Snap Shot A 36-year-old women complains of severe episodes of headache, tremulousness, palpitations, and anxiety. The patient has noted a change in her voice and she has difficulty swallowing solids. On PE there is a palpable, nontender swelling in the front of her neck that moves with degluttition. There is not cervical lymphadenopathy. Lab studies show hypercalcemia. An X-ray of the cervical region shows irregular calcifications in mass, while an MRI of the abdomen shows confirms the presence of bilateral adrenal lesions.(Type IIA) Introduction Cancer syndrome with several associated endocrine neoplasms concurrance occurs secondary to each organ's common embryologic origin All MEN syndromes have AD inheritance There are 3 types MEN I (Wermer's syndrome) parathyroid tumors pituitary tumors (prolactin or GH) pancreatic islet cell/endocrine tumors Zollinger-Ellison syndrome insulinomas VIPomas present with WDHA syndrome Watery Diarrhea Hypokalemia Achlorhydria glucagonomas presentation gastric ulcers secondary to gastrin production by ZE syndrome kindey stones secondary to increased serum calcium as result of increased PTH MEN IIA (Sipple's syndrome) medullary thyroid carcinoma secretes calcitonin pheochromocytoma parathyroid tumors MEN IIB medullary thyroid carcinoma pheochromocytoma oral/intestinal ganglioneuromatosis associated with marfanoid habitus MEN IIa and IIb share several common features (reason it is not MEN II and III) medulllary thyroid carcinoma pheochromocytoma ret association