SHM Converge Scientific Abstract ePoster Gallery-Multiple Endocrine Neoplasia 1 in a Young Man With Seizures

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This case describes a 29-year-old man with a strong family history of MEN1 who presented with seizures and was later found to have classic manifestations of multiple endocrine neoplasia type 1. Initial labs showed hypercalcemia with elevated parathyroid hormone, consistent with primary hyperparathyroidism. Additional endocrine testing revealed elevated gastrin, chromogranin A, and pancreatic polypeptide levels, suggesting functional neuroendocrine tumors.<br /><br />Imaging demonstrated a pituitary microadenoma, multiple pancreatic lesions, and duodenal submucosal lesions. Endoscopic biopsy confirmed well-differentiated, low-grade neuroendocrine tumors in the duodenum and pancreas. A DOTATATE PET-CT showed multiple somatostatin receptor–avid pancreatic lesions, supporting multifocal neuroendocrine neoplasia.<br /><br />During hospitalization, the patient had several generalized tonic-clonic seizures, but EEG did not show evidence that the seizures were due to hypoglycemia or an insulin-secreting tumor. He was treated with antiepileptic medications and remained seizure-free after stabilization. Clinicians concluded that his epilepsy was likely unrelated to MEN1, since he was euglycemic with appropriately low insulin and C-peptide levels.<br /><br />For his hyperparathyroidism, he underwent outpatient subtotal parathyroidectomy with biochemical improvement. He was also started on lanreotide to help slow tumor growth, and further surgery for duodenal and pancreatic lesions was being considered. He continues to follow with endocrinology and gastroenterology for ongoing surveillance of calcium, PTH, prolactin, pituitary hormones, and repeat brain and gastrointestinal imaging.<br /><br />The authors emphasize that MEN1 should be suspected in patients with a compatible family history and endocrine abnormalities, and that diagnosis and management require multidisciplinary care.

Asset Subtitle

Nitya Batra

Meta Tag

Author List Daniel Misra, Daniel Shelden, Nishant Aggarwal, Nitya Batra, Shailesh Niroula

Category Clinical Vignettes

Concept Multiple Endocrine Neoplasia Type 1

Concept Primary Hyperparathyroidism

Concept Pituitary Adenoma

Concept Duodenopancreatic Neuroendocrine Tumor

Concept Hypercalcemia

Distinguished Non-Finalist

Presenter Organization William Beaumont Hospital

Presenting Author Nitya Batra

Track Adult

Keywords

MEN1

multiple endocrine neoplasia type 1

primary hyperparathyroidism

neuroendocrine tumors

pituitary microadenoma

pancreatic lesions

duodenal lesions

hypercalcemia

lanreotide

subtotal parathyroidectomy

Multiple Endocrine Neoplasia Type 1

Primary Hyperparathyroidism

Pituitary Adenoma

Duodenopancreatic Neuroendocrine Tumor

Hypercalcemia