Endocrine Abstracts

Introduction: Wermer syndrome or multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary disease characterized by the presence of generally benign tumors of the endocrine glands.

Observation: We report the case of a 68-year-old patient with a family history of a sister having a primary hyperaldosteronism and a personal history of primary hyperaldosteronism who was referred to our department for the exploration of asymptomatic hypercalcemia. The biological assessment showed an hypercalcemia at 2.96 mmol/l, an hypophosphoremia at 0.71 mmol/l and a high PTH at 220 pg/ml with a normal creatinine level at 83 µmol/l and a normal vitamin D level at 43 ng/ml in favor of the diagnosis of primary hyperparathyroidism. Cervical ultrasound showed a left upper parathyroid nodule of 1.5 x 1 cm but which had no scintigraphic correspondence. The cervico-thoracic scanner showed a double localization of ectopic parathyroid adenoma. The association of primary hyperaldosteronism with primary hyperparathyroidism falls within the scope of MEN1. Therefore, the patient benefited from a subtotal parathyroidectomy given the significant risk of recurrence.

Discussion: The particularity of our case is that MEN1 was revealed at an advanced age by the association of primary hyperaldosteronism with primary hyperparathyroidism. Hence the need to always be vigilant in front of any endocrine neoplasia. In addition to early diagnosis, multidisciplinary care and follow-up are mandatory and for life.