Step I Atrophy (Apoptosis vs. Autophagocytosis)

[PagingDr.F]

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Came across this Q:

According to Pathoma: Decrease in cell number occurs via apoptosis. Decrease in cell size occurs via autophagy.

Is there something in the question stem that specifically points at one over the other? Otherwise, I feel like both of these could be correct no?

 

[Reperfused]

Where is this qs from?
It clearly says “decrease in size”.

 

[PagingDr.F]

Where is this qs from?
It clearly says “decrease in size”.

It says "adrenal glands become decreased in size". Both, loss of Cell # (apoptosis) and loss of cell size (autophagy) would cause a decrease in size of tissue, no? I agree that if it had said "adrenal gland cells decrease in size" then it would clearly be autophagocytosis.

I'm just trying to get ready for the NBME pathology subject test and an upperclassmen recommended these Qs from webpatho (Pathology examination questions for medical education - WebPath)

 

[AFishAnt]

I think the main difference is that in apoptosis the cells are not there at all whereas in autophagy the cells are still functioning but at a lesser level than before. This usually happens when there's decreased utilization or stimulation of the organ like in this patient who has Sheehan syndrome. Since theres a drop in ACTH due to infarction of the pituitary, the adrenals aren't being stimulated to produce cortisol which means that the adrenal cells do not need as much machinery (proteins) to keep up with the production of hormones so they downgrade their cellular components. There's no reason for the cells to die off completely. Cells undergo apoptosis when there is irreversible injury such as during infarction.

An example of apoptosis would be the pituitary gland in this patient with Sheehan syndrome since the pituitary is not getting enough blood flow to keep the cells alive. If they asked about the pituitary then the answer would've been apoptosis I believe.

I think the take-away is that you have to look at the cause of the decrease in size of the organ to figure out if it's apoptosis or autophagy.

 

[PagingDr.F]

I think the main difference is that in apoptosis the cells are not there at all whereas in autophagy the cells are still functioning but at a lesser level than before. This usually happens when there's decreased utilization or stimulation of the organ like in this patient who has Sheehan syndrome. Since theres a drop in ACTH due to infarction of the pituitary, the adrenals aren't being stimulated to produce cortisol which means that the adrenal cells do not need as much machinery (proteins) to keep up with the production of hormones so they downgrade their cellular components. There's no reason for the cells to die off completely. Cells undergo apoptosis when there is irreversible injury such as during infarction.

An example of apoptosis would be the pituitary gland in this patient with Sheehan syndrome since the pituitary is not getting enough blood flow to keep the cells alive. If they asked about the pituitary then the answer would've been apoptosis I believe.

I think the take-away is that you have to look at the cause of the decrease in size of the organ to figure out if it's apoptosis or autophagy.

Thanks! This actually makes a lot of sense now.