Enteropancreatic malignancy associated with multiple endocrine neoplasia type 1: risk factors and pathogenesis.
BACKGROUND
Enteropancreatic malignancy is an important cause of morbidity and mortality associated with multiple endocrine neoplasia type 1 (MEN 1). However, the risk factors and mechanisms of the tumorigenesis of this malignancy are poorly understood.


METHODS
The authors conducted a retrospective study of factors associated with the development of malignant enteropancreatic tumor in 69 patients with MEN 1 belonging to a single family.


RESULTS
Metastatic enteropancreatic tumor and gastrinoma were identified in 20% and 36% of patients, respectively. Compared with MEN 1 patients who did not have an immediate family history of enteropancreatic malignancy, MEN 1 patients with a first-degree relative affected by enteropancreatic malignancy had an increased risk of developing disseminated tumor (odds ratio, 3.7; P < 0.05). In addition, hypergastrinemia and advanced age were both associated with a significant increase in the risk of enteropancreatic malignancy. Elevated serum glycoprotein alpha subunit levels were associated with enterochromaffin-like cell hyperplasia, gastric carcinoid formation, and disseminated enteropancreatic tumor in hypergastrinemic patients (P < 0.05).


CONCLUSIONS
Disease modifier factors act in concert with the MEN 1 gene to modulate the development of enteropancreatic neoplasia. It is possible to identify MEN 1 patients at high risk for developing aggressive enteropancreatic tumors. Heritable disease modifier factor(s) affecting enteropancreatic malignancy appear to reside at loci distinct from that of the MEN 1 gene.
Royal Hobart Hospital, Australia. jburges@postoffice.utas.edu.au
J R
JR
Burgess
T M
TM
Greenaway
V
V
Parameswaran
D R
DR
Challis
R
R
David
J J
JJ
Shepherd
D000236:Adenoma / Q000209:etiology; D000328:Adult; D005260:Female; D015408:Gastrinoma / Q000209:etiology*; D005755:Gastrins / Q000097:blood; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications*; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
D005755:Gastrins