Document Type : Case Report(s)

Authors

1 Department of Oral Medicine and Oral Pathology, School of Dentistry, Zawia University, Zawia, Libya

2 Department of Biochemistry, School of Medicine, Zawia University, Zawia, Libya

3 Department of Histology/Pathology, National Cancer Institution, Sabratha, Libya

4 Department of Oral and Maxillofacial Surgery, School of Dentistry, Zawia, Libya

Abstract

Multiple endocrine neoplasia (MEN) is a rare inherited disease caused by multiple complex mutations in the RET gene. It is characterized by the occurrence of tumors involving more than two endocrine glands in the same patient. MEN is classified into two types: MEN type 1 (Wermer syndrome) and MEN type 2, which is further subclassified into two phenotypes: MEN 2A (Sipple syndrome) and MEN 2B (Shimcke syndrome). Sipple syndrome is the most common type of MEN type 2. It is characterized by the presence of medullary thyroid carcinoma (MTC), unilateral or bilateral pheochromocytoma, and primary hyperparathyroidism due to parathyroid cell hyperplasia or adenoma. In this article, the authors report a case of a 34-year-old Libyan woman with Rh positive B blood group who presented with an enlarged neck mass. Based on clinical, radiological, biochemical, and cytological assessments, the mass was diagnosed as MTC. Two weeks apart, the patient underwent right adrenalectomy and total thyroidectomy, while the parathyroid glands were found to be normal and preserved. In cases where a neck mass is the only symptom manifestation, it is crucial to carefully investigate for other MEN 2A findings, especially if there is a family history of MTC, to ensure a good prognosis. Patients with MEN 2A should undergo regular screening and be managed by a multidisciplinary team.

Highlights

Ruwaida Mira (Google Scholar)

Keywords

Main Subjects

How to cite this article:

Mira R, Mira R, Sherad MO, Rohuma M. Sipple syndrome: from diagnosis to management-A case report. Middle East J Cancer. 2024;15(1):72-8. doi: 10.30476/mejc.2023.95092.1754.

  1. Brandi ML, Gagel RF, Angeli A, Bilezikian JP, Beck-Peccoz P, Bordi C, et al. Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab. 2001;86(12):5658-71. doi: 10.1210/jcem.86.12.8070.
  2. Ungureanu S, Şipitco N, Alexa Z, Gonţa V, Bujac M, Parnov M, et al. MEN 2A syndrome - multiple endocrine neoplasia with autosomal dominant transmission. Int J Surg Case Rep. 2020;73:141-5. doi: 10.1016/j.ijscr.2020.07.015.
  3. Sipple J. The association of pheochromocytoma and thyroid cancer. Am J Med. 1961;31(1):163–6.  doi:1016/0002-9343(61)90234-0.
  4. Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. 2015;25(6):567-610. doi: 10.1089/thy.2014.0335.
  5. Zhao L, Yang C, Liang C. Simultaneous medullary thyroid carcinoma
    and pheochromocytoma: a case report of MEN2A. Int J Clin Exp Med. 2016;9(6):12269-74. doi:1940-5901/IJCEM0021871.
  6. Tang KL, Lin Y, Li LM. Diagnosis and surgical treatment of multiple endocrine neoplasia type 2A. World J Surg Oncol. 2014;12:8. doi: 10.1186/1477-7819-12-8.
  7. Raue F, Frank-Raue K. Genotype-phenotype correlation in multiple endocrine neoplasia type 2. Clinics (Sao Paulo). 2012;67 Suppl 1(Suppl 1):69-75. doi: 10.6061/clinics/2012(sup01)13.
  8. Engelbach M, Görges R, Forst T, Pfützner A, Dawood R, Heerdt S, et al. Improved diagnostic methods in the follow-up of medullary thyroid carcinoma by highly specific calcitonin measurements. J Clin Endocrinol Metab. 2000;85(5):1890-4. doi: 10.1210/jcem.85.5.6601.
  9. Clark JR, Fridman TR, Odell MJ, Brierley J, Walfish PG, Freeman JL. Prognostic variables and calcitonin in medullary thyroid cancer. 2005;115(8):1445-50. doi: 10.1097/01.mlg.0000168114.90852.a6.
  10. Tam AA, Özdemir D, Fakı S, Bilginer MC, Ersoy R, Çakır B. ABO blood groups, Rh factor, and thyroid cancer risk: to 'B' or not to 'B'. Endocr Res. 2020;45(2):137-46. doi: 10.1080/07435800.2019.1695261.
  11. American Thyroid Association Guidelines Task Force; Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. 2009;19(6):565-612. doi: 10.1089/thy.2008.0403. Erratum in: Thyroid. 2009;19(11):1295.
  12. Leboulleux S, Baudin E, Travagli JP, Schlumberger M. Medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2004;61(3):299-310. doi: 10.1111/j.1365-2265.2004.02037.x.
  13. Romei C, Pardi E, Cetani F, Elisei R. Genetic and clinical features of multiple endocrine neoplasia types 1 and 2. J Oncol. 2012;2012:705036. doi: 10.1155/2012/705036.
  14. Thosani S, Ayala-Ramirez M, Palmer L, Hu MI, Rich T, Gagel RF, et al. The characterization of pheochromocytoma and its impact on overall survival in multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 2013;98(11):E1813-9. doi: 10.1210/jc.2013-1653.
  15. Prihantono P, Palinggi E, Haryasena H, Hamdani W, Binekada IMC. Surgical treatment for parathyroid adenoma: a case report. Open Access Maced J Med Sci. 2019;7(15):2497-501. doi: 10.3889/oamjms.2019.418.