Int J Thyroidol.  2022 Nov;15(2):121-124. 10.11106/ijt.2022.15.2.121.

Multiple Endocrine Neoplasia 2A Detected by Peptic Ulcer Perforation with Hypercalcemia

  • 1Department of Surgery, Dankook University College of Medicine, Cheonan, Korea


Multiple endocrine neoplasia type 2A is autosomal dominantly inherited disease with RET oncogene mutation. Hyperparathyroidism occurs less frequently and severe hyperparathyroidism is rare in multiple endocrine neoplasia type 2A. We experienced a case of 38-year-old man with peptic ulcer perforation and hypercalcemia who was diagnosed as multiple neoplasia type 2A. Although peptic ulcer disease with hypercalcemia is very rare in MEN 2A, clinical suspicion of multiple endocrine neoplasia and germline mutational test would be important for accurate diagnosis and treatment.


Hyperparathyroidism; Peptic ulcer; MEN 2A


  • Fig. 1 Thyroid sonography shows both 1.4-cm-sized heterogeneous low echoic solid nodules with multiple low echoic nodules around thyroid which is suspected of parathyroid hyperplasia (arrow).

  • Fig. 2 Computed tomography of neck shows both thyroid mass with multiple parathyroid hyperplasia (arrows).

  • Fig. 3 Tc-99m sestamibi parathyroid scan shows multiple uptake in delayed image of 2 hour which is compatible with parathyroid hyperplasia.

  • Fig. 4 The resected specimen of upper thyroid lobes shows whitish tan cut surface which is characteristic finding of medullary thyroid carcinoma. Dissected lymph nodes of central compartment are included in the lower part of photo (black arrows). The sizes of excised parathyroid are 3 cm of left upper one, 1.5 cm of right upper and 1.2 cm of left lower ones (white arrows). The right lower parathyroid is about 7 mm sized which is auto-transplanted to left forearm.



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