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An unusual association of neuroendocrine tumors in MEN 1A

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Abstract

Multiple Endocrine Neoplasia type 1 is an autonomic dominant disease with a high degree of penetrance. It is characterized by combinations of over 20 different endocrine and nonendocrine tumors. A 25-year-old woman was referred for 1 year-evolution amenorrhea and bilateral galactorrhea. She also had fasting hypoglycaemia and hypercalcemia, and she was diagnosed of Multiple Endocrine Neoplasia type 1A. Resection of three parathyroid glands was performed showing hyperplasia of principal cells. Post-parathyroidectomy serum levels of calcium and intact PTH were normal but 3 years later serum calcium levels rose again. A 99mTc-sestamibi scan showed increased uptake in the low right area compatible with adenoma. After biochemical test showing probable insulinoma, somatostatin receptor scintigraphy showed a focal captation in head and body of pancreas. MRI found two nodules in the same localization. An antral gastrectomy, total pancreatoduodenectomy, colecistectomy and truncal vagotomy was performed and histopathologic examination revealed a combination of neuroendocrine tumors: gastrinomas, somastotinomas, glucagonomas and insulinomas. After surgery she started with tingling in fingers, toes and lips, and calcium levels was 5.9 mg/dl and PTH intact 3 pg/ml. A new 99m Tc-sestamibi scan showed no captation and cervical ultrasonography was normal. Now, 2 years later, she continues with normal calcium and i-PTH levels. This report represents an unusual case of MEN 1A with association of insulinomas, gastrinomas glucagonomas and somatostatinomas in the same patient.

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Acknowledgments

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Bone Metabolic Unit, Endocrinology Department, Hospital Universitario San Cecilio, Av. Dr. Oloriz 16, 18012, Granada, Spain

    Mariela Varsavsky, Rebeca Reyes-García, Guillermo Alonso García & Manuel Muñoz-Torres

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  1. Mariela Varsavsky
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  2. Rebeca Reyes-García
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  3. Guillermo Alonso García
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  4. Manuel Muñoz-Torres
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Correspondence to Manuel Muñoz-Torres.

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Varsavsky, M., Reyes-García, R., Alonso García, G. et al. An unusual association of neuroendocrine tumors in MEN 1A. Pituitary 15, 393–397 (2012). https://doi.org/10.1007/s11102-011-0334-z

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  • DOI: https://doi.org/10.1007/s11102-011-0334-z

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