SHM Converge Scientific Abstract ePoster Gallery-Occult Loss, Obvious Clues: Multiple Endocrine Neoplasia Type 1-Related Gastric Neuroendocrine Tumors Causing Symptomatic Anemia

Occult Loss, Obvious Clues: Multiple Endocrine Neoplasia Type 1-Related Gastric Neuroendocrine Tumors Causing Symptomatic Anemia

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This case describes a 61-year-old woman with MEN1 (history of parathyroid adenoma and pituitary microadenoma) and prior gastric carcinoid resection who presented with 4 weeks of progressive dyspnea, fatigue, and bilateral leg edema. She also used NSAIDs daily. Evaluation showed profound anemia (Hgb 4.2 g/dL) with iron deficiency and low B12, along with recurrent hypercalcemia and elevated PTH consistent with active MEN1-related endocrine disease. Cardiac and pulmonary workup did not explain her symptoms.<br /><br />Her hospital course required 4 units of packed red blood cells, IV iron, and vitamin B12 replacement, after which her symptoms improved. Endoscopy revealed innumerable polypoid lesions in the gastric fundus, and biopsy confirmed well-differentiated gastric neuroendocrine tumors with submucosal invasion. Colonoscopy showed only minor additional findings, making the gastric lesions the likely source of blood loss.<br /><br />The discussion emphasizes that MEN1 can cause hypergastrinemia, which leads to ECL-cell hyperplasia and multifocal fundic gastric NETs. These tumors may ooze chronically and cause occult gastrointestinal bleeding, resulting in severe iron-deficiency anemia and sometimes B12 deficiency. NSAID use may worsen bleeding risk.<br /><br />Key management steps include stabilization with transfusion, iron and B12 repletion, acid suppression, and avoidance of NSAIDs. Long-term care may involve endoscopic treatment, somatostatin analogs, and ongoing MEN1 surveillance.<br /><br />The main takeaway is that diffuse fundic gastric NETs should be considered a potentially life-threatening but treatable cause of occult GI blood loss in MEN1 patients, and early endoscopy is important when anemia develops.

Asset Subtitle

Kairui Sun

Meta Tag

Author List Kairui Sun, Maxwell Bressman MD

Category Clinical Vignettes

Concept Multiple Endocrine Neoplasia Type 1

Concept Fundic Gastric Neuroendocrine Tumor

Concept Hypergastrinemia

Concept Occult Gastrointestinal Bleeding

Concept Iron Deficiency Anemia

Distinguished Non-Finalist

Presenter Organization Greenwich Hospital

Presenting Author Kairui Sun

Track Adult

Keywords

MEN1

gastric neuroendocrine tumors

occult gastrointestinal bleeding

iron-deficiency anemia

vitamin B12 deficiency

hypergastrinemia

fundic gastric lesions

endoscopy

NSAID use

parathyroid adenoma

Multiple Endocrine Neoplasia Type 1

Fundic Gastric Neuroendocrine Tumor

Hypergastrinemia

Occult Gastrointestinal Bleeding

Iron Deficiency Anemia