We report of a male patient aged 32 years who presented with primary hyperparathyroidism. Three parathyroid glands were resected. At the age of 46 years, nervus facialis irritation was noted, and an MRI scan incidentally revealed a non-functioning pituitary adenoma with affection of the chiasma opticum. The patient underwent transsphenoidal operation resulting in pituitary insufficiency postoperatively. At the same time, primary hyperparathyroidism reoccurred and a parathyroid adenoma located at the thymus was resected. The mother of the patient died early due to multiple tumors. The patient was suspected to have multiple endocrine neoplasia type 1 (MEN1) and genetic analysis was performed. In addition, on clinical examination, multiple exostoses were noticed and an additional genetic analysis was performed. His father was reported to have multiple osteochondromas too. MEN1 was diagnosed in the patient showing a novel heterozygote mutation c.2T>A in exon 2, codon 1 (start codon ATG>AAG;p.Met1?) of the MEN1 gene. In genetic mutational analysis of the EXT1 gene, another not yet known mutation c.1418-2A>C was found in intron 5 of the EXT1 gene (heterozygotic). In conclusion, we report novel mutations of the EXT1 and the MEN1 genes causing hereditary multiple osteochondromas and MEN1 in one patient.
Learning points: It is important to ask for the patient's family history in detail.Patients with MEN1 are characterized by the occurrence of tumors in multiple endocrine tissues and nonendocrine tissues, most frequently parathyroid (95%), enteropancreatic neuroendocrine (50%), and anterior pituitary (40%) tissues.Familiar MEN1 has a high degree of penetrance (80-95%) by the age over 50; however, combinations of the tumors may be different in members of the same family.Patients with EXT1 gene mutations should be monitored for possible transformation of bone lesions into osteochondrosarcoma.
Keywords: 2015; Adult; Bone; Bone pain; CT; Calcitriol; Calcium (serum); Endosonography; FT4; Gastroenterology; Genetic analysis; Germany; Glucocorticoids; Hereditary multiple osteochondroma; Hydrocortisone; Hyperparathyroidism (primary); IGF1; Immunohistochemistry; Levothyroxine; MEN1; Male; March; Non-functioning pituitary adenoma; Octreotide scan; Osteoporosis; PTH; Parathyroid; Pituitary; Pituitary adenoma; Prolactin; Sestamibi scan; Skeletal deformity; Testosterone; Transsphenoidal surgery; Ultrasound; Unique/unexpected symptoms or presentations of a disease; Visual field assessment; Visual field defect; White; X-ray; phosphate (serum).