Chapter 18

Endocrine System

QUESTIONS 3 The parents of an 8-year-old boy are concerned about his

weight loss following a flu-like illness. Urinalysis reveals
Select the single best answer.
glucosuria (glucose in the urine). His fasting blood glu-
cose is 220 mg/dL (normal = 50 to 100 mg/dL). The
1 A 34-year-old woman with a multiple endocrine neoplasia
child is diagnosed with diabetes mellitus type 1. Which
syndrome dies of malignant thyroid cancer. The patient’s
of the following cells in the endocrine pancreas produces
organs are examined at autopsy for evidence of additional
insulin?
endocrine neoplasms. Identify the normal epithelial tis-
sue in the center of the field (shown in the image). (A) Alpha cells
(B) Beta cells
(C) Delta cells
(D) F cells
(E) PP cells

4 A 24-year-old woman experiences severe bleeding dur-

ing delivery of a preterm infant due to abnormal sepa-
ration of the placenta. Five months later, she presents
with profound lethargy, pallor, muscle weakness, failure
of lactation, and amenorrhea. You suspect that the mul-
tiple hormone deficiencies in this patient were caused by
postpartum injury to which of the following endocrine
organs?
(A) Adrenal glands
(B) Ovaries
(C) Parathyroid glands
(A) Adrenal medulla (D) Pituitary gland
(B) Pancreatic islet (E) Thyroid gland
(C) Parathyroid gland
(D) Pituitary pars intermedia 5 You are asked to give a lecture on the cellular and molec-
(E) Thyroid follicle ular mechanisms of hormone secretion. The cytoplasm
of which of the following endocrine cells is expected
2 Which of the following cytologic features is most useful to show an abundance of dense core, membrane-
for distinguishing between alpha, beta, and delta cells in bound secretory granules when examined by electron
the endocrine tissue identified in Question 1? microscopy?
(A) Cell size and shape (A) Follicular cells of the ovary
(B) Differential reactivity with eosin (B) Granulosa lutein cells of the ovary
(C) DNA content (ploidy) (C) Interstitial cells of the testis
(D) Immunostaining property (D) Parafollicular cells of the thyroid
(E) Size of secretory granules (E) Spongiocytes of the adrenal cortex

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6 The parents of an 8-week-old girl complain that their

child is apathetic and sluggish. Further testing reveals
mental and physical retardation. The child is diagnosed
with cretinism. Hormone replacement therapy is initi-
ated. Agenesis during development of which of the
following organs would explain the pathogenesis of
physical and mental retardation in this infant?
(A) Adrenal glands
(B) Parathyroid glands
(C) Pineal gland
(D) Pituitary gland
(E) Thyroid gland

7 A 50-year-old man suffers massive head trauma in a

motor vehicle accident and expires. Sections of the
patient’s hypothalamus and pituitary gland are examined (A) Microglial cells
at autopsy. Identify the region indicated by the asterisk (B) Neurons
(shown in the image). (C) Oligodendrocytes
(D) Pituicytes
(E) Schwann cells

10 Electron microscopic examination of the neuroendo-

crine tissue described in Question 9 reveals dilated ter-
minal axons containing dense core, membrane-bound
secretory vesicles. What is the appropriate term for the
dilated portions of terminal axons in the posterior lobe
of the pituitary?
(A) Corpora amylacea
(B) Herring bodies
(C) Neurokeratin vacuoles
(D) Neurophysin droplets
(E) Nissl substance

