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Faggiano A, Fazzalari B, Mikovic N, Russo F, Zamponi V, Mazzilli R, Guarnieri V, Piane M, Visco V, Petrucci S. Clinical Factors Predicting Multiple Endocrine Neoplasia Type 1 and Type 4 in Patients with Neuroendocrine Tumors. Genes (Basel) 2023; 14:1782. [PMID: 37761922 PMCID: PMC10531237 DOI: 10.3390/genes14091782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this study is to evaluate the predictive role of specific clinical factors for the diagnosis of Multiple Endocrine Neoplasia type-1 (MEN1) and type-4 (MEN4) in patients with an initial diagnosis of gastrointestinal, bronchial, or thymic neuroendocrine tumor (NET). METHODS Patients referred to the NET Unit between June 2021 and December 2022 with a diagnosis of NET and at least one clinical criterion of suspicion for MEN1 and MEN4 underwent molecular analysis of the MEN1 and CDKN1B genes. Phenotypic criteria were: (1) age ≤ 40 years; (2) NET multifocality; (3) MEN1/4-associated manifestations other than NETs; and (4) endocrine syndrome related to NETs or pituitary/adrenal tumors. RESULTS A total of 22 patients were studied. In 18 patients (81.8%), the first-level genetic test was negative (Group A), while four patients (25%) were positive for MEN1 (Group B). No patient was positive for MEN4. In Group A, 10 cases had only one clinical criterion, and three patients met three criteria. In Group B, three patients had three criteria, and one met all criteria. CONCLUSION These preliminary data show that a diagnosis of NET in patients with a negative family history is suggestive of MEN1 in the presence of ≥three positive phenotypic criteria, including early age, multifocality, multiple MEN-associated manifestations, and endocrine syndromes. This indication may allow optimization of the diagnosis of MEN in patients with NET.
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Affiliation(s)
- Antongiulio Faggiano
- Endocrinology Unit, Sant’Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (B.F.); (N.M.); (F.R.); (V.Z.); (R.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
| | - Beatrice Fazzalari
- Endocrinology Unit, Sant’Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (B.F.); (N.M.); (F.R.); (V.Z.); (R.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
| | - Nevena Mikovic
- Endocrinology Unit, Sant’Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (B.F.); (N.M.); (F.R.); (V.Z.); (R.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
| | - Flaminia Russo
- Endocrinology Unit, Sant’Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (B.F.); (N.M.); (F.R.); (V.Z.); (R.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
| | - Virginia Zamponi
- Endocrinology Unit, Sant’Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (B.F.); (N.M.); (F.R.); (V.Z.); (R.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
| | - Rossella Mazzilli
- Endocrinology Unit, Sant’Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (B.F.); (N.M.); (F.R.); (V.Z.); (R.M.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
| | - Vito Guarnieri
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 Foggia, Italy;
| | - Maria Piane
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy
| | - Simona Petrucci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (M.P.); (V.V.); (S.P.)
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy
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Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience. J Clin Med 2022; 11:jcm11071967. [PMID: 35407574 PMCID: PMC8999236 DOI: 10.3390/jcm11071967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Primary hyperparathyroidism (PHPT) in the most common and earliest manifestation of multiple endocrine neoplasia type-1 (MEN1). Epidemiological data have been reported in MEN1 patients but data on long-term follow-up focusing on PHPT are scarce. Methods: In this retrospective cohort study, we included patients diagnosed with MEN1-related PHPT that were under regular follow-up in our institution. Results: Data on 68 patients (39 males), with a mean age at MEN1-diagnosis of 39 ± 13.06 years, were analyzed. Pancreatic neuroendocrine tumors were encountered in 82% (71% nonsecreting) followed by pituitary adenomas in 66% (49% nonsecreting). Mean age at PHPT diagnosis was 35.2 ± 4.0 years. Parathyroidectomy was performed in 57 patients (82.3%), of whom 56% achieved long-term remission, while 12.2% and 31.5% had persistent and recurrent disease, respectively (median follow-up of 4 years; range 1–21 years). Cinacalcet restored serum calcium levels in 33.8%, both as first and as a second line treatment. Permanent hypoparathyroidism occurred in 19.2%. MEN1 pathogenic variants were identified in 77.2% of the tested individuals, but no genotype-phenotype associations were reported. Conclusions: MEN1-related PHPT involves a multiglandular disease and its management remains a therapeutic challenge, as recurrent disease can develop even after 20 years of follow-up. Prolonged follow-up of these patients at referral centers is critical for their optimal management.
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