Presentation
The objective of this study is to present a familial Cushing syndrome (CS) caused by multiple endocrine neoplasia type 1 (MEN-1)-associated thymic carcinoid. [ncbi.nlm.nih.gov]
It has been reported that supernumerary glands present in up to 20% of MEN1 patients, which is explains the limitations of preoperative studies. [shifrinmd.com]
Entire Body System
- Fatigue
However, most people with endocrine disease complain of fatigue and weakness. Blood and urine tests to check your hormone levels can help your doctors determine if you have an endocrine disorder. [webmd.com]
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019 [patientslikeme.com]
A person may have hyperparathyroidism for many years with no symptoms or have symptoms such as kidney stones, bone thinning, nausea and vomiting, high blood pressure (hypertension), weakness, and fatigue. [endocrineweb.com]
Hyperparathyroidism disrupts the normal balance of calcium in the blood, which can lead to kidney stones, thinning of the bones ( osteoporosis ), high blood pressure ( hypertension ), loss of appetite, nausea, weakness, fatigue, and depression. [en.wikipedia.org]
HPT can cause weakened bones, pain, fatigue, and kidney stones; when associated with MEN1, HPT is more difficult to cure because all the parathyroid glands are affected by multiple tumors. [genome.gov]
Gastrointestinal
- Abdominal Pain
High levels of gastrin, ulcers, inflammation of the esophagus, diarrhea and abdominal pain Headaches and changes in vision Problems with sexual function and fertility Acromegaly (enlargement of the bones) Cushing’s syndrome Excess production of breast [mdanderson.org]
Abdominal pain may be due to dyspepsia, peptic ulcer disease, constipation, or pancreatitis, all of which more commonly occur in the presence of hypercalcaemia. [endobible.com]
Zollinger-Ellison syndrome may include severe gastric ulcers, abdominal pain, loss of appetite, chronic diarrhea, malnutrition, and subsequent weight loss. Other non-beta islet cell tumors associated with MEN1 are discussed below. [en.wikipedia.org]
Abdominal computed tomography (CT scan) or abdominal MRI scan beginning at age 20. [rarediseases.info.nih.gov]
The symptoms are very varied according to the type and extent of the glands affected and may include: Abdominal pain Amenorrhea Constipation or diarrhea Depression and anxiety Decreased libido Fatigue and weakness Headache Loss of appetite and weight [news-medical.net]
- Nausea
A 53-year-old woman presented with nausea and severe primary hyperparathyroidism. Computed tomography revealed parathyroid masses, shown later to be bilateral parathyroid carcinomas and adenomas. [ncbi.nlm.nih.gov]
Abdominal pain may be due to dyspepsia, peptic ulcer disease, constipation, or pancreatitis, all of which more commonly occur in the presence of hypercalcaemia, as does nausea and anorexia. [endobible.com]
A person may have hyperparathyroidism for many years with no symptoms or have symptoms such as kidney stones, bone thinning, nausea and vomiting, high blood pressure (hypertension), weakness, and fatigue. [endocrineweb.com]
Pituitary tumors can lead to headaches, vision problems, nausea and vomiting. In women, menstrual periods may become irregular or stop completely. Men may have decreased fertility, diminished sexual desire, and/or erectile dysfunction. [rarediseases.info.nih.gov]
Skin
- Papule
Acneiform papules. 20. LIPOMAS • 20-30% MEN1 cases CNS • Meningiomas – 8% • Ependymomas – 1% 21. Diagnosis • Biochemical abnormalities with clinical features in age 22. Parathyroid tumors. • Serum PTH. • Serum Calcium. 23. [slideshare.net]
Musculoskeletal
- Osteoporosis
A 50-year-old woman was referred for further evaluation of elevated calcium levels and osteoporosis. Biochemical abnormalities included hypercalcemia with elevated parathyroid hormone. [ncbi.nlm.nih.gov]
These symptoms can progress into further complications, such as muscle weakness, osteoporosis, kidney stones, mental and behavioural changes. [medic8.com]
Hyperparathyroidism disrupts the normal balance of calcium in the blood, which can lead to kidney stones, thinning of the bones ( osteoporosis ), high blood pressure ( hypertension ), loss of appetite, nausea, weakness, fatigue, and depression. [en.wikipedia.org]
Urogenital
- Polyuria
Common symptoms associated with hypercalcemia include polydipsia, polyuria, constipation, and generalized malaise. [emedicine.com]
The need for frequent urination (polyuria). Blocked bowels or constipation. Fatigue. These symptoms can progress into further complications, such as muscle weakness, osteoporosis, kidney stones, mental and behavioural changes. [medic8.com]
The commonest manifestation of this is increased thirst, followed by polyuria and nocturia. Increased urinary calcium loss also predisposes to renal stone formation and hence renal colic. [endobible.com]
Neurologic
- Headache
We report a diagnostic confirmation by laparoscopic ultrasound of an insulinoma and its successful removal by laparoscopic enucleation in an 8- year-old boy who was admitted to our hospital with a history of recurrent episodes of absences, headache, and [ncbi.nlm.nih.gov]
High levels of gastrin, ulcers, inflammation of the esophagus, diarrhea and abdominal pain Headaches and changes in vision Problems with sexual function and fertility Acromegaly (enlargement of the bones) Cushing’s syndrome Excess production of breast [mdanderson.org]
Has the patient developed a new headache or neuralgia? Assess for red flag symptoms: headaches present on waking and worse on coughing or leaning forward are more suggestive of increased intracranial pressure. [endobible.com]
Local tumor expansion may cause visual disturbance, headache, and hypopituitarism. Pituitary tumors in MEN 1 patients appear to be larger and behave more aggressively than sporadic pituitary tumors. [en.wikipedia.org]
