A 35 year old male known case of MEN 1 presents to OPD with urinary stones and increased serum calcium. Next investigation to be done is?
Patient of MEN 1 have Pituitary adenoma Parathyroid adenoma-Most common and earliest manifestation is hyperparathyroidism with symptomatic hypercalcemia. Pancreatic adenoma (Gastrinoma>insulinoma) In diagnosed cases of MEN1 where nephrocalcinosis is documented, evaluation of pancreatic adenoma is impoant. The most common pancreatic adenoma in MEN 1 is ZES and hence for evaluation of ZES, secretin study is done. Subsequently 72 hours fasting test and endoscopic ultrasound will be useful for evaluation of insulinoma. The incidence of ZES in MEN I is 70% versus insulinoma being 10%. Surgical management is Definitive treatment of choice = If a MEN 2A patient has the same presentation, then calcitonin levels and urinary metanephrine levels shall be performed =In MEN IIA, incidence of medullary carcinoma thyroid (90%) is more than that of pheochromocytoma (20-35%).
Urinary Metanephrine
Secretin study
Serum calcitonin levels
72 hour prolonged fasting
Disorders of Adrenal Gland