A 40-year-old male presents with recurrent kidney stones, peptic ulcers, and joint pain. He also reports constipation and depression. What could be the cause, and what are the next steps?
This patient's symptoms suggest multiple endocrine neoplasia type 1 (MEN1), a condition characterized by tumors of the parathyroid, pituitary, and pancreatic islet cells. This leads to hyperparathyroidism, pituitary adenomas, and gastrinomas (Zollinger-Ellison syndrome), respectively. The next step would be to measure serum calcium, PTH, gastrin, and prolactin levels. Genetic testing for the MEN1 gene mutation would confirm the diagnosis. Treatment would be targeted at the specific hormone excess and tumors.