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    Multiple Endocrine Neoplasias

    • MEN1  (3 P's)
      • Pancreatic (Gastrinoma, Insulinoma)
      • Pituitary (66%)
      • Primary hyperparathyroidism (one or more parathyroid adenomas)
    • MEN2A
      • Primary Hyperparathyroidism
      • Pheochromocytoma
      • Medullary Thyroid Cancer
    • Feature MEN1 MEN2A MEN2B
      Pancreatic

      Gastrinoma

      Insulinoma

      VIPoma

         
      Pituitary Adenoma

      66% (prolactinoma

               usually)

         
      Parahytoid Hyperplasia 90% 50%  
      Medullary Thyroid Ca   100% 85%
      Pheochromocytoma   >33% 50%
      Mucosal Neuroma     100%
      Gene MEN1 RET RET

     

    MEN-1

    • Characterized by:
      • Hyperparathyroidism
      • Pancreatic Neoplasms (incl. gastrinomas)
        • 1/4 develop Zollinger-Ellison Syndrome (ZES)
      • Pituitary Tumors (usually prolactinomas)
        • Sometimes: acromegaly, cushing's, and non-functioning tumors can occur.
    • Note on Zollinger-Ellison Syndrome:
      • Diarrhea (acid hypersecretion + inactivation of gastric enzymes & bicarb)
      • Diagnose with:
        • Serum Gastric Level
        • Secretin Stimulation Test
        • Endoscopic Ultrasound 
        • NOTE: MRI has very poor detection rate (10-40%) - not recommended. 
      • For details on ZES - See Gastroenterology>Stomach>ZES
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