• Carolina Chaves, Tiago Nunes da Silva, Bernardo Dias Pereira, João Anselmo, Isabel Claro, Branca M Cavaco, Ana Saramago, and Valeriano Leite.
• Serviço de Endocrinologia e Nutrição, Hospital Divino Espírito Santo de Ponta Delgada, Azores Islands, Portugal.
• Medicine (Baltimore). 2021 Dec 10; 100 (49): e28145e28145.

RationaleMultiple Endocrine Neoplasia type 1 (MEN1) is a familial syndrome that results from the disruption of a tumor suppressor protein called MENIN. Its management is challenging, as MEN1 affects different endocrine tissues and predisposes to both benign and malignant tumors. MENIN-deficient cells have recently been recognized to play a role in triggering autoimmunity. Herein, we present a case of MEN1 with multiple endocrine and autoimmune disorders.Patient ConcernsA 50 years old female with a 25 years history of complicated nephrolithiasis presented with primary hyperparathyroidism.DiagnosesOver several decades, she was diagnosed with recurrent primary hyperparathyroidism, autoimmune thyroiditis, multinodular goiter, pernicious anemia, metastatic gastric type 1 neuroendocrine tumor, macroprolactinemia, gonadotropin deficiency, mucosa-associated lymphoid tissue lymphoma of the thyroid gland, positive anti-calcium sensor receptor antibodies, and BRCA 1/2-negative invasive breast cancer. The autoimmune regulator gene was sequenced, but no pathogenic variants were found. Next-generation sequencing revealed both a pathogenic MEN1 mutation and a benign CDC73 gene variant. Familial genetic screening revealed a large kindred with multiple carriers of one or both genetic variants (MEN1 = 19; CDC73 = 7).InterventionsThe patient underwent surgical excision of three parathyroid glands, total thyroidectomy and breast tumorectomy plus tamoxifen, and monthly injections of octreotide. The patient and family members with the MEN1 mutation are under a life-long surveillance program for MEN1 prototypic tumors.OutcomesThe patient was stable and alive during a 24-years follow-up period.LessonsWith the present case, the authors highlight a new interplay between MENIN and the immune system, which may have implications for future targeted life-long surveillance and treatment of MEN1 patients.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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