title: Multiple endocrine neoplasia type 1 with upper gastrointestinal hemorrhage and perforation: a case report and review.
abstract: Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary syndrome known to predispose subjects to endocrine neoplasms in a variety of tissues such as the parathyroid glands, pituitary gland, pancreas and gastrointestinal tract. We herein report a patient with a past history of pituitary adenoma, presenting with symptoms of chronic diarrhea for nearly one year and a sudden upper gastrointestinal hemorrhage as well as perforation without signs. Nodules in the duodenum and in the uncinate process and tail of pancreas and enlargement of the parathyroid glands were detected on preoperative imaging. Gastroscopy revealed significant ulceration and esophageal reflux diseases. The patient underwent subtotal parathyroidectomy and autotransplantation, pylorus-preserving pancreaticoduodenectomy and pancreatic tail resection and recovered well. The results observed in our patient suggest that perforation and bleeding of intestine might be symptoms of Zollinger-Ellison Syndrome in patients with MEN1.
authors.affiliation: Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Lu
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Da-Dao
authors.initials: DD
authors.lastname: Jing
authors.forename: Xie-Ning
authors.initials: XN
authors.lastname: Wu
authors.forename: Lun-Gen
authors.initials: LG
authors.lastname: Lu
authors.forename: Gen-Quan
authors.initials: GQ
authors.lastname: Zhou
authors.forename: Xing-Peng
authors.initials: XP
authors.lastname: Wang
mesh_terms: D000328:Adult; D001706:Biopsy; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications* / Q000175:diagnosis; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015043:Zollinger-Ellison Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
keywords: Gastrinoma; Gastrointestinal hemorrhage; Hyperparathyroidism; Perforation; Pituitary adenoma