Abstract
Multiple endocrine neoplasia type I (MEN-1) is an autosomal dominant syndrome associated with anterior pituitary, parathyroid, and enteropancreatic endocrine tumors as well as other endocrine and nonendocrine tumors [1]. MEN-1 is defined as the presence of two of three main MEN-1-related manifestations, or at least one manifestation plus a first degree relative with at least one MEN-1-related manifestation [1,2]. The estimated prevalence of MEN-1 ranges from 1 in 10,000 to 1 in 100,000 [3], with 43 and 94% penetrance of MEN-1 by ages 20 and 50, respectively [4].
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Brandi ML Gagel RF, Angeli A et al (2001) Guidelines for diagnosis and therapy of MEN type 2 and type 2 Clin Endocrinol Metab 86(12 5658–5671
Marx SJAgarwal SK, Kester MB et al (1999) Multiple endocrine neoplasia type I: Clinical and genetic features of the hereditary endocrine neoplasias ecent Prog Horm Res 54:397–438
Chandrasekharappa SC, Siradanahalli CG, Manickam P et al (1997 Positional cloning of the gene for multiple endocrine neoplasia-type 1 SPBience 276(5311):404–407
Trump D Farren B, Wooding C et al (1996) Clinical studies of multiple endocrine neoplasia type 1 J Med 89:653–669
Larsson CSkogseid B Oberg K et al (1988 Multiple endocrine neoplasia type 1 gene maps to chromosome 11 and is lost in insulinoma NPBture 332(6159):85–87
Dean PG van Heerden JA, Farley DR et al (2000) Are patients with multiple endocrine neoplasia type 1 prone to premature death? World J Surg 24(11):1437–1441
Doherty GM, Olson JA, Frisella MM et al (1998) Lethality of multiple endocrine neoplasia type I orld J Surg 22(6581–586
Geerdink EA Van der Luijt RB, Lips CJ (2003) Do patients with multiple endocrine neoplasia syndrome type 1 benefit from periodical screening? Eur J Endocrinol 149(6):577–582
Wilkinson S, The BT, Davey KR et al (1993) Cause of death in multiple endocrine neoplasia type 1 rch Surg 128(6683–690
Lairmore TC Piersall LD, DeBenedetti MK et al (2004) Clinical genetic testing and early surgical intervention in patients with multiple endocrine neoplasia type 1 (MEN 1). Ann Surg 239(5):637–647
Brandi ML, Marx SK, Aurbach GD, Fitzpatrick LA (1987) Familial multiple endocrine neoplasia type I: a new look at pathophysiology. Endocr Rev 8(4):391–405
Marx S, Spiegel AM, Skarulis MC et al (1998) Multiple endocrine neoplasia type 1: clinical and genetic topics. Ann Intern Med 129(6):484–494
Marx SJ (2001) Multiple endocrine neoplasia type 1. In: Beaudet SCR, AL SWS, Valle D (eds) The metabolic and molecular bases of inherited disease, 8th edn. McGraw-Hill, New York, pp 943–966
Uchino S, Noguchi S, Sato M et al (2000) Screening of the MEN-1 gene and discovery of germ-line and somatic mutations in apparently sporadic parathyroid tumors. Cancer Res 60(19):5553–5557
Rizzoli R, Green J, Marx SJ (1985) Primary hyperparathyroidism in familial multiple endocrine neoplasia type I. Am J Med 78(3):467–474
Marx SJ, Menczel J, Campbell G et al (1991) Heterogenous size of the parathyroid glands in familial multiple endocrine neoplasia type 1. Clin Endocrinol 35(6):521–526
Lamers CB, Froeling PG (1979) Clinical significance of hyperparathyroidism in familial multiple endocrine adenomatosis type I (MEA I). Am J Med 66(3):422–424
Burgess JR, David R, Parameswaran V et al (1998) The outcome of subtotal parathyroidectomy for the treatment of hyperparathyroidism in multiple endocrine neoplasia type 1. Arch Surg 133(2):126–129
Powell AC, Alexander HR, Pingpank JF et al (2008) The utility of routine transcervical thymectomy for MEN-1 related hyperparathyroidism. Surgery 144(6):878–883
Elaraj DM, Skarulis MC, Libutti SK et al (2003) Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1. Surgery 134(6):858–864
Norton JA, Venzon DJ, Berna MJ et al (2008) Prospective study of surgery for primary hyperparathyroidism (HPT) in multiple endocrine neoplasia-type 1 and Zollinger-Ellison syndrome. Ann Surg 247(3):501–510
