A multi-disciplinary panel of medical experts will take on multiple endocrine neoplasia type 2a (MEN2a) and hypoparathyroidism during two special sessions on Sunday.
The panel will start with a look at two cases of MEN2a starting at 8:15 am in Ballroom D, and move on to two cases of hypoparathyroidism at 8:45 am, according to session moderator Naifa L. Busaidy, MD, FACE, Associate Professor of Medicine and Director of the Thyroid Nodule Clinic in the Department of Endocrine Neoplasia & Hormonal Disorders at the University of Texas – MD Anderson Cancer Center. She will be joined on the panel by David Terris, MD, FACS, FACE, Surgical Director of the Thyroid and Parathyroid Center at Augusta University in Georgia and Swati Mehrotra, MD, Associate Professor of Pathology, Loyola University Medical Center, Maywood, IL.
MEN2a is a rare genetic syndrome spread in an autosomal dominant pattern. Everyone with MEN2a either has medullary thyroid cancer (MTC) or will get MTC at some point in their life.
“Patients with MEN2a are susceptible to get tumors of their adrenal gland called pheochromocytoma,” said Dr. Busaidy. “Those tumors need to be taken care of when you can identify them with a blood test and with imaging. When those are identified, it’s important that one resects or takes out those adrenal tumors before the thyroid.”
She said the panel would discuss timing of surgery, screening MTC patients for related disorders, genetic counseling and approaches to treatment. Patients with an inherited form of MTC usually have a mutation in a gene called the RET proto-oncogene.
“It’s a complex disorder, but it needs a multidisciplinary team,” said Dr. Busaidy. She noted that a good endocrinologist will know MTC can be associated 20 percent of the time with MEN2a; an excellent surgeon well versed in thyroid cancer is required because MTC is very rare and can often be associated with pheochromocytomas; and a good pathologist, particulary one specializing in head and neck or endocrine tumors, is needed to correctly diagnose the condition because MTC can be misdiagnosed as other cancers.
MTC can also be associated with hypoparathyroidism. Because of the proximity of the parathyroid gland to the thyroid, patients are at risk for damage to the gland.
“When the thyroid is removed for whatever reason, either the blood supply to the parathyroids can be nicked or the parathyroids themselves can be involved with tumor or can be removed with the thyroid; basically you lose your parathyroid glands which means you lose the source of your parathyroid hormone,” she said. And, because the parathyroid hormone is critical to signaling calcium, patients can end up with problems.
While the majority of patients see only temporary hypoparathyroidism, Dr. Busaidy noted, sometimes the parathyroid does not recover so patients must be heavily supplemented with calcium and vitamin D.
“ We’ll discuss two cases of hypoparathyroidism where the parathyroid hormones are not working. They are on fairly high doses of calcium and vitamin D,” she said. “What are the complications that can happen from that? How much calcium and vitamin D? How do you follow these patients long term?”
The panel will also discuss the availability of the newer parathyroid hormone drug and what the implications are for its use.
“Everyone thinks it will be this magical drug but I think it is important for them to understand what has been proven and what hasn’t. It gives them ideas for further research and more information about how to talk to their patients about its use,” she said.