MEN Syndromes

A 38-year-old man with MEN 1 syndrome presents with severe gastric ulcer disease refractory to standard proton pump inhibitor therapy. Endoscopy confirms multiple gastric and duodenal ulcers. Serum gastrin level is markedly elevated at 2500 pg/mL (normal <100). What is the drug of choice for long-term management of this gastrinoma?

A 42-year-old woman from Delhi presents to the endocrinology clinic for evaluation of hypertension (BP 164/102 mmHg) and episodic palpitations with diaphoresis. Plasma metanephrines are markedly elevated. On examination, she has a firm, non-tender thyroid nodule. TSH is normal, but fine-needle aspiration cytology (FNAC) shows C-cell hyperplasia and focal medullary thyroid carcinoma (MTC). Serum calcium is 10.8 mg/dL and PTH is 78 pg/mL (normal 15–65). Her 16-year-old daughter has been found to have elevated calcitonin (45 pg/mL; normal <10) on routine screening. What is the most likely diagnosis?

A 38-year-old man presents with recurrent nephrolithiasis and hypercalcaemia. Biochemistry shows elevated PTH (120 pg/mL, normal 10–65) and serum calcium 11.2 mg/dL. On further questioning, he reports a family history of thyroid nodules and medullary thyroid carcinoma in his mother. Which investigation is most appropriate to confirm the suspected diagnosis?

A 42-year-old woman with a history of recurrent peptic ulcer disease and chronic diarrhoea is found to have a fasting serum gastrin of 850 pg/mL (normal < 100). Gastric pH is 1.5. She has a past history of primary hyperparathyroidism treated surgically. Which investigation is most appropriate to confirm the suspected diagnosis and guide management?

A 38-year-old man from rural Maharashtra presents with a family history of medullary thyroid carcinoma and hypertension. Genetic testing reveals a RET proto-oncogene mutation. Which feature would best distinguish his diagnosis (MEN 2A) from MEN 2B?