Component of MEN 2A Before Surgery Before Surgery After Surgery After Surgery
Biochemical Findings Imaging Histopathology Imaging/ biochemical findings
Pheochromocytoma (Pre-pregnancy) 24-hour Urine Adrenaline: 81.74 ug/day (Normal < 20ug/day) Noradrenaline: 197.66 ug/day (Normal < 90 ug/day) Urinary Free Cortisol: 76ug/day (Normal <120 ug/day) S. DHEAS: 210 ug/dL CECT abdomen: Bilateral enlargement of adrenal gland, with heterogenous mass with areas of necrosis and cystic changes Size: 7.6 X 5.4 cm on right side and 5.5 X 4.4 cm on left side 68-Ga-DOTANOC Scan: Uptake in the solid component of the lesions bilaterally
Bilateral pheochromocytoma; PASS-4
None
Medullary Thyroid Carcinoma
S.Calcitonin (Pre-pregnancy): 20 pg/ml (Normal < 5 pg