BOF: 2.15
A 54-year-old male presents with abdominal pain and
diarrhoea. He had been taking diclofenac for backache. Clinical examination
was unremarkable. He underwent endoscopy, which showed multiple duodenal
ulcers, CLO test was negative. He was treated with a proton pump inhibitor but
symptoms continued. He was admitted for further investigation which were as
follows:
Hb 11.0
MCV 77 fl
Calcium 3.0 mmol/L
Phosphate 0.7 mmol/L
The likely diagnosis is:
a)
Crohn’s disease
b)
Non-steroidal induced ulcers and colopathy
c)
Multiple endocrine neoplasia
d)
Chronic pancreatitis
e)
Hyperparathyroidism
Answer:
c)
The patient has diarrhoea, abdominal pain and
hypercalcaemia. The ulceration of his duodenum is not associated with Helicobacter
pylori and does not respond to proton pump inhibitors. This suggests
hypergastrinaemia due to Zollinger-Ellison syndrome. Hypercalcaemia with low
phosphate suggests hyperparathyroidism. The combination of Zollinger-Ellison
syndrome and hyperparathyroidism suggests the patient has Type I multiple
endocrine neoplasia
(MEN)
