Management dilemmas in MEN1
Nitin Gholap, David Lloyd*, Miles Levy.
Department of Endocrinology, University Hospitals Leicestershire
*Department of Surgery, University Hospitals Leicestershire
A 17 year old girl with MEN-1 who is currently asymptomatic has presented with a small 1.5cm lesion in neck of pancreas on MRI. She had a large incidental ovarian cyst that has been excised.
Gut hormone levels are normal and there is biochemical evidence of mild primary hyperparathyroidism (calcium 2.61 mmol/l; NR 2.2-2.6).
Endoscopic ultrasound scan showed a 1.2 x 0.8cm lesion with a similar lesion next to it toward head end of the pancreas. A fine needle aspirate of the main lesion has confirmed a neuro-endocrine tumour. An octreotide scan is normal with no areas of increased uptake.
Her father died recently of pancreatic malignancy (he also had prolactinoma and hyperparathyroidism) adding to the anxiety in the family.
We would like the audience and the panel to advise us on whether they would consider surgery, and if so what operation, and to discuss the pros and cons of conservative management.