Clinical Characteristics in Multiple Endocrine Neoplasia Type 1 in Japan: A review of 106 patients Katsuhiko YOSHIMOTO 1,2, Shiro SAITO 1 1. The First Department of Internal Medicine 2. Otsuka Department of Clinical and Molecular Nutrition, School of Medicine, The University of Tokushima, Tokushima, Japan A review of 106 patients with multiple endocrine neoplasia (MEN) type 1 reported between 1966-1989 in Japan was conducted in order to clarify the natural history of this disease. Sporadic MEN 1 was found in 61 patients, and familial MEN 1 was found in 45 patients from 15 families. The mean ages at diagnosis of the two groups were 46.2 and 41.3 years, respectively, and the male to female ratio was 3:4. With regards to the involvement of the pituitary, parathyroid and endocrine pancreas, the combination of three endocrine glands was 31%, and that of two was 48%, in which the pituitary, parathyroid and endocrine pancreas had tumorous lesions in 60%, 88% and 63%, respectively. The first clinical manifestations of MEN 1 were the symptoms of hyperparathyroidism (32%), pituitary tumors (26%), peptic ulcer (28%) and hypoglycemia (13%). These symptoms appeared between 6 and 57 years of age (mean 34 years). The main clinical symptoms of the pituitary tumors were acromegaly and gigantism (37%), galactorrhea-amenorrhea syndrome (20%), Cushing' s disease (10%) and visual disturbance due to compression of the tumor (20%). The clinical manifestations of hyperparathyroidism were mainly asymptomatic hypercalcemia (41%), nephrolithiasis (42%) and osteitis fibrosa (5%). In the patients with pancreatic tumor, Zollinger-Ellison syndrome (52%) and hypoglycemic symptoms (42%) were found. Tumors in the adrenal cortex, thyroid, carcinoid and lipoma were detected in association with MEN 1 in the frequencies of 28%, 21%, 9% and 5%, respectively. Death was reported in 37 patients between 9 and 86 years of age (mean 50.0 years). The cause of death was gastrointestinal bleeding and perforation (45%), surgery (24%) and disseminated carcinomatosis (18%). Recently, the gene predisposing to this syndrome has been assigned to chromosome 11 (11q13) in non-japanese cases but not yet in Japanese MEN 1 patients.

1) Amano, S, Hazama, F., Haebara, H., Tsurusawa, M. and Kaito, H.: Ectopic ACTH-MSH producting carcinoid tumor with multiple endocrine neoplasia in a child. Acta Path. Jap., 28: 721-730, 1978. 2) Ballard, H.S., Frame, B. and Hartsock, R.J. : Familial multiple endocrine adenoma-peptic ulcer complex. Medicine, 43: 481-516, 1964. 3) Benson, L., Ljunghall, S., Akerstrom, G. and Oberg, K. : Hyperparathyroidism presenting as the first lesion in multiple endocrine neoplasia type 1. Am. J. Med., 82: 731-736, 1987. 4) Croisier, J.-C., Azerad, E. and Lubertzki, J.: L' adenomatose polyendocrinienne (syndrome de Wermer). Sem. Hop. Paris, 47: 494-519, 1971. 5) Eberle, F. and Griin, R.: Multiple Endocrine Neoplasia, Type I (MEN I). Ergeb. Inn. Med. Kinderheilkd, 64: 75-149, 1981. 6) Fitzpatrick, L.A.: Hypercalcemia in the Multiple Endocrine Neoplasia Syndromes. Endocrinology and Metabolism Clinics of North America, 18: 741-752, 1989. K., Nakamura, Y. and Nordenskjold, M. : Multiple endocrine neoplasia type 1 gene maps to chromosome 11 and is lost in insulinoma. Nature, 332: 85-87, 1988. 10) Lips, C.J.M., Vasen, H.F.A., Lamers, C.B.H.W. : Multiple Endocrine Neoplasia Syndromes. CRC Critical Reviews in Oncology/Hematology, 2: 117-184, 1984. 11) Marx, S.J., Spiegl, A.M., Levine, M.A., Rizzoli, R.E., Lasker, R.D., Santora, A.C., Downs, R.W. and Auerbach, G.D. : Familial hypocalciuric hypercalcemia. The relation to primary parathyroid hyperplasia. N. Eng. J. Med., 307: 416-427, 1982.

12) Marx, S.J. : Familial multiple endocrine neoplasea type 1. Mutation of a tumor suppressor gene. Trends in Endocrinology and Metabolism, 1: 76-82, 1989. 16) Oberg, K., Skogseid, B. and Eriksson, B., Multiple Endocrine Neoplasia Type 1 (MEN 1). Clinical, biochemical and general investigations. Acta Oncologica, 28: 383-387, 1989. 17) Rizzoli, R., Green III, J. and Marx, S.J. : Primary hyperparathyroidism in familial multiple endocrine neoplasia type 1. Long-term follow up of serum calcium levels after parathyroidectomy. Am. J. Med., 78: 467-474, 1985.