RESUMEN
BACKGROUND: Multiple endocrine neoplasias (MENs) are a group of hereditary diseases involving multiple endocrine glands, and their prevalence is low. MEN type 1 (MEN1) has diverse clinical manifestations, mainly involving the parathyroid glands, gastrointestinal tract, pancreas and pituitary gland, making it easy to miss the clinical diagnosis. CASE SUMMARY: We present the case of a patient in whom MEN1 was detected early. A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hospital. Blood tests at admission revealed hypercalcemia and hypophosphatemia, and emission computed tomography of the parathyroid glands revealed a hyperfunctioning parathyroid lesion. Gastroscopy findings suggested a duodenal bulge and ulceration. Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb. Further blood tests revealed elevated levels of serum gastrin. Surgery was performed, and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy. The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year. CONCLUSION: For patients who present with gastrointestinal symptoms accompanied by hypercalcemia and hypophosphatemia, clinicians need to be alert to the possibility of MEN1.
Asunto(s)
Hipercalcemia , Neoplasia Endocrina Múltiple Tipo 1 , Neoplasias de las Paratiroides , Paratiroidectomía , Humanos , Neoplasia Endocrina Múltiple Tipo 1/cirugía , Neoplasia Endocrina Múltiple Tipo 1/diagnóstico , Neoplasia Endocrina Múltiple Tipo 1/complicaciones , Neoplasia Endocrina Múltiple Tipo 1/patología , Masculino , Neoplasias de las Paratiroides/cirugía , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/complicaciones , Persona de Mediana Edad , Hipercalcemia/diagnóstico , Hipercalcemia/etiología , Hipercalcemia/sangre , Adenoma/cirugía , Adenoma/diagnóstico , Adenoma/patología , Adenoma/sangre , Neoplasias Duodenales/cirugía , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/patología , Hipofosfatemia/etiología , Hipofosfatemia/diagnóstico , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/sangre , Tumores Neuroendocrinos/patología , Diarrea/etiología , Diarrea/diagnóstico , Detección Precoz del Cáncer/métodos , Gastroscopía , Resultado del TratamientoRESUMEN
INTRODUCTION: The epithelial tight junctions of intestine were impaired in murine model of type 2 diabetes mellitus (T2DM). The aim of this work was to investigate the alteration of intestinal barrier in T2DM patients. METHODS: 90 patients with T2DM and 28 healthy controls were recruited. Serum lipopolysaccharide (LPS), Zonulin, and intestinal fatty acid binding protein (IFABP) were measured by ELISA, based on which a derived permeability risk score (PRS) was calculated. Subgroup analyses were conducted based on the glycemic control (HbA1câ¯<â¯7%, or HbA1câ¯≥â¯7%), the amount of chronic diabetic complications, and the use of aspirin at the time. RESULTS: Serum LPS, Zonulin, and IFABP, and PRS of T2DM group were significantly higher than those of the control group (pâ¯<â¯0.05 for all). Serum LPS and PRS was higher in T2DM patients with poor glycemic control (both pâ¯<â¯0.05). Patients with more chronic complications of diabetes had higher serum LPS and IFABP, and PRS (all pâ¯<â¯0.05). No differences were found in these serum markers between T2DM patients being treated with aspirin or not. CONCLUSIONS: Intestinal barrier function was impaired in T2DM patients. Poor glycemic control and more chronic complications of diabetes were associated with worse intestinal barrier function. Treatment with aspirin did not aggravate the impairment of intestinal barrier in T2DM patients.
