title: A Possible New Multiple Endocrine Neoplasia Mutation in a Patient with a Prototypic Multiple Endocrine Neoplasia Presentation.
abstract: BACKGROUND
  Multiple endocrine neoplasia (MEN) type 1 syndrome is an uncommon inherited disorder characterized by the occurrence of tumors involving two or more endocrine glands. These tumors include pheochromocytoma, adrenal cortical and neuroendocrine tumors including (bronchopulmonary, thymic, gastric), lipomas, angiofibromas, collagenomas, and meningiomas. MEN-4 is very rare and has been characterized by the occurrence of parathyroid and anterior pituitary tumors in association with tumors of the adrenals, kidneys, and reproductive organs.
  
  
  CONCLUSIONS
  We report the case of a 40-year-old male without significant family history of endocrine disease who was found to have primary hyperparathyroidism, a pituitary tumor causing acromegaly, thyroid cancer, renal cell carcinoma, and pancreatic cysts. We posit that this represents a new version of MEN-4. While renal tumors (angiomyolipoma) have been reported as part of the MEN-4 phenotype, to our knowledge, this is the first case reported of the association of MEN-1 and/or MEN-4 phenotype with this unique constellation of tumors, including renal cell carcinoma. Interestingly, this patient tested negative (DNA sequencing/deletion) for MEN-1 (menin), MEN-4 (CDKN1B) and VHL genes.
  
  
  CONCLUSIONS
  Thus, while this case has clinical characteristics consistent with either MEN-1 or MEN-4, it may represent a unique genetic variant.
authors.affiliation: Diabetes and Cardiovascular Center, University of Missouri, Mo., USA.
authors.forename: Rino
authors.initials: R
authors.lastname: Buzzola
authors.affiliation: Diabetes and Cardiovascular Center, University of Missouri, Mo., USA.
authors.forename: Lilamani Romayne
authors.initials: LR
authors.lastname: Kurukulasuriya
authors.affiliation: Diabetes and Cardiovascular Center, University of Missouri, Mo., USA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Touza
authors.affiliation: Neurosurgery, University of Missouri, Mo., USA.
authors.forename: Norman S
authors.initials: NS
authors.lastname: Litofsky
authors.affiliation: Diabetes and Cardiovascular Center, University of Missouri, Mo., USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brietzke
authors.affiliation: Diabetes and Cardiovascular Center, University of Missouri, Mo., USA; Departments of Medicine and Physiology, University of Missouri, Mo., USA; Harry S. Truman VA Hospital, Columbia, Mo., USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Sowers
keywords: Acromegaly; Hyperparathyroidism; Multiple endocrine neoplasia; Mutation and tumor