[Multiple endocrine neoplasia type I or Werner syndrome. What is important to know about surgery of a rate disease]

[Multiple endocrine neoplasia type 1: about a case]

La néoplasie endocrinienne multiple type1 (NEM1) est une maladie rare, définie par l'atteinte tumorale, chez le même sujet, d'au moins deux glandes endocrines affectant l'antéhypophyse, les parathyroïdes et le tissu endocrine duodéno-pancréatique. Cette pathologie héréditaire autosomique dominante est liée à la mutation du gène NEM1 codant pour la ménine et situé sur le chromosome 11q13. Il existe, toutefois, des formes sporadiques dans 8 à 14% des cas. La lésion endocrinienne initiale peut être unique dans environ 75%. Cependant, chacune des principales atteintes peut être inaugurale. Le cas rapporté ici est révélé par un adénome hypophysaire somatoprolactinique ayant un caractère agressif, ne répondant pas au traitement conventionnel. La découverte d'une hyperparathyroïdie primaire ainsi qu'une tumeur neuroendocrine du pancréas (pNET) sept ans plus tard en font toute la particularité. L'attitude thérapeutique est discutée au sein d'une équipe pluridisciplinaire spécialisée dans le domaine de la pathologie endocrine.

Observatoire francophone des néoplasies endocriniennes multiples de type 1. Un outil du Groupe d'étude des Tumeurs Endocrines (GTE)

Wermer's syndrome or Multiple Endocrine Neoplasia Type-1 (MEN1) is an autosomal dominant inherited disease, related to mutations in MEN1, an approximately 10-kb gene encoding menin, localized on chromosome 11q13. The Endocrine Tumor Group (GTE) has set up a MEN1 observatory of 1001 regularly followed MEN1 cases. This observatory aims at registering and evaluating MEN1 cases in a large cohort. Any new study on a particular unexplored aspect of the disease may be proposed by a physician to the GTE. This article describes the way to diagnose a new MEN1 case and to register it. Procedures for participating in a new study are presented. Some original results are quoted.

Epidemiology data on 108 MEN 1 patients from the GTE with isolated nonfunctioning tumors of the pancreas

OBJECTIVE

To analyze the penetrance and clinical course of isolated nonfunctioning tumors of the pancreas (NFTP) in MEN 1 patients, and to propose a strategy for managing them.

SUMMARY BACKGROUND DATA

Pancreaticoduodenal tumors develop in a majority of MEN 1 patients and are a major cause of death. The natural history of NFTP is poorly defined, and no clear-cut guidelines have been widely accepted regarding treatment.

METHODS

Data on 108 patients with isolated NFTP among 579 MEN 1 patients from the French Endocrine Tumor Study Group (GTE) were analyzed. Survival rates were calculated using the Kaplan-Meier method.

RESULTS

The penetrance of NFTP was 34% at age 50, making it the most frequent pancreaticoduodenal tumor in MEN 1 patients. Forty-three patients (40%) underwent surgery, 32 of them curatively. No patient died because of surgery. Average life expectancy for patients with NFTP was shorter than that for MEN 1 patients who did not have pancreaticoduodenal tumors. Thirteen patients died during follow-up, 10 due to NFTP. Tumor size was correlated with the risks of metastasis and death. These risks were low for patients with tumors<or=20 mm.

CONCLUSIONS

NFTP are currently the most common tumors of the pancreaticoduodenal region in patients with MEN 1. Prevention of tumor spread by surgery should be balanced with potential operative mortality and morbidity. We do not recommend routine surgery for NFTP<or=20 mm.