The Changing Face of Multiple Endocrine Neoplasia 2A: From Symptom-Based to Preventative Medicine
Authors' conclusion
These insights into MEN2A presentation, adjusted by birth year, illustrate the shift from reactive to preventative medicine, enabling less extensive risk-reducing surgery.
Study context
- Population
- Carriers of RET mutations who underwent surgery for multiple endocrine neoplasia (MEN2A)155 index, 445 nonindex
- Participants
- 604 carriers
- Exposure
- Older vs more recent birth cohorts
- Outcome
- Temporal changes in MEN2A presentation across birth cohorts
Methodological detailsbirth cohort analyses (10-year increments; ≤1950 to 2011-2020), 237 carriers high-risk, 165 moderate-high risk, 202 low-moderate risk mutations
- Birth cohort analyses (10-year increments; ≤1950 to 2011-2020)
- 237 carriers high-risk, 165 moderate-high risk, 202 low-moderate risk mutations
Main finding
As reported in the abstract
- Index patients declined with increasing recency of birth cohorts (P < .001)
- 41-74% to 0%
- Medullary thyroid cancer (MTC) declined (P < .001)
- 96-100% to 0-33%
- Node metastases diminished (P ≤ .001; high and low-moderate risk mutations)
- 62-70% to 0%
- Biochemical cure after thyroidectomy surged (P ≤ .019; high and low-moderate mutations)
- 17-33% to 100%
- Median age at thyroidectomy fell (P < .001)
- 51-63 to 3-5 years
- Median age at first adrenalectomy fell (P ≤ .013; high and moderate-high risk mutations)
- 46-51 to 24-25 years
- Median age at parathyroidectomy fell
- 43.5-66 to 16.5-32 years
- MTC diameters decreased (P ≤ 002); pheochromocytoma diameters nonsignificant
- 14-32 to 1-4 mm
Observational data: associations, not effects.
Original publication
The Changing Face of Multiple Endocrine Neoplasia 2A: From Symptom-Based to Preventative Medicine. J Clin Endocrinol Metab. Published 17 March 2023. doi:10.
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