Delayed diagnosis of MEN1 after kidney transplantation: unrecognized pre-transplant features and implications for clinical practice.
Kaiyo Ichikawa, Shunta Hori, Mitsuru Tomizawa et al.
✦ AI-curated · Sources linked
Case in brief
A 68-year-old man with end-stage renal disease underwent living-donor kidney transplantation and had persistent hypercalcemia afterward. Evaluation showed recurrent hyperparathyroidism with bilateral parathyroid enlargement. Pre-transplant imaging had also shown an adrenal adenoma and a pancreatic tail lesion; subsequent pituitary MRI and genetic testing confirmed MEN1. Review of his history identified additional pre-transplant findings suggestive of the syndrome that had not been recognized. The case illustrates how CKD-related metabolic abnormalities can obscure MEN1 before transplantation.
What made this case unusual
MEN1 was diagnosed only after transplantation, despite multiple suggestive pre-transplant findings, including recurrent multiglandular hyperparathyroidism and lesions involving the adrenal gland and pancreas.
Diagnostic / clinical pearl
In a kidney-transplant candidate with recurrent or multiglandular hyperparathyroidism, consider MEN1 even when CKD-related calcium-phosphate abnormalities complicate interpretation.
Why it matters
Recognizing MEN1 before transplantation may inform pre-transplant risk assessment and support appropriate long-term oncological surveillance.