Abstract

Multiple endocrine neoplasia type 1 (MEN1) is a syndrome emerging from characteristic mutations of MEN1 gene with concurrently enunciated multiple endocrine and tumours and associated non-endocrine neoplasm. Previously designated as Werner’s syndrome, MEN1 syndrome denominates genomic mutation within chromosome 11q13 or a tumour suppressor gene with a distinctive protein product nomenclated as “menin”. MEN1 syndrome demonstrates an autosomal dominant pattern of disease inheritance where genomic mutations delineate a comprehensive (100%) disease penetrance. MEN1 gene was initially identified in 1997 upon chromosome 11q13. Although twelve genetic mutations were primarily identified, currently beyond eighteen hundred genomic mutations are scripted1, 2. MEN1 syndrome is comprised of diverse combination of twenty or more endocrine and non-endocrine tumours exemplifying a classic triad of pituitary, parathyroid and pancreatic neoplasm. Diverse non endocrine tumours enunciated with MEN1 syndrome are denominated with meningioma, ependymoma or angiofibroma1, 2. Endocrine tumours are discerned on account of excessive hormonal secretion engendered from various neoplasm or on account of neoplastic evolution. Approximately 10% instances can occur due to a de-novo genomic variant. Offspring of an individual with MEN1 syndrome quantifies a 50% possibility of inheriting the genomic variant. Cogent prenatal diagnosis can be determined in instances where specific genomic variant of a particular family is known. Physical, psychological and social restrictions are prevalent with MEN1 syndrome. Heterozygotes with MEN1 genetic variant are denominated as carriers and manifest a two- fold possible mortality1, 2.

Highlights

  • Multiple endocrine neoplasia type 1 (MEN1) is a syndrome emerging from characteristic mutations of MEN1 gene with concurrently enunciated multiple endocrine and tumours and associated non-endocrine neoplasm

  • Primary hyperparathyroidism arising within MEN1 syndrome is commonly a multi-glandular disorder accompanied by enlargement of quadruple parathyroid glands instead of a singular adenoma, adoption of imaging modalities may be unsatisfactory for diagnosis

  • Endocrine neoplasia exemplified with MEN1 syndrome are distributed as parathyroid (90%), anterior pituitary (30% to 40%), pancreas or gastrointestinal tract (30% to 70%), adrenal cortex and thymus

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Summary

Disease Characteristics

MEN1 demonstrates variable familial clustering with a prevalence of 1:30,000 to 1 in 500,000 individuals. Parathyroid neoplasm are significantly enunciated in endocrinal MEN1 and manifest hypercalcemia or primary hyperparathyroidism with consequent hypersecretion of parathyroid hormone. Pituitary neoplasm with MEN1 syndrome is constituted by prolactin secreting anterior pituitary adenoma or prolactinoma which delineates oligo-menorrhoea, amenorrhoea and galactorrhoea in implicated females and sexual dysfunction with infrequent gynecomastia in males. Anterior pituitary adenoma secreting growth hormone demonstrates acromegaly[3,4]. Combined anterior pituitary adenomas secreting growth hormone/ prolactin (GH/PRL) can enunciate acromegaly, oligo-menorrhoea/amenorrhoea/ galactorrhoea in females and sexual dysfunction and/or gynecomastia in males. Well differentiated endocrine neoplasm of gastro-entero- pancreatic (GEP) tract are symbolized by gastrinoma engendering a Zollinger- Ellison syndrome, insulinoma with consequent hypoglycaemia, glucagonoma with emergent hyperglycaemia, anorexia, glossitis, anaemia, diarrhoea, venous thrombosis and cutaneous rash besides a vasoactive intestinal peptide secreting adenoma (VIPoma) enunciating watery diarrhoea, hypokalemia and achlorhydria syndrome. Well differentiated neoplasm of gastro-entero-pancreatic (GEP) tract can delineate tumefaction of the stomach, duodenum, pancreas and intestinal tract[4,5]

Associated clinical presentations are
Clinical Elucidation
Secreting prolactinoma Growth hormone secreting
Insulinoma Carcinoid tumours Facial angiofibromas
Disease Supervision
Diagnostic Manifestations
Investigative Assay
Findings
Therapeutic Options
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