11 A 16-year-old boy presents with lethargy and head-

(A) Median eminence of the infundibulum
(B) Paraventricular nucleus of the hypothalamus
(C) Pars distalis of the adenohypophysis
(D) Pars nervosa of the neurohypophysis
(E) Pars tuberalis of the adenohypophysis
8 For the autopsy specimen examined in Question 7, the
arrows shown in the image identify which of the follow-
ing anatomic structures?
(A) Median eminence of the infundibulum
(B) Paraventricular nucleus of the hypothalamus
(C) Pars distalis of the adenohypophysis
(D) Pars nervosa of the neurohypophysis
(E) Pars tuberalis of the adenohypophysis
9 The endocrine organ identified in Questions 7 and 8 is
examined at higher magnification (shown in the image).
The arrows identify the nuclei of which of the following
types of cells?
aches. His parents note that he drinks water exces-
sively. A 24-hour urine collection shows polyuria. His
fasting blood sugar is normal. Laboratory studies reveal
decreased serum levels of antidiuretic hormone (ADH).
This polypeptide hormone is synthesized in which of the
following organs/glands?
(A) Adrenal cortex
(B) Adrenal medulla
(C) Hypothalamus
(D) Kidney
(E) Posterior pituitary
12 For the patient described in Question 11, ADH (argi-
nine vasopressin) enters the systemic circulation through
fenestrated capillaries that are present in which of the
following anatomic locations?
(A) Median eminence of the infundibulum
(B) Paraventricular nucleus of the hypothalamus
(C) Pars distalis of the anterior pituitary
(D) Pars nervosa of the posterior pituitary
(E) Pars tuberalis of the anterior pituitary

13 Immunohistochemical methods are used to identify a subset
of axons in the posterior pituitary that contain oxytocin and
its intracellular-binding protein (neurophysin). Following
release from these terminal axons, oxytocin travels through
the circulation and binds to G protein–coupled receptors
on the surface of which of the following types of cells?
(A) Clara cells
(B) Granulosa cells
(C) Parietal cells
(D) Primary oocytes
(E) Smooth muscle cells
14 A section through the pituitary gland is examined
at autopsy. The cystic, epithelial structures observed
between the pars nervosa and the pars distalis (indicated
by arrows in the image) are most likely remnants of
which of the following embryonic cells or tissues?
(A) Coelomic epithelium
(B) Neural crest cells
(C) Oral (pharyngeal) ectoderm
(D) Pharyngeal pouch mesenchyme
(E) Primitive gut endoderm
15 The hypothalamo–hypophyseal portal system conveys
releasing hormones (neuropeptides) from the median
eminence of the hypothalamus directly to which of the
following anatomic locations?
(A) Infundibular nucleus of the hypothalamus
(B) Paraventricular nucleus of the hypothalamus
(C) Pars distalis of the anterior pituitary
(D) Pars nervosa of the posterior pituitary
(E) Supraoptic nucleus of the hypothalamus
16 At autopsy, a section of the hypothalamus and pituitary
is stained by H&E and examined at high magnification
(shown in the image). Based on the diversity of cellular
morphology and the variable staining patterns (acido-
phils, basophils, and chromophobes), you believe that
Endocrine System 255
this image was most likely obtained from which of the
following locations?
(A) Infundibular nucleus of the hypothalamus
(B) Paraventricular nucleus of the hypothalamus
(C) Pars distalis of the adenohypophysis
(D) Pars nervosa of the neurohypophysis
(E) Supraoptic nucleus of the hypothalamus
17 A subset of the cells described in Question 16 synthesize
and secrete timed pulses of FSH and LH that regulate the
ovarian cycle and ovulation. These gonadotropins enter
the systemic circulation through which of the following
vascular beds?
(A) Primary plexus of the median eminence
(B) Primary plexus of the pars distalis
(C) Primary plexus of the pars nervosa
(D) Secondary plexus of the median eminence
(E) Secondary plexus of the pars distalis
18 Binding of FSH to the plasma membranes of follicu-
lar epithelial cells in the ovary is known to activate G
protein–coupled receptors that regulate the maturation
of ovarian follicles. FSH receptor binding stimulates the
production of which of the following second messenger
molecules in ovarian follicular cells?
(A) Arachidonic acid
(B) Calcium
(C) cAMP
(D) Diacylglycerol
(E) Inositol triphosphate
19 A 33-year-old woman who is not pregnant complains of
headaches and irregular menses. On physical examina-
tion, the breasts are firm and producing milk. MRI of
the patient’s head shows a tumor of the anterior pitu-
itary (arrow shown on the radiograph). Which of the fol-
lowing pituitary tumors is the most likely cause of these
clinical and pathologic findings?
256 Chapter 18

