Multiple endocrine neoplasia type 2A

Linas Juodelė, Virgilijus Krasauskas, Algimantas Žindžius, Elona Juozaitytė¹, Juozas Pundzius

Clinic of Surgery, ¹Clinic of Oncology, Kaunas University of Medicine, Lithuania

Key words: multiple endocrine neoplasia syndrome type 2A, c-ret protooncogene, medullary thyroid carcinoma, pheochromocytoma, primary hyperparathyroidism.

Summary. Multiple endocrine neoplasia (MEN) type 2A, or Sipple syndrome, is a rare autosomal dominantly inherited syndrome, which is characterized as combination of medullary thyroid carcinoma, pheochromocytoma, primary hyperparathyroidism, sometimes with rarer inherited disorders like Hirschsprung disease and cutaneous lichen amyloidosis. Syndrome is caused by germinative mutations in c-ret protooncogene, which are typical for different MEN 2 syndromes. We report a clinical case of MEN 2A. A 43-year-old female patient was operated on for pheochromocytoma 7 years after diagnosis and treatment of spread medullary thyroid carcinoma. This is the most common combination of MEN 2A tumors. Diagnosis was based upon clinical data, tumors combinations and analysis of inherited endocrine pathology in first-line relatives. This syndrome has already been diagnosed in Lithuania, but in the last decade after determining the genetic basis of MEN 2 and applying modern genetic examinations in clinical praxis, the strategy of diagnostics and prophylaxis of this syndrome has changed and survival prognosis for patients with this syndrome has improved. Conception of pathogenesis and clinical features of MEN 2A syndrome, genetic selection of inheritors of this syndrome is one more step in early cancer diagnosis, which allows to use cancer prevention measures in time, to apply effective treatment and improve patients’ prognosis. Reporting this clinical case of MEN 2A we aimed to pay attention of general practitioners to this rare, but in Lithuania diagnosed too, syndrome and its clinic, diagnostic, and treatment features.

Correspondence to L. Juodelė, Clinic of Surgery, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: juodele@hotmail.com

Received 7 December 2005, accepted 10 March 2006