Endocrine Abstracts

Introduction: Multiple endocrine neoplasia type 1 (MEN1) is a cancer syndrome characterized by the development of neuroendocrine tumors of the pituitary gland, parathyroid and pancreas, and other neoplasms such as adrenocortical tumors and carcinoid.

Observation: We report the case of a 70-year-old women with acromegaly that diagnosed 15 years ago, in relation with pituitary macroadenoma (30×25 mm) invading the left cavernous sinus and in contact with the third ventricle without endocrine or ophthalmological repercussions. The impact of acromegaly is diabetes mellitus treated with insulin complicated by retinopathy. The visceral assessment revealed a hypertension with cardiomegaly and a multinodular goiter diagnosed 2 years after the discovery of the acromegaly. Refusing pituitary surgery and radiotherapy, the patient remains uncontrolled with maximal dose of somatostatin analogues and dopaminergic agonists, the Gh level is 70 and IGF1 is 638 ng/ml. Exploration of the goiter finds 3 nodules (20 to 30 mm of diameter) benign in fine needle aspiration biopsy, operated 10 years later and the pathological examination finds papillary carcinoma of the thyroid, patient is treated by iodine 131 under recombinant TSH, It is currently in remission, her thyroglobulin level is under 0.20 ng/ml. During evolution, the patient presents bilateral renal lithiasis repeatedly, the balance allowed the discovery of a primary hyperparathyroidism with high serum calcium and PTH around 150 pg/ml due to a right inferior parathyroid adenoma, complicated with osteoporosis for which the patient refused surgery. In this clinical context, the genetic studies to search presence of mutation in MEN1 gene encoding the menin protein was performed and confirm multiple endocrine neoplasia type1.

Conclusion: The hypersecretion of Gh induces an organomegaly, and the development of multinodular goiter is very frequent but discovery of thyroid carcinoma is rare, the prevalence of this association remains to be determined.