(A) Amyloid
(B) Colloid
(C) Fibrin
(A) Corticotroph adenoma (D) Hyaline
(B) Gonadotroph adenoma (E) Mucin
(C) Lactotroph adenoma
(D) Somatotroph adenoma 23 For the patient described in Questions 21 and 22, which
(E) Thyrotroph adenoma of the following terms best describes the biochemical com-
position of the material stored within the thyroid follicles?
20 Which of the following cells helps to organize clusters of (A) Complex carbohydrate
glandular epithelial cells in the pars distalis of the ante- (B) Glycoprotein
rior pituitary? (C) Pentapeptide
(A) Fibrous astrocytes (D) Proteoglycan
(B) Folliculostellate cells (E) Steroid
(C) Pituicytes
(D) Reticuloepithelial cells 24 You are asked to present a seminar on the pharmacoge-
(E) Satellite cells netics of thyroid hormone secretion. Which of the fol-
lowing types of enzymes is required for the conversion
21 A 52-year-old woman complains of swelling in the ante- of iodinated thyroglobulin to active thyroid hormones
rior portion of her neck that she first noticed 6 months (T3 and T4) in the cytoplasm of follicular epithelial cells?
ago. Except for some discomfort during swallowing, (A) Glycosyltransferase
the patient does not report any significant symptoms. (B) Lysosomal protease
Laboratory studies show elevated serum levels of thyroid (C) Myeloperoxidase
hormones (T3 and T4). These tyrosine-based polypeptide (D) Serine phosphatase
hormones are synthesized and secreted by which of the (E) Tyrosine kinase
following endocrine cells?
(A) Chief cells 25 A 48-year-old woman presents with flank pain.
(B) Follicular cells Laboratory studies show elevated serum levels of para-
(C) Leydig cells thyroid hormone (PTH) and calcium. Imaging studies
(D) Oxyphil cells reveal stones in the patient’s right renal pelvis and ureter.
(E) Parafollicular cells Which of the following endocrine cells secretes a poly-
peptide hormone that opposes the action of PTH and
22 Physical examination of the patient described in Question decreases serum calcium levels in this patient?
21 reveals a symmetrically enlarged thyroid gland (goi- (A) Chief cells
ter). A portion of the goitrous thyroid is removed for (B) Follicular cells
cosmetic reasons. Which of the following terms best (C) Leydig cells
describes the material filling the lumens of the follicles (D) Oxyphil cells
shown in the image? (E) Parafollicular cells
 Endocrine System 257

26 A sample of the thyroid gland is collected at autopsy and (A) Accumulation of procalcitonin
embedded in plastic for computer-based morphometric (B) Decreased section of triglycerides
analysis. Thin (1.5 μm) sections are stained with H&E (C) Decreased thyroglobulin synthesis
and examined by light microscopy (shown in the image). (D) Increased secretion of triglycerides
Identify the clear cells within the circle. (E) Increased thyroglobulin uptake

29 Which of the following best describes the average epi-

thelial morphology of a hypoactive thyroid gland?
(A) Pseudostratified columnar
(B) Simple columnar
(C) Simple squamous
(D) Stratified cuboidal
(E) Stratified squamous

