Who were those MEN hiding behind the Ulcers?

A Case Report





MEN1, gastrinoma, octreotide LAR, meningioma


Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant disease caused by a mutation in the MEN1 gene. We present a 65-year-old man with MEN1 who has primary hyperparathyroidism, microprolactinoma, meningioma and gastrinoma. He had undergone parathyroidectomy followed by tumour excision of meningioma. The duodenal gastrinoma lesion was inoperable as it was close to the superior mesenteric artery with high surgery risk. Medical therapy with octreotide LAR had been initiated and showed good biochemical response as well as disease progression control.

Chemoembolization was proposed if the duodenum lesion reduces in size on maintenance treatment with octreotide LAR. This case highlights the challenges in managing this rare condition and octreotide LAR has shown to be effective in controlling the disease progression in MEN1 with inoperable gastrinoma.


Download data is not yet available.

Author Biographies

Shazatul Reza Binti Mohd Redzuan, Hospital Tengku Ampuan Rahimah

Endocrine Unit, Endocrine Unit, Medical Department,

Yong Sy Liang, Hospital Tengku Ampuan Rahimah

Endocrine Unit, Medical Department


Christopoulos C, Papavassiliou E. Gastric neuroendocrine tumors: Biology and management. Ann Gastroenterol. 2005;18(2):127–40.

Falchetti A. Genetic screening for multiple endocrine neoplasia syndrome type 1 (MEN-1): When and how. F1000 Med Rep. 2010;2:14. https://www.ncbi.nlm.nih.gov/pubmed/20948872. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948394. https://doi.org/10.3410/M2-14.

Thakker RV, Newey PJ, Walls GV, et al. Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). J Clin Endocrinol Metab. 2012;97(9):2990-3011. https://www.ncbi.nlm.nih.gov/pubmed/22723327. https://doi.org/10.1210/jc.2012-1230.

Asgharian B, Chen YJ, Patronas NJ, et al. Meningiomas may be a component tumor of multiple endocrine neoplasia type 1. Clin Cancer Res. 2004;10(3);869-80. https://www.ncbi.nlm.nih.gov/pubmed/14871962. https://doi.org/10.1158/1078-0432.ccr-0938-3.

Brandi ML, Gagel RF, Angeli A, et al. Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab. 2001;86(12):5658-71. https://www.ncbi.nlm.nih.gov/pubmed/11739416. https://doi.org/10.1210/jcem.86.12.8070.

Thomas-Marques et al. Prospective endoscopic ultrasonographic evaluation of the frequency of nonfunctioning pancreaticoduodenal endocrine tumor in patients with MEN1. Am J Gatroenterol. 2006;101(2):266-73. https://www.ncbi.nlm.nih.gov/pubmed/16454829. https://doi.org/10.1111/j.1572-0241.2006.00367.x.

Trouillas J, Labat-Moleur F, Sturm N, et al. Pitutary tumor and hyperplasia in MEN 1: A case control study in a series of 77 patient versus 2509 non-MEN1 patient. Am J Surg Pathol. 2008;32(4):534-43. https://www.ncbi.nlm.nih.gov/pubmed/18300794. https://doi.org/10.1097/PAS.0b013e31815ade45.

Ito T, Igarashi H, Uehara H, Berna MJ, Jensen RT. Causes of death and prognostic factors in multiple endocrine neoplasia type 1: A prospective study: comparison of 106 MEN1/Zollinger-Ellison syndrome patients with 1613 literature MEN1 patients with or without pancreatic endocrine tumors. Medicine (Baltimore). 2013;92(3):135-81. https://www.ncbi.nlm.nih.gov/pubmed/23645327. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3727638. https://doi.org/10.1097/MD.0b013e3182954af1.

Doherty GM, Lairmore TC, DeBenedetti MK. Multiple endocrine neoplasia type 1 parathyroid adenoma development over time. World J Surg. 2004;28(11):1139-42. https://www.ncbi.nlm.nih.gov/pubmed/15490065. https://doi.org/10.1007/s00268-004-7560-8.

Norton JA, Jensen RT. Role of surgery in Zollinger-Ellison syndrome. J Am Coll Surg. 2007;205(4 Suppl):S34-7. https://www.ncbi.nlm.nih.gov/pubmed/17916516. https://doi.org/10.1016/j.jamcollsurg.2007.06.320.

Norton JA. Surgical treatment and prognosis of gastrinoma. Best Pract Res Clin Gastroenterol. 2005;19(5):799-805. https://www.ncbi.nlm.nih.gov/pubmed/16253901. https://doi.org/10.1016/j.bpg.2005.05.003.

Berardi R, Morgese F, Torniai M, et al. Medical treatment for gastroenteropancreatic neuroendocrine tumors. World J Gastrointest Oncol. 2016;8(4):389-401. https://www.ncbi.nlm.nih.gov/pubmed/27096034. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824717. https://doi.org/10.4251/wjgo.v8.i4.389.

Tomassetti P, Migliori M, Caletti GC, Fusaroli P, Corinaldesi R, Gullo L. Treatment of type II gastric carcinoid tumors with somatostatin analogues. N Engl J Med. 2000;343(8):551-4. https://www.ncbi.nlm.nih.gov/pubmed/10954763. https://doi.org/10.1056/NEJM200008243430805.



How to Cite

Redzuan, S. R. B. M., & Liang, Y. S. (2020). Who were those MEN hiding behind the Ulcers? A Case Report. Journal of the ASEAN Federation of Endocrine Societies, 35(2), 210–214. https://doi.org/10.15605/jafes.035.02.10



Case Reports

Similar Articles

You may also start an advanced similarity search for this article.