Multiple Endocrine Neoplasia (MEN) Endocrinology

Multiple Endicrine neoplasia: A group of heritable syndromes characterized by abherant growth of benign or malignant tumors in a subset of endocrine tissues.

• Types
o MEN I: tumors involving the parathyroid glands; endocrine pacreas; and the pituitary
o MEN IIA: medullary carcinoma of the thyroid gland; pheochromocytoma; and hyperparathyroidism
o MEN 2B: medullary carinoma of the thyroid; multiple neuromas; and pheochromocytoma

MEN I (Wermer’s syndrome)

• Autosomal dominant
• 2-20/100,000
• features:
o hyperparathyroidism*
o enteropancreatic tumors (gastrinomas/Zollinger-Ellison syndrome; VIPomas; glucagonomas; insuilinomas)**
o pituitary adenomas (prolactinomas)***
o adrenal adenomas
o carcinoid tumors
o facial angiofibromas

*Note: Predator attacking victim’s parathyroid (hyperparathyroidism)gland by grasping either side of the victim’s neck
**Note: Predator attacking the victim by kicking him to the abdomen inducing tumors.
***Note: Predator attacking the victim’s pituitary gland by poking the victim between his eyes inducing pituitary adenoma.

MEN1.2b.gifMEN1.1b.gif MEN1.3b.gif

• Symptoms are related to the respective tumors

• Treatment
o Hyperparathyroidism
• Partial or total resection of parathyroid glands
• Prophylactic thymectomy
o Gastrinomas
• Proton pump inhibitors
• Correction of hypercalcemia

• Autosominal dominant
• 1-10/100,00

MEN IIA (Sipple’s syndrome)-like sheep
• features
o medullary carcinoma of the thyroid (80-100%)*
• calcitonin producing parafollicular cells
o hyperparathyroidism**
o pheochromocytoma (50%)
• Hypertension; headache; palpitations; diaphoresis
• Super-strength demonstrated by the sheep after conquering the victim indicates the elevated catacholamines ***

o Hirschsprung’s disease

MEN2.1.gif MEN2.2.gifMEN2.3.gif

*Note: Sheep attacking victim’s thyroid resulting in medullary thyroid carcinoma
**Note: Sheep attacks parathyroid gland resulting in hyperparathyroidism
***Note: Sheep has power after eating the very nutritional thyroid and parathyroid organs and develops pheochromocytoma

• Features
o Medullary carcinoma of the thyroid*
o Pheochromocytoma**
o Marfanoid body habitus
o Multiple neuromas of the conjunctiva; lips; labia; tongue; mucosa; larynx***


*Note: Werewolf attacking victim’s thyroid resulting in medullary thyroid carcinoma.
**Note: Werewolf now becomes very powerfull immediatelly, and develops pheochromocytoma after eating the thyroid gland.
***Note: Werewolf develops neuromas from all the energy produced from the pheochromocytoma.

July 10, 2006