30 As part of your research on mechanisms of thyroid hor-

mone secretion, you develop a monoclonal antibody
directed against the sodium/iodide cotransporter (sym-
porter). Using indirect immunofluorescence assays, you
demonstrate that this antibody specifically binds (labels)
which of the following cells and membranes within the
thyroid gland?
(A) Chief cells (A) Apical membranes of capillary endothelial cells
(B) Follicular cells (B) Apical membranes of follicular epithelial cells
(C) Macrophages (C) Basolateral membranes of capillary endothelial
(D) Oxyphil cells cells
(E) Parafollicular cells (D) Basolateral membranes of follicular epithelial cells
(E) Plasma membranes of parafollicular cells
27 The cells identified in Question 26 are derived from which of
31 A 36-year-old woman undergoes surgery to remove a fol-
the following cells/tissues during embryonic development?
licular carcinoma of the thyroid. Normal tissue (shown
(A) Coelomic epithelium
in the image) along the margin of the surgical specimen
(B) Neural crest is examined by light microscopy in the hospital. Identify
(C) Oral (pharyngeal) ectoderm the tissue/structure indicated by the arrow.
(D) Paraxial mesoderm
(E) Primitive gut endoderm

28 A thyroid biopsy is obtained from a 46-year-old woman

with an enlarged thyroid gland (shown in the image).
The pathologist notes clear vacuoles (arrows shown in
the image) in the colloid, next to the apical surface of the
follicular epithelium. What is the biological significance
of this histologic finding?

(A) Cervical ganglion

(B) Diffuse lymphatic tissue
(C) Parathyroid gland
(D) Thyroid gland
(E) Vagus nerve

32 A parathyroid gland collected at autopsy is stained

with H&E and examined by light microscopy (shown
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in the image). Which of the following best describes (A) Chief cells
the organization of principal cells in this specimen? (B) Follicular cells
(C) Oxyphil cells
(D) Parafollicular
(E) Parietal cells

35 You are asked to discuss your research on parathyroid

(A) Cords of epithelial cells separated by fenestrated
capillaries
(B) Epithelial follicles filled with gelatinous glycoprotein
(C) Isolated polygonal cells embedded in a pseudostrat-
ified epithelium
(D) Pyramidal-shaped acinar cells lining a central lumen
(E) Simple squamous epithelial cells lining open vascu-
lar spaces
gland pathophysiology at a national conference on
“aging and the endocrine system.” Which of the follow-
ing cells is expected to be relatively more abundant in
the parathyroid glands of an elderly patient, compared
to a younger patient?
(A) Adipocytes
(B) Chief cells
(C) Endothelial cells
(D) Fibroblasts
(E) Macrophages
36 The internal organs of a 54-year-old woman who died of
breast cancer are examined at autopsy. An H&E-stained
section of a retroperitoneal organ is shown in the image.
The pale-staining parenchymal cells that surround the
central vein (indicated by the arrow) are identified as
which of the following types of cells?

33 A 72-year-old man complains of abdominal discomfort.

Physical examination reveals neuromuscular weakness.
Laboratory studies show markedly elevated levels of
serum calcium and parathyroid hormone (PTH). This
polypeptide hormone is synthesized and secreted by
which of the following endocrine cells?
(A) Chief cells
(B) Follicular cells
(C) Oxyphil cells
(D) Parafollicular cells
(E) Parietal cells

34 The parathyroid glands (shown in the image) are exam-

ined at the autopsy of an 84-year-old woman. Identify
the large eosinophilic cells indicated by the arrows.
(A) Chromaffin cells
(B) Clara cells
(C) Merkel cells
(D) Parietal cells
(E) Schwann cells

37 Imaging studies demonstrate a suprarenal mass in a

50-year-old woman with a history of hypertension (indi-
cated by the arrow on the radiograph). Histologic exami-
nation of the surgical specimen reveals a chromaffin cell
neoplasm. Chromaffin cells are derived from which of the
following cells/tissues during embryonic development?
 Endocrine System 259
(A) Chromogranin
(B) Connexin
(C) Eumelanin
(D) Netrin
(E) Neurophysin

40 A section of the adrenal gland collected at autopsy is

stained with H&E and examined by light microscopy.
Name the region of the gland indicated by the rectangu-
lar box shown in the image.