Marx SJ, Simonds WF, Agarwal SK et al (2002) Hyperparathyroidism in hereditary syndromes: special expressions and special managements. J Bone Miner Res 17(Suppl 2):N37–N43
Udelsman R, Pasieka JL, Sturgeon C et al (2009) Surgery for Asymptomatic Primary Hyperparathryoidism: Proceedings of the Third International Workshop. J Clin Endocrinol Metab 94(2):366–372
Doppman JL, Miller DL (1991) Localization of parathyroid tumors in patients with asymptomatic hyperparathyroidism and no previous surgery. J Bone Miner Res 6(Suppl 2):S153–S158
Kivlen MH, Bartlett DL, Libutti SK et al (2001) Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery 130(6):991–998
Malmaeus J, Benson L, Johansson H et al (1986) Parathyroid surgery in the multiple endocrine neoplasia type I syndrome: choice of surgical procedure. World J Surg 10:668–672
Hellman P, Skogseid B, Juhlin C et al (1992) Findings and long term results of parathyroid surgery in multiple endocrine neoplasia type 1. World J Surg 16:718–723
Hellman P, Skogseid B, Oberg K et al (1998) Primary and reoperative parathyroid operations in hyperparathyroidism of multiple endocrine neoplasia type 1. Surgery 124:993–999
Tonelli F, Marcucci T, Fratini G et al (2007) Is total parathyroidectomy the treatment of choice for hyperparathyroidism in multiple endocrine neoplasia type 1? Ann Surg 246(6):1075–1082
Arnalsteen LC, Alesina PF, Quiereux JL et al (2002) Long-term results of less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery 132:1119–1125
Feldman AL, Sharaf RN, Skarulis MC et al (1999) Results of heterotopic parathyroid autotransplantation: a 13-year experience. Surgery 126:1042–1048
Gibril F, Chen Y-J, Schrump D et al (2003) Prospective study of thymic carcinoids in patients with multiple endocrine neoplasia type 1. J Clin Endocrinol Metab 88(3):1066–1081
Ferolla P, Falchetti A, Filosso P et al (2005) Thymic neuroendocrine carcinoma (carcinoid) in multiple endocrine neoplasia type 1 syndrome: the Italian series. J Clin Endocrinol Metab 90:2603–2609
Teh BT, Zedenius J, Kytola S et al (1998) Thymic carcinoids in multiple endocrine neoplasia type 1. Ann Surg 228(1):99–105
Manes JL, Taylor HB (1973) Thymic carcinoid in familial multiple endocrine adenomatosis. Arch Pathol 95:252–255
LeBodic M-F, Heymann M-F, Lecomte M et al (1996) Immunohistochemical study of 100 pancreatic tumors in 28 patients with multiple endocrine neoplasia, type 1. Am J Surg Pathol 20(11):1378–1384
Pipeleers-Marichal M, Somers G, Willems G et al (1990) Gastrinomas in the duodenums of patients with multiple endocrine neoplasia type 1 and the Zollinger-Ellison syndrome. N Engl J Med 322(11):723–727
Chiang H-C, O’Dorisio TM, Huang SC et al (1990) Multiple hormone elevations in Zollinger-Ellison syndrome. Gastroenterology 99(6):1565–1575
Lodish MB, Powell AC, Abu-Asab M et al (2008) Insulinoma and gastrinoma syndromes from a single intrapancreatic neuroendocrine tumor. J Clin Endocrinol Metab 93(4):1123–1128
Norton JA, Fraker DL, Alexander HR et al (1999) Surgery to cure the Zollinger-Ellison syndrome. N Engl J Med 341(9):635–644
MacFarlane MP, Fraker DL, Alexander HR et al (1995) Prospective study of surgical resection of duodenal and pancreatic gastrinomas in multiple endocrine neoplasia type 1. Surgery 118:973–980
Thompson NW (1998) Management of pancreatic endocrine tumors in patients with multiple endocrine neoplasia type 1. Surg Oncol Clin N Am 7(4):881–891
Gibril F, Schumann M, Pace A, Jensen RT (2004) Multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Medicine (Baltimore) 83(1):43–83
Weber HC, Venzon DJ, Lin JT et al (1995) Determinants of metastatic rate and survival in patients with Zollinger-Ellison syndrome: a prospective long-term study. Gastroenterology 108(6):1637–1649
Norton JA, Alexander HR, Fraker DL et al (2003) Possible primary lymph node gastrinoma: occurrence, natural history, and predictive factors. Ann Surg 237(5):650–659
