Endocrine Abstracts

Introduction: Primary hyperparathyroidism and prolactinoma can be associated as part of a MEN1. However, the association of the two pathologies can also be seen outside of a syndrome predisposing to endocrine tumors.

Case presentation: F.L., a 33-year-old woman followed for end-stage renal failure, during her follow-up hyperparathyroidism was discovered without any idea of the culprit and the victim: is the renal failure secondary to hyperparathyroidism or the other way around? The patient presented with severe headaches and bilateral blindness, an MRI of the pituitary was requested showing a pathological process of the base of the skull measuring 41 * 36.5 * 31 compressing the optic chiasm, and a biological assessment was performed with a prolactin level of 600 ng/ml. The diagnosis of prolactinoma was retained.

Discussion: MEN1 is an autosomal dominant disease due to a mutation of the MEN1 gene which codes for menin. Patients with MEN1 syndrome have endocrine (parathyroid, entero-pancreatic) and non-endocrine tumors (lipomas, angiofibromas, collagenomas, etc.). Primary Hyperparathyroidism is a common condition and less than 5% of cases are related to MEN1. It affects 90% of patients with MEN1, and Pituitary adenomas on the other hand affect about 40% of patients. These are often macroadenomas (85%). The predominant adenomas are prolactin adenomas (about 60%), and it is more voluminous than sporadic adenomas. Pancreatic involvement affects 75-90% of MEN1 carriers (multiple gastrinomas, multifocal insulinomas).

Conclusion: In our case, it is difficult to decide whether the association of prolactinoma and hyperparathyroidism is fortuitous or within the context of MEN1, especially since the primary origin of hyperparathyroidism cannot be confirmed.