Workup
Diagnosis [ edit ] In a diagnostic workup individuals with a combination of endocrine neoplasias suggestive of the MEN1 syndrome are recommended to have a mutational analysis of the MEN1 gene if additional diagnostic criteria are sufficiently met, mainly [en.wikipedia.org]
Nephrolithiasis was suspected and further workup was performed. [ispub.com]
X-Ray
- Nephrolithiasis
On follow-up, hypercalcemia with high parathyroid hormone (PTH) levels was detected, associated with nephrolithiasis and low bone mineral density in the spine and hip. [ncbi.nlm.nih.gov]
Nephrolithiasis was suspected and further workup was performed. [ispub.com]
Asymptomatic hypercalcemia is the most common manifestation: about 25% of patients have evidence of nephrolithiasis or nephrocalcinosis. [en.wikipedia.org]
Clinical manifestations can include hypercalcemia, nephrolithiasis, and bone abnormalities (osteitis fibrosa cystica). Common symptoms associated with hypercalcemia include polydipsia, polyuria, constipation, and generalized malaise. [emedicine.com]
Serum
- Gastrin Increased
[…] hormone: increased production of cortisol Gastrin: increased risk of stomach ulcers Glucagon: increased risk of diabetes mellitus Parathyroid hormone: increased risk of hypercalcemia and kidney stones Vasoactive intestinal peptide: severe diarrhea Cause [news-medical.net]
• Hypercalcemia may increase gastrin secretion from gastrinoma 10. [slideshare.net]
Treatment
Treatment for prolactinomas in MEN1 should be no different as of isolated prolactinomas; initial medical therapy with dopamine agonists is the treatment of choice (1). [ispub.com]
The treatment of MEN1-associated adrenal tumors is similar to that for non-MEN1 adrenal tumors. [pancreas.imedpub.com]
The prognosis might improve by preclinical tumor diagnosis and appropriated treatment. [ncbi.nlm.nih.gov]
Prognosis
Although prognosis is stage dependent for patients with thymoma, patients with thymic carcinoids and MEN 1 have been reported to have an extremely poor prognosis, with many patients dying of complications from thymic carcinoid rather than dying of other [ncbi.nlm.nih.gov]
[…] in MEN1 patients Prognosis according to the severity of the disease in a given patient, and to the quality of a regular follow up; mean age at death is relatively similar to that of the general population; nevertheless, death may occur early in life [atlasgeneticsoncology.org]
Etiology
In addition, no etiological relationship between seminoma and MEN1 has yet been reported. [ncbi.nlm.nih.gov]
Authors previously reported that MEN1 mutations in such patients were etiologic factors for MEN1, but the present study is the first to demonstrate that these mutations are related to PC. [atlasofscience.org]
However, more research is required to investigate the etiology of the condition. MEN1 is inherited in an autosomal dominant inheritance pattern. [news-medical.net]
(Etiology) Multiple Endocrine Neoplasia Type 1 disorders are genetically inherited It is inherited in an autosomal dominant pattern, which means any parent with the abnormal gene can pass it on to their children - a single copy of the gene is sufficient [dovemed.com]
Epidemiology
Netherlands. 3 Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. 4 Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. 5 Departments of Endocrinology and Metabolism and Clinical Epidemiology [ncbi.nlm.nih.gov]
Epidemiology • Incidence 1 in 30,000. • M:F=1:1 • No racial or ethnic predilection. • Diagnosis before 10 years of age is rare. 6. [slideshare.net]
Second-hit mutations in MEN1 have been documented in angiofibromas, collagenomas, and lipomas in patients with MEN1. [12, 13, 14] Epidemiology Frequency Worldwide, the frequency of MEN1 is estimated to be 1 case in 30,000 persons. [15] Race- and sex-related [emedicine.medscape.com]
Cutaneous tumours are common in MEN1 and include multiple angiofibromas (previously considered pathognomonic for tuberous sclerosis), collagenomas, and lipomas. [ 4 ] Epidemiology The prevalence throughout the world is estimated to be 1 in 20,000 to 1 [patient.info]
Familial carcinoid tumors and subsequent cancers: a nationwide epidemiologic study from Sweden. Int J Cancer, 94 (2001), pp. 444-448 [8] AM Oliveira, HD Tazelaar, KA Wentzlaff, NS Kosugi, N Hai, A Benson, et al. Familial pulmonary carcinoid tumors. [archbronconeumol.org]
Pathophysiology
To gain insights into MEN1 pathophysiology, menin-interacting partners and pathways have been identified to investigate its tumor suppressor and other functions. [ncbi.nlm.nih.gov]
[…] cohort of patients with Zollinger-Ellison syndrome due to gastrinomas, for example, the dermatological criterion of more than 3 angiofibromas or 1 or more collagenomas was sensitive (75%) and specific (95%) for the diagnosis of MEN1. [5] Background Pathophysiology [emedicine.medscape.com]
Pathophysiological study of diarrhoea in a patient with medullary thyroid carcinoma. Evidence against a secretory mechanism and for the role of shortened colonic transit time. [kjorl.org]
Prevention
Prophylactic transcervical thymectomy should be performed in all patients (consider the presence of supernumerary parathyroid glands and prevents the development of thymic carcinoid). [shifrinmd.com]
[…] youth use of smokeless tobacco, FDA expanded its youth tobacco prevention campaign, “The Real Cost” to include a smokeless tobacco prevention campaign. [fda.gov]
Resection of the most severely affected part of the pancreas, whether left or right, associated with enucleation of concomitant macroadenomas in the preserved pancreas is recommended for the treatment of hypoglycemic/hyperinsulinemic syndrome and to prevent [ncbi.nlm.nih.gov]