Cadiot G, Vuagnat A, Doukjan I et al (1999) Prognostic factors in patients with Zollinger-Ellison syndrome and multiple endocrine neoplasia type 1. Gastroenterology 116:286–293
Gibril F, Venzon DJ, Ojeaburu JV (2001) Prospective study of the natural history of gastrinoma in patients with MEN-1: definition of an aggressive and a nonaggressive form. J Clin Endocrinol Metab 86(11):5282–5293
Hoffman KM, Gibril F, Entsuah LK et al (2006) Patients with multiple endocrine neoplasia type 1 with gastrinomas have an increased risk of severe esophageal disease including stricture and the premalignant condition, Barrett’s esophagus. J Clin Endocrinol Metab 91(1):204–212
Berna MJ, Hoffmann M, Serrano J et al (2006) Serum gastrin in Zollinger-Ellison syndrome I. Medicine 85:295–330
Berna MJ, Hoffmann M, Long SH et al (2006) Serum gastrin in Zollinger-Ellison syndrome II. Medicine 85:331–364
Roy PK, Venzon DJ, Shojamenesh H (2000) Zollinger-Ellison syndrome. Medicine 79(6):379–411
Alexander HR, Fraker DL, Norton JA et al (1998) Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger-Ellison syndrome. Ann Surg 228(2):228–238
Norton JA, Jensen RT (2004) Resolved and unresolved controversies in the surgical management of patients with Zollinger-Ellison syndrome. Ann Surg 240(5):757–773
Gibril F, Reynolds JC, Doppman JL et al (1996) Somatostatin receptor scintigraphy: its sensitivity compared with that of other imaging methods in detecting primary and metastatic gastrinomas. Ann Intern Med 125(1):26–34
Cadiot G, Lebtahi R, Sarda L et al (1996) Preoperative detection of duodenal gastrinomas and peripancreatic lymph nodes by somatostatin receptor scintigraphy. Gastroenterology 111:845–854
Alexander HR, Bartlett DL, Venzon DJ et al (1998) Analysis of factors associated with long-term (five or more years) cure in patients undergoing operation for Zollinger-Ellison syndrome. Surgery 124:1160–1166
Wamsteker EJ, Gauger PG, Thompson NW, Scheiman JM (2003) EUS detection of pancreatic endocrine tumors in asymptomatic patients with type 1 multiple endocrine neoplasia. Gastroinest Endosc 58(4):531–535
Thompson JC, Lewis BG, Wiener I, Townsend CM Jr (1983) The role of surgery in Zollinger-Ellison syndrome. Ann Surg 197(5):594–607
Sheppard BC, Norton JA, Doppman JL et al (1989) Management of islet cell tumors in patients with multiple endocrine neoplasia: a prospective study. Surgery 106:1108–1118
van Heerden JA, Smith SL, Miller LJ (1986) Management of the Zollinger-Ellison syndrome in patients with multiple endocrine neoplasia type I. Surgery 100(6):971–975
Norton JA, Doppman JL, Jensen RT (1992) Curative resection in Zollinger-Ellison syndrome. Ann Surg 215(1):8–18
Sugg SL, Norton JA, Fraker DL et al (1993) A prospective study of intraoperative methods to diagnose and resect duodenal gastrinomas. Ann Surg 218(2):138–144
Bartsch DK, Langer P, Wild A et al (2000) Pancreaticoduodenal endocrine tumors in multiple endocrine neoplasia type 1: surgery or surveillance. Surgery 128:958–966
Norton JA, Alexander HR, Fraker DL et al (2001) Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg 234(4):495–506
Libutti SK, Alexander HR Jr (2006) Gastrinoma: sporadic and familial disease. Surg Oncol Clin N Am 15(3):479–496
Shepherd JJ (1991) The natural history of multiple endocrine neoplasia type 1. Highly uncommon or highly unrecognized? Arch Surg. 126(8):935–952
Demeure MJ, Klonoff DC, Karam JH et al (1991) Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach. Surgery 110:998–1005
Rasbach DA, van Heerden JA, Telander RL et al (1985) Surgical management of hyperinsulinism in the multiple endocrine neoplasia, type 1 syndrome. Arch Surg 120:584–589
Dizon AM, Kowalyk S, Hoogwerf B (1999) Neuroglycopenic and other symptoms in patients with insulinomas. Am J Med 106:307–310
Nikfarjam M, Warshaw AL, Axelrod L et al (2008) Improved contemporary surgical management of insulinomas. Ann Surg 247(1):165–172
Hirshberg B, Livi A, Bartlett DL et al (2000) Forty-eight-hour fast: the diagnostic test for insulinoma. J Clin Endocrinol Metab 85:3222–3226
