictures, which is most likely compatible with patient’s condition?
A
B
Case 5 Uncontrolled hypertension A 53 y/o male, experienced episodes of “headiness” and nape discomfort, increasing in frequency and severity. His symptoms were relieved upon intake of antihypertensive medication. In between attacks, he is apparently normal. During the last attack, BP was 190/110, PR 102/mi, RR 26/min, Temp 36.8 C. Initial work-up revealed slight tachycardia on ECG, normal CXR and elevated 24hr urinary VMA. He was informed of possible pathology in adrenal gland causing hypertension.
A. Explain the salient features in the patient’s history. C. Which laboratory and ancillary work-ups are necessary to confirm the diagnosis? What will be the expected results?
•Differentiate the following histopathologic pictures of adrenal lesions as to : 1. Morphology and etiopathogenesis 2. Epidemiology 3. Clinical manifestations 4. Possible outcome/complications •Among these histopathologic pictures, which is compatible with the patient’s condition?
Slide A
Slide B
Slide C
Slide D
Situational Analysis
Endocrine Pathology SY 2005-2006
Antonio M. Cruz, MD Lorna B. Lioanag, MD
Case 1 Enlarging neck A 43 y/o female noted gradual neck enlargement every time she got pregnant. She had occasional irritability and palpitations; excessive sweating and easy fatigability. Since 1 year ago, she lost 15 kg despite eating adequately. Later, the patient developed exophthalmos, prompting consult. On PE, PR 105/min, regular; RR of 24/min; BP 130/80; T 37.2 C; BW 52.7 kg. Thyroid lobes are easily palpable, moves with deglutition, soft, nontender, no nodules noted. Chest and abdominal findings are normal.
A. Explain the signs and symptoms in this patient. B. Discuss the etiopathogenesis of exophthalmos and weight loss in this patient?
She has been diagnosed to have "diffuse toxic goiter ". A. Which laboratory and ancillary procedures are necessary to evaluate patient's condition? B. What would be the expected results?
Eventually, thyroidectomy was done. A. Which of the following histopathology is compatible with patient's history and physical examination findings? B. Differentiate the histopathologic findings as to: 4. morphology and etiopathogenesis 5. epidemiology 6. clinical manifestations 7. possible outcome / complications
Slide A
Slide B
Slide C
Slide D
Slide E
CASE 2 Firm mass on the neck A 34 y/o female noted “slight swelling” of the neck during pregnancy. After giving birth, the swelling persisted on one side. Consult revealed a palpable, non-tender, firm nodule on the swollen side that moves with deglutition. Aside from the “swollen neck”, the patient is apparently normal.
A. What are the salient features in the patient’s history? What is the significance of the palpable nodule in the neck? C. What diagnostic work-ups could be done to evaluate patient’s condition? What will be the expected results?
•Differentiate the following histopathologic pictures as to : 1. Morphology and etiopathogenesis 2. Epidemiology 3. Clinical manifestations 4. Possible outcomes/complications •Among the histopathologic pictures, which is the most likely compatible with patient’s condition?
Slide A
Slide B
Slide C
Slide D
Case 3 Body weakness A 65 y/o female complained of bone pains, recurrent abdominal cramps and constipation. She is also often lethargic and feeling weak. She had recurrent UTI due to presence of calcium oxalate stones in her urine. She has been told of possible parathyroid pathology.
Explain the salient features in the patient’s history that points to a possible parathyroid problem. What other conditions present the same way as the parathyroid problem of the patient? Which laboratory and ancillary work-ups are necessary to confirm the diagnosis? What will be the expected results?
Differentiate the following histopathologic pictures as to : 1. Morphology and etiopathogenesis 2. Epidemiology 3. Clinical manifestations 4. Possible outcome/complications Among the histopathologic pictures, which is most likely compatible with patient’s condition?
A
B
Case 4 Galactorrhea A tall voluptuous 24 y/o female experienced “double vision” upon waking up. Since adolescence, her menses were irregular menses but she has been amenorrheic for the past 3 months. Physical examination revealed large breasts, with minimal white secretions expressed from the nipples.
A. Explain the history and clinical findings in this patient. What are the possible causes? D. Which laboratory and ancillary work-ups are necessary to support the diagnosis? What will be the expected results?
•Differentiate the following histopathologic pictures as to : 1. Morphology 2. Epidemiology 3. Clinical manifestations 4. Possible outcome/complications •Among the histopathologic pictures, which is most likely compatible with patient’s condition?
A
B
Case 5 Uncontrolled hypertension A 53 y/o male, experienced episodes of “headiness” and nape discomfort, increasing in frequency and severity. His symptoms were relieved upon intake of antihypertensive medication. In between attacks, he is apparently normal. During the last attack, BP was 190/110, PR 102/mi, RR 26/min, Temp 36.8 C. Initial work-up revealed slight tachycardia on ECG, normal CXR and elevated 24hr urinary VMA. He was informed of possible pathology in adrenal gland causing hypertension.
A. Explain the salient features in the patient’s history. C. Which laboratory and ancillary work-ups are necessary to confirm the diagnosis? What will be the expected results?
•Differentiate the following histopathologic pictures of adrenal lesions as to : 1. Morphology and etiopathogenesis 2. Epidemiology 3. Clinical manifestations 4. Possible outcome/complications •Among these histopathologic pictures, which is compatible with the patient’s condition?
Slide A
Slide B
Slide C
Slide D
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