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Multiple Endocrine Neoplasia Type 1 in Poland: a Two-Centre Experience

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Multiple Endocrine Neoplasia Type 1 in Poland: a Two-Centre Experience Original paper Endokrynologia Polska DOI: 10.5603/EP.a2019.0031 Volume/Tom 70; Number/Numer 5/2019 ISSN 0423–104X Multiple endocrine neoplasia type 1 in Poland: a two-centre experience Przemysław Soczomski1, Beata Jurecka-Lubieniecka1, Natalia Rogozik2, Andrzej Tukiendorf3, Barbara Jarząb1, Tomasz Bednarczuk2 1Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute — Oncology Centre Gliwice Branch, Gliwice, Poland 2Department of Internal Diseases and Endocrinology, Medical University of Warsaw, Warsaw, Poland 3Department of Public Health, Wroclaw Medical University, Wroclaw, Poland Abstract Introduction: Multiple endocrine neoplasia type 1 (MEN1) has been causing problems for clinicians since it was first described in 1954 by ORIGINAL PAPER Wermer. Not only its rarity, but also its variable clinical manifestations and lack of genotype-phenotype correlation make it hard to establish evidence-based guidelines for the management of this syndrome. Nationwide registers and population-based research are the best means to improve knowledge about this rare disease. As yet, there is no example of such research in the Polish population of MEN1 patients. Material and methods: We performed a retrospective analysis of clinical and genetic data of patients diagnosed with MEN1 syndrome and followed-up in two polish referral centres in the years 1994–2018. Results: We analysed 79 patients, of whom the majority were women. The mean age of the patient population was 43 years, mean age at MEN1 diagnosis was 37.95 years, and mean interval from initial symptoms to MEN1 diagnosis was 6.93 years. Primary hyperparathyroid- ism (PHP), gastroenteropancreatic neuroendocrine tumour (GEP-NET), and pituitary adenoma (PA) developed in 90%, 52%, and 47% of patients, respectively. The dominance of insulinoma with low prevalence of gastrinoma is the most vivid difference, when compared to previously described populations. Moreover, we found 3.5-fold higher risk of developing a pituitary tumour in patients with a frameshift mutation with the STOP codon of the MEN1 gene. Conclusions: The Polish population of patients with MEN1 is different than previously described European and Asian populations, primarily in prevalence of functional NETs. A frameshift mutation with the STOP codon of the MEN1 gene significantly increases the risk of PA. Further studies with a larger cohort of patients are needed to fully describe the Polish population and improve diagnosis and management of the syndrome. (Endokrynol Pol 2019; 70 (5): 385–391) Key words: multiple endocrine neoplasia type 1; MEN1; Polish population; genotype-phenotype correlation Introduction Due to the sparsity of the syndrome, it is challeng- ing to perform high-quality research and then establish Multiple Endocrine Neoplasia type 1 (MEN1) is a rare, evidence-based guidelines for therapy [6, 9]. Therefore, genetically conditioned syndrome predisposing to therapeutic schemes of non-genetically conditioned primary hyperparathyroidism (PHP), neuroendocrine endocrine tumours have been used in such cases, in tumours of the gastric tract (GEP-NET), pituitary ad- spite of remarkable differences [10]. enomas (PA), and other endocrine and non-endocrine The need for nationwide cohort studies and national tumours. This disorder is caused by germline mutation registers of rare diseases has been mentioned in many of a tumour suppressor gene that is located at 11q13 papers [9, 11, 12], and now we have such examples in locus and encodes a protein called menin. The majority European and Asian populations [4, 13–16]. Despite of cases are familial, with an autosomal-dominant in- these multi-centre studies, which analyse large groups heritance pattern, but in approximately 10% it can also of patients (from 258 to 734), there have also been pa- appear sporadically due to de novo mutations [1]. The pers presenting single-centre experiences [17, 18]. In estimated prevalence of MEN1 in post-mortem studies all of these studies, female dominance of up to 64% is is 0.25% and in vivo is about 2–3 per 100,000 individuals noted, and the prevalence of typical tumours varies at [1–3]. What seems to be most important for the patients 77–96%, 46–59%, and 32–53% for PHP, GEP-NET, and is an increased risk of premature death and impaired PA, respectively. None of these research papers reports quality of life, related to the syndrome [4–8]. a significant correlation between the genotype and Przemysław Soczomski, Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute — Oncology Centre Gliwice Branch, Poland, tel: (+48) 793 629 398, e-mail: [email protected] *Institution from which the paper