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