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Zollinger-Ellison syndrome in MEN1 — RCPSC IM MCQ

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HardGastroenterology/HepatologyZollinger-Ellison syndrome in MEN1RCPSC IM

A patient with recurrent ulcers, fasting hypergastrinemia and gastric pH below 2 also has hypercalcemia and recurrent nephrolithiasis. What additional evaluation is most important?

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Correct answer: B — Assess for MEN1, including primary hyperparathyroidism and pituitary disease

The best answer is “Assess for MEN1, including primary hyperparathyroidism and pituitary disease”. Acid hypersecretion with gastrinoma plus hypercalcemia suggests MEN1, commonly involving parathyroid, pancreatic-duodenal and pituitary tumours. Recognizing the syndrome changes biochemical testing, imaging, genetic counselling and family assessment. Biochemical confirmation of each component precedes localization, and genetic counselling can identify relatives who need staged surveillance.

Reference: Endocrine Society clinical practice guideline library: https://www.endocrine.org/clinical-practice-guidelines