Snapshot A 35-year-old women presents to her primary care physician with 2 months of severe episodes of headache, tremulousness, palpitations, and anxiety. The patient has noted a recent change in her voice, and she has difficulty swallowing solids. On physical exam there is a palpable, nontender swelling in the front of her neck that moves with swallowing. There is no cervical lymphadenopathy. Lab studies show hypercalcemia. An ultrasound of the neck shows irregular calcifications within a mass, and an MRI of the abdomen shows the presence of bilateral adrenal lesions. (Multiple endocrine neoplasia [MEN] type IIA) Introduction Overview login to view 6 more bullets Epidemiology Prevalence login to view 2 more bullets Classification MEN I (Wermer syndrome) login to view 13 more bullets MEN II login to view 16 more bullets Presentation Symptoms login to view 12 more bullets Physical exam login to view 8 more bullets Imaging Ultrasound of neck login to view 5 more bullets Magnetic resonance imaging (MRI) or computed tomography (CT) scan of abdomen login to view 4 more bullets Studies TSH levels login to view 2 more bullets Serum calcitonin login to view 1 more bullet Free serum metanephrine level login to view 4 more bullets Serum PTH and calcium levels login to view 1 more bullet Serum glucose login to view 2 more bullets Serum glucagon login to view 1 more bullet Serum insulin and C-peptide login to view 1 more bullet Serum gastrin login to view 1 more bullet Treatment Medical login to view 6 more bullets Surgical login to view 21 more bullets Prognosis Dependent on MEN type and which neoplasias occur in individual patient