(A) Coelomic epithelium

(B) Endoderm of primitive gut
(C) Neural crest
(D) Oral (pharyngeal) ectoderm
(E) Pharyngeal pouch mesenchyme

38 A 24-year-old skydiver asks you about the physiology of (A) Capsule

the “adrenaline rush” that she experiences when jumping (B) Medulla
from airplanes. Which of the following neurotransmit- (C) Zona fasciculata
ters stimulates the release of adrenalins from chromaffin (D) Zona glomerulosa
cells in the adrenal medulla? (E) Zona reticularis
(A) Acetylcholine
(B) Dopamine 41 A 40-year-old woman complains of recent changes in
(C) Glutamate her bodily appearance, including upper truncal weight
(D) Norepinephrine gain and moon facies. Endocrine studies reveal elevated
(E) Serotonin serum levels of cortisol and corticotropin (ACTH). The
patient is subsequently diagnosed with Cushing disease.
39 A high-magnification view of the adrenal gland and cen- ACTH is synthesized primarily by endocrine cells in
tral vein is shown in the image. Which of the following which of the following anatomic locations?
proteins provides a useful marker for dense core, secretory (A) Adrenal cortex, zona fasciculata
granules in the cytoplasm of these neuroendocrine cells?
(B) Adrenal cortex, zona glomerulosa
(C) Adrenal cortex, zona reticularis
(D) Anterior pituitary
(E) Neurohypophysis

42 A 53-year-old man complains of muscle weakness and

dizziness of 3 months’ duration. His blood pressure is
elevated (185/100 mm Hg). Endocrine studies reveal ele-
vated serum levels of aldosterone. Cells in which of the fol-
lowing anatomic locations secrete this mineralocorticoid?
(A) Adrenal cortex, zona fasciculata
(B) Adrenal cortex, zona glomerulosa
(C) Adrenal cortex, zona reticularis
(D) Adrenal medulla
(E) Anterior pituitary
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43 Another section of the adrenal gland (shown in the of gastrin. If this patient has a gastrin-secreting tumor,
image) collected at autopsy shows long, parallel cords of then imaging studies would most likely reveal a mass in
epithelial cells separated by sinusoidal capillaries. These which of the following organs/glands?
histologic features are characteristic of which of the fol- (A) Adrenals
lowing zones or regions? (B) Pancreas
(C) Parathyroids
(D) Pituitary
(E) Thyroid

46 You are asked to discuss the neuropharmacology of the

pineal gland at a conference on “advances in psychobiol-
ogy.” What is the principal hormone produced by the
pineal gland located in the posterior wall of the third
ventricle of the brain?
(A) Dopamine
(B) β-Endorphin
(C) Melatonin
(D) Proopiomelanocortin
(E) Serotonin

47 A newborn is discovered to have ambiguous genitalia

(A) Capsule
(shown in the image). Virilization of female genitalia in
(B) Medulla
this neonate was most likely caused by increased pro-
(C) Zona fasciculata duction of androgens by fetal cells located in which of
(D) Zona glomerulosa the following endocrine organs?
(E) Zona reticularis

44 A high-magnification view of the adrenal cortex is exam-

ined by light microscopy (shown in the image). Which
of the following cytologic features best characterizes the
glandular epithelial cells in this specimen?

(A) Adrenal glands

(B) Ovaries
(C) Pancreas
(D) Pituitary gland
(E) Thyroid gland
(A) Apical membrane microvilli
48 What is the major source of cholesterol present in the
(B) Dense, membrane-bound secretory granules
foamy cytoplasm of spongiocytes in the zona fasciculata
(C) Glycogen-filled vacuoles
of the adrenal cortex?
(D) Intracellular lipid droplets
(A) Chylomicrons
(E) Segmented nuclei
(B) De novo biosynthesis
(C) High-density lipoproteins
45 A 44-year-old woman suffers from long-standing peptic
ulcer disease that is largely unresponsive to pharmaco- (D) Low-density lipoproteins
logic therapy. Laboratory studies reveal high serum levels (E) Very low-density lipoproteins