Doherty GM, Doppman JL, Shawker TH et al (1991) Results of a prospective strategy to diagnose, localize, and resect insulinomas. Surgery 110:989–997
Norton JA, Fang TD, Jensen RT (2006) Surgery for gastrinoma and insulinoma in multiple endocrine neoplasia type 1. J Natl Compr Canc Netw 4(2):148–153
O’Riordain DS, O’Brien T, van Heerden JA et al (1994) Surgical management of insulinoma associated with multiple endocrine neoplasia type I. World J Surg 18:488–494
Hiramoto JS, Feldstein VA, LaBerge J, Norton JA (2001) Intraoperative ultrasound and preoperative localization detects all occult insulinomas. Arch Surg 136:1020–1026
Doppman JL, Chang R, Fraker DL et al (1995) Localization of insulinomas to regions of the pancreas by intra-arterial stimulation with calcium. Ann Intern Med 123:269–273
Anderson MA, Carpenter S, Thompson NW et al (2000) Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol 95(9):2271–2277
Norton JA, Shawker TH, Doppman JL et al (1990) Localization and surgical treatment of occult insulinomas. Ann Surg 212(5):615–620
Miller DL, Doppman JL, Metz DC et al (1992) Zollinger-Ellison syndrome: technique, results and complications of portal venous sampling. Radiology 182(1):235–241
Zeiger MA, Shawker TH, Norton JA (1993) Use of intraoperative ultrasonography to localize islet cell tumors. World J Surg 17:448–454
Brown CK, Bartlett DL, Doppman JL et al (1997) Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas. Surgery 122:1188–1193
Grover AC, Skarulis M, Alexander HR et al (2005) A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas. Surgery 138:1033–1038
Albright SA, McCart JA, Libutti SK, et al. (2002) Rapid measurement of insulin using the Abbott IMx: application to the management of insulinoma. Ann Clin Biochem 39(Pt5):513–515
Jordan PH Jr (1999) A personal experience with pancreatic and duodenal neuroendocrine tumors. J Am Coll Surg 189(5):470–482
Lo CY, Lam KY, Fan ST (1998) Surgical strategy for insulinomas in multiple endocrine neoplasia type I. Am J Surg 175(4):305–307
Verges B, Boureille F, Goudet P (2002) Pituitary disease in MEN Type 1 (MEN-1): data from the France-Belgium MEN-1 multicenter study. J Clin Endocrinol Metab 87(2):457–465
Corbetta S, Pizzocaro A, Peracchi M et al (1997) Multiple endocrine neoplasia type 1 in patients with recognized pituitary tumours of different types. Clin Endocrinol 47(5):507–512
Trouillas J, Labat-Moleur F, Sturm N et al (2008) Pituitary tumors and hyperplasia in multiple endocrine neoplasia type 1 syndrome (MEN-1): a case-control study in a series of 77 patients versus 2509 non-MEN-1 patients. Am J Surg Pathol 32(4):534–543
Marx SJ, Nieman LK (2002) Aggressive pituitary tumors in MEN-1: do they refute the two-hit model of tumorigenesis. J Clin Endocrinol Metab 87(2):453–456
Skogseid B, Larsson C, Lindgren P-G et al (1992) Clinical and genetic features of adrenocortical lesions in multiple endocrine neoplasia type 1. J Clin Endocrinol Metab 75(1):76–81
Burgess JR, Harle RA, Rucker P et al (1996) Adrenal lesions in a large kindred with multiple endocrine neoplasia type 1. Arch Surg 131(7):699–702
Darling TN, Skarulis MC, Steinberg SM et al (1997) Multiple facial angiofibromas and collagenomas in patients with multiple endocrine neoplasia type 1. Arch Dermatol 133(7):853–857
Pack S, Turner ML, Zhuang Z et al (1998) Cutaneous tumors in patients with multiple endocrine neoplasia type 1 show allelic deletion of the MEN-1 gene. J Invest Dermatol 110:438–440
Schussheim DM, Skarulis MC, Agarwal SK et al (2001) Multiple endocrine neoplasia type 1: new clinical and basic findings. Trends Endocrinol Metab 12(4):173–178
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Powell, A.C., Libutti, S.K. (2010). Multiple Endocrine Neoplasia Type 1: Clinical Manifestations and Management. In: Sturgeon, C. (eds) Endocrine Neoplasia. Cancer Treatment and Research, vol 153. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0857-5_16
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