originates 385 MEN1 in Poland: a two-centre experience Przemysław Soczomski et al. phenotype. However, the cohort studies are suscep- Results tible to different kinds of bias, including selection and information [6]. By the end of December 2018, 95 patients met the diag- The aims of this study were clarification of the nostic criteria of MEN1 syndrome and were included clinical and genetic features of Polish patients with in the database. In 15 cases (16%) only the information MEN1 and an attempt to establish a genotype-phe- about sex, age, family history, and type of genetic muta- notype correlation. To the best of our knowledge, it tion was provided, and one case was lost to follow-up. is the first research to perform such an evaluation in These cases were excluded from further analysis. recent years. Patients general characteristics Material and methods Out of 79 registered patients 59.49% (47 patients) were women and 40.51% (32 patients) were men, with We retrospectively analysed clinical and genetic data collected be- a mean age of 43.00 (SD 16.21) years and median age tween the years 2004 and 2018 in patients affected by MEN1. All of of 42 years. Faxmily history of MEN1 syndrome was the data are from two referral endocrinological centres in Poland: — Department of Nuclear Medicine and Endocrine Oncology, Ma- present in 67.09% of patients, from whom 18 different ria Sklodowska-Curie Institute – Oncology Centre, Gliwice Branch; families were noted. — Department of Internal Diseases and Endocrinology, Medical ORIGINAL PAPER The mean age at MEN1 diagnosis was 37.95 University of Warsaw. We gathered information about the following: date of birth, (SD ± 15.87) years, and the median age was 36.5 gender, first MEN1 manifestation (type and age of onset), age at years. The mean age at MEN 1 diagnosis in subgroups of MEN1 diagnosis, family history, all MEN1-associated endocrine index cases and family members was 38.63 (SD ± 14.13) tumours, past and current treatment, and type of MEN1 gene and 36.6 (SD ± 18.59) years, respectively. All of the mutation. MEN1 diagnosis was established according to current guidelines general data about patients are presented in Table I. [1]. Nevertheless, patients with clinical diagnosis but negative In most of the cases, the initial symptoms were genetic test for a MEN1 gene mutation were not included in the caused by PHP (renal stones, bone fractures, randomly data base. In 17 patients diagnosed before 2012 we used the previ- ous guidelines [19]. diagnosed hypercalcaemia, or parathyroid tumour in Mutational analysis of the MEN1 gene was undertaken in all of the imaging study). The prevalence of all of the observed patients suspected of having MEN1 syndrome according to clinical initial symptoms is presented in Figure 1. The mean symptoms. PCR-based Sanger sequencing of genomic DNA from interval from the initial symptoms to MEN1 diagnosis a peripheral blood sample was performed. In all of the patients, exons 2–10 of the MEN1 gene and introns involved in the alterna- was 6.93 (SD ± 8.27) years. Delays between the diag- tive splicing process were analysed. Next Generation Sequencing nosis of a particular tumour and MEN1 are presented (NGS) and Multiplex ligation-dependent probe amplification in Table II. (MLPA) were introduced in 2017 and used in mutational analysis in the patients previously considered negative for a MEN1 gene mutation in Sanger sequencing. Prevalence of tumours When a patient was positive for a MEN1 gene mutation, mutational Primary hyperparathyroidism was the most prevalent analysis was performed in first-line family members as well. The data are presented as mean with standard deviation (SD), MEN1-associated lesion. It occurred in 71 (89.87%) median, and percentage. Logistic regression was used to assess the cases and was the initial lesion in 37 cases. The mean impact of the mutation type and the exon involved in the mutation age at PHP diagnosis was 35.99 (SD ± 14.00) years with on the occurrence of the studied clinical events. The strength of the a mean delay of 2.49 (SD ± 4.80) years to MEN1 diagno- association between the analysed variables and the clinical event was expressed as a classical odds ratio (OR). For all the statistical sis. Surgery was performed in 74.65% of patients. Out analysis performed, p < 0.05 was considered significant. of these, 77.36% had a subtotal parathyroid excision; Table I. General characteristics of population All Index cases Family members W: 47 (59.49%) W: 33 (67.35%) W: 14 (46.67%) Sex M: 32 (40.51%) M: 16 (32.65%) M: 16 (53.33%) 43 44.61 36.6 Mean age [years] SD ± 16.21 SD ± 14.89 SD ± 18.59 Median age [years] 42 42 42 Mean age at MEN1 diagnosis 37.95 38.63 36.6 [years] SD ± 15.87 SD ± 14.13 SD ± 18.59 W — women; M — men; SD — standard deviation 386 Endokrynologia Polska 2019; 70 (5)
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