This will help you keep the multiple endocrine neoplasia syndromes straight in your head:
- MEN1: the number “1” in MEN1 should remind you of primary or prime number. MEN1 involves things that start with the letter P:
- Pituitary adenoma
- Parathyroid hyperplasia
- Pancreatic islet cell tumors (gastrinoma, insulinoma, glucagonoma)
- MEN2A: happens to involve the letter C (This is MEN2A, so there are two C’s in each item!):
- Calcitonin (medullary carcinoma of the thyroid with elevated calcitonin level)
- Calcium (parathyroid hyperplasia, which causes elevated calcium levels)
- Catecholamines which are made in the chromocytes (as in pheochromocytoma)
- Men 2B: B is for big (marfanoid habitus) and for belly problems (mucosal neuromas)
Here is a table to help drive home the key features of the multiple endocrine neoplasia syndromes:
Clinical presentation
- MEN1
- Hypercalcemia: brittle bones (fractures, due to osteoporosis), kidney stones, abdominal moans (abdominal pain), and psychiatric overtones (confusion).
- Treatment-resistant peptic ulcer disease (gastrinoma) or hypoglycemia (insulinoma).
- MEN2A
- Hypercalcemia: brittle bones (fractures, due to osteoporosis), kidney stones, abdominal moans (abdominal pain), and psychiatric overtones (confusion).
- Elevated catecholamines: severe, treatment-resistent hypertension (particularly paroxysmal in nature, with headaches, palpitations, and diaphoresis).
- MEN2B
- Marfanoid habitus
- Mucosal neuromas on lips, tongue and eyelids.
- Note that Abraham Lincoln was said (apocryphally?) to have been marfanoid, and he clearly was one of the great “men to be” (MEN2B)!
References
- Board Basics (2012, reviewed here)
- The Merck Manual for Health Care Professionals (accessed 6/9/2013)
- John G. Sotos MD (2008), The Physical Lincoln
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