title: Multiple endocrine neoplasia type 1 in end-stage renal failure.
abstract: A 59-year-old woman with chronic renal failure due to type 2 diabetes mellitus (DM) is presented. Her father and a brother had a history of brain tumor. Her blood urea nitrogen and serum creatinine levels were 102 mg/dl and 4.5 mg/dl, respectively. Her serum Ca(2+) and Pi were within the normal range (9.4 mg/dl and 5.4 mg/dl, respectively). Her intact parathyroid hormone (PTH) level was 1 730 000 pg/ml. A (99m)Tc-methoxy-isobutylisonitrile scintigraphy showed high uptake in three parathyroid glands. A magnetic resonance image showed microadenoma in the pituitary gland. The serum gastrin level was high. Genetic examination revealed a mutation of the MEN1 gene (894-9 G --> A). From these findings, she was diagnosed with multiple endocrine neoplasia (MEN) type 1. Subsequently, a parathyroidectomy was performed successfully, a parathyroid gland was transplanted to her right forearm, and her serum Ca(2+) level was controlled at 8.5-9.0 mg/dl. It is very important to identify MEN1 if an end-stage renal disease (ESRD) patient has hyperparathyroidism with multigland involvement. Examination of the MEN1 gene may be valuable to make an accurate diagnosis and choose the appropriate therapy in some ESRD patients with hyperparathyroidism.
authors.affiliation: Department of Internal Medicine III, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Suzuki
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Katoh
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Takahashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Asahi
authors.forename: Shigeatsu
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Kosugi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Seiichi
authors.initials: S
authors.lastname: Takenoshita
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000175:diagnosis / Q000235:genetics* / Q000503:physiopathology* / Q000628:therapy; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010375:Pedigree
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium