A Possible New Multiple Endocrine Neoplasia Mutation in a Patient with a Prototypic Multiple Endocrine Neoplasia Presentation.

BACKGROUND: Multiple endocrine neoplasia (MEN) type 1 syndrome is an uncommon inherited disorder characterized by the occurrence of tumors involving two or more endocrine glands. These tumors include pheochromocytoma, adrenal cortical and neuroendocrine tumors including (bronchopulmonary, thymic, gastric), lipomas, angiofibromas, collagenomas, and meningiomas. MEN-4 is very rare and has been characterized by the occurrence of parathyroid and anterior pituitary tumors in association with tumors of the adrenals, kidneys, and reproductive organs. SUMMARY: We report the case of a 40-year-old male without significant family history of endocrine disease who was found to have primary hyperparathyroidism, a pituitary tumor causing acromegaly, thyroid cancer, renal cell carcinoma, and pancreatic cysts. We posit that this represents a new version of MEN-4. While renal tumors (angiomyolipoma) have been reported as part of the MEN-4 phenotype, to our knowledge, this is the first case reported of the association of MEN-1 and/or MEN-4 phenotype with this unique constellation of tumors, including renal cell carcinoma. Interestingly, this patient tested negative (DNA sequencing/deletion) for MEN-1 (menin), MEN-4 (CDKN1B) and VHL genes. KEY MESSAGE: Thus, while this case has clinical characteristics consistent with either MEN-1 or MEN-4, it may represent a unique genetic variant.

Middle cerebral artery involvement in systemic lupus erythematosus presenting as a stroke--an unusual initial presentation of the disease.

Systemic lupus erythematosus (SLE) disproportionately affects the African American population and usually presents with a constellation of symptoms. Along with hematologic, musculoskeletal, serous and skin involvement, the most common causes of morbidity are attributed to altered blood rheology causing accelerated atherosclerotic vascular disease (ASVD). ASVD occurs in predominantly premenopausal women at an age where ASVD is rare or uncommon. Classical central nervous system manifestations are very rare from the outset of the disease. Here we present a 44-year old African American woman with newly diagnosed SLE and no significant atherosclerotic risk factors, who presented initially with symptoms of subacute stroke.