Open AccessWHEN EVEN THE CLASSICS REQUIRE CLOSE SURVEILLANCE – A TYPICAL CASE OF MEN SYNDROME
Author(s) -
Irina Zaharia,
Radu Mirică,
Razvan Iosifescu,
Traian Dumitraşcu,
Ioana Michaela Stănel,
Mara Mardare,
A Spânu,
N Iordache,
Octav Ginghină
Publication year - 2020
Publication title -
journal of surgical sciences
Language(s) - English
Resource type - Journals
eISSN - 2457-5364
pISSN - 2360-3038
DOI - 10.33695/jss.v7i2.354
Subject(s) - medicine , primary hyperparathyroidism , parathyroidectomy , scintigraphy , multiple endocrine neoplasia , hyperparathyroidism , parathyroid hormone , radiology , endocrine system , pancreas , medical history , general surgery , hormone , calcium , biochemistry , chemistry , gene
The genetic syndrome known in literature as the Multiple Endocrine Neoplasia type 1 (MEN 1) istransmitted in a dominant manner. The primary discovery of more than two endocrine tumorformations representative for MEN 1 should guide the doctor to the suspicion and subsequentconfirmation of the diagnosis. Statistics state a long association of the MEN 1 syndrome with thetumors discovered in the small intestine and the pancreas with the adenomas encountered in theparathyroid and pituitary glandular tissueWhile in postmenopausal women, the primaryhyperparathyroidism is diagnosed mostly with abnormal levels of parathyroid hormone and serumcalcium specifically. The most useful preoperative imaging tools are neck ultrasound scanning andtechnetium-99m sestamibi scintigraphy. Using bilateral neck exploration, subtotal, andparathyroidectomy are proposed. Our case consists of a 54 years old female, diagnosed with rightinferior parathyroid adenoma. With three first degree relatives operated for neuroendocrinepancreatic tumors, her medical history includes distal corporeal-caudal pancreatectomy for aneuroendocrine tumor four years ago. Laboratory tests unveil increased calcium (12, 41 mg/dl) andglucose (150 mg/dl) levels. During hospitalization, the patient’s representative parameters formonitoring hyperparathyroidism maintained at high levels. Parathyroid ultrasound and the 99mTctetrofosmin/99mTc-pertechnetate parathyroid scintigraphy sustained the diagnosis. Consequently,the patient was proposed for a subtotal parathyroidectomy with a pathology examination. It is highlyrecommended the interdisciplinary cooperation for the monitoring and management of patients withsuspicion of MEN 1. The annual assessment of serum calcium level, together with the parathyroidhormones, is proposed as a screening tool in early diagnosis.