Multiple endocrine neoplasia type-1

A 38-year-old man with multiple endocrine neoplasia type-1 (Wermer's syndrome) is described. The patient had refractory duodenal ulcers and raised basal acid output (55 mmol/hour) and fasting serum gastrin (1190 pg/ml). Abdominal CT scan revealed mass lesions (gastrinomas) in the head of the pancreas. He also had persistent hypercalcemia, hypophosphatemia, right ureteric calculi, increased urinary calcium and phosphorus and enlarged parathyroids on ultrasound and CT of the neck. Parathormone level was raised, but the pituitary gland was normal on CT scan of the head. The patient was managed initially with histamine H2-blockers, omeprazole and parathyroidectomy; enucleation of the tumor masses in the pancreas was done subsequently.