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MEN1 with gastrinoma — SCE Endocrinology MCQ

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ModerateNeuroendocrine/MENMEN1 with gastrinomaSCE Endocrinology

A 55-year-old man has recurrent duodenal ulcers and diarrhoea. Gastrin is 1,600 ng/L after proton-pump inhibitor withdrawal, gastric pH is 1.4 and secretin stimulation increases gastrin further. Calcium is 2.81 mmol/L with raised PTH. What is the most likely diagnosis?

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Correct answer: D — MEN1 with Zollinger-Ellison syndrome

MEN1 with Zollinger-Ellison syndrome is best because acidic hypergastrinaemia with a positive secretin test confirms gastrinoma, and primary hyperparathyroidism suggests MEN1. The alternatives are less appropriate because atrophic gastritis has high gastric pH; MEN2A centres on RET-driven MTC and phaeochromocytoma; IBS does not raise gastrin; VIPoma causes watery diarrhoea with hypokalaemia. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: MEN1 clinical practice guidance; ENETS guidance