Endocrine Abstracts

Recurrent hypercalcemia after successful parathyroidectomy has been reported to be higher than previously thought. Most cases are transient and often associated with other factors, with only a minority requiring treatment. Multidisciplinary diagnosis is necessary to prevent persistence and recurrence. A 55-year-old female patient with a history of surgical removal of a right parathyroid adenoma four years prior, lost from follow-up, was referred to our clinic for persistent asthenia, weight loss and stool modification. Recent familial history with two sons operated for primary hyperparathyroidism. The biological assessment revealed a recurrence of primary hyperparathyroidism, renal failure (creatinine clearance 27 mg/dl), persistent anemia with high levels of Ca19-9 and Chromogranine A, and normal adrenal and pituitary hormonal profile. Abdominal CT scan pointed out bilateral adrenal adenoma, left renal lithiasis, obstructive pelvic calculus and grade IV left hydronephrosis. An exploration of the upper and lower digestive tubes was performed by endo and colonoscopy, revealing an active ulcer and chronic gastroduodenitis. In addition, a Scintigraphy with Tektrotyde (573.7 MBq) highlighted a small nodular hepatic lesion with a Krenning 2 score. The Tc99 Sestamibi imaging confirmed hot uptake lesions in the superior and inferior left parathyroid regions and a slight uptake in the right parathyroid region. With confirmatory imaging findings and presenting symptoms, our patient was clinically diagnosed with MEN 1 syndrome and underwent surgical and medical management in the urology and surgical department. Genetic findings and confirmation of MEN 1 syndrome in her eldest son reinforced our clinical suspicion.

Conclusion: Multiple endocrine neoplasia (MEN1) is a rare, inherited multi-tumor syndrome, often underdiagnosed, affecting neuroendocrine and non-endocrine tissues. Its aspects are highly variable, with no genotype-phenotype correlation. In our patient, MEN1 syndrome was revealed at an advanced age by recurrent primary hyperparathyroidism (parathyroid hyperplasia), non-functional adrenal bilateral lesions and neuroendocrine hepatic tumour. Long-term follow-up of serum calcium should be considered in patients after successful parathyroidectomy.