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PMID: 14747767 Published · ppublish English Case Reports Comparative Study Journal Article Review

Multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome: a prospective study of 107 cases and comparison with 1009 cases from the literature.

Medicine ·Vol. 83 ·No. 1 ·2004-01-00 ·Pages 43-83

Gibril F, Schumann M, Pace A, Jensen RT

Abstract

In patients with multiple endocrine neoplasia type 1 (MEN1), the most common functional pancreatic endocrine tumor (PET) syndrome is Zollinger-Ellison syndrome (ZES). ZES has been well studied in its sporadic form (that is, without MEN1); however, there are limited data on patients with MEN1 and ZES (MEN1/ZES), and the long-term natural history is largely unknown. To address this issue we report the results of a prospective long-term National Institutes of Health (NIH) study of 107 MEN1/ZES patients and compare our results with those of 1009 MEN1/ZES patients in 278 case reports and small series in the literature. Patients were clinically, radiologically, and biochemically evaluated yearly for all MEN1 manifestations (mean follow-up, 10 yr; range, 0.1-31 yr). Compared with patients from the literature, the NIH MEN1/ZES patients more frequently had pituitary (60%) and adrenal (45%) disease and carcinoid tumors (30%), but had equal frequency of hyperparathyroidism (94%), thyroid disease (6%), or lipomas (5%). Twenty-five percent of both the NIH and the literature patients lacked a family history of MEN1; ZES was the initial clinical manifestation of MEN1 in 40%. ZES onset preceded the diagnosis of hyperparathyroidism in 45%. However, ZES was rarely (8%) the only initial manifestation of MEN1 if careful testing was done. ZES occurred before age 40 years in 50%-60% of the current patients, in contrast to older studies. The diagnosis of ZES is delayed 3-5 years from its onset and is delayed as long as in sporadic ZES cases. Pituitary disease and carcinoid tumors (gastric > bronchial, thymic) are more frequent than generally reported, whereas a second functional PET is uncommon. In patients with MEN1/ZES without a family history of MEN1, the MEN1 manifestations are not as severe. This study shows that MEN1/ZES patients differ in many aspects from those commonly reported in older studies involving few MEN1/ZES patients. In this study we have identified a number of important clinical and laboratory features of MEN1/ZES that were not previously appreciated, which should contribute to earlier diagnosis and improve both short- and long-term management.

MeSH Terms
Adult Age Distribution Age of Onset Aged Diagnosis, Differential Disease Progression Female Follow-Up Studies Gastrinoma/blood,diagnosis Genetic Testing Hormones/blood Humans Male Middle Aged Multiple Endocrine Neoplasia Type 1/diagnosis,epidemiology,therapy Prospective Studies Survival Analysis Tomography, X-Ray Computed Treatment Outcome Zollinger-Ellison Syndrome/blood,diagnosis,epidemiology
Chemicals
Hormones
Authors & Affiliations
4 authors, click to expand affiliations / ORCID
Gibril Fathia
From Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
Schumann Michael
Pace Andrea
Jensen Robert T
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Article Info
Journal
Medicine
Abbr.
Medicine (Baltimore)
ISSN
0025-7974
Published
2004-01-00
Pages
43-83
Language
English
Region
United States
NLM ID
2985248R
Subset
IM
Corrections
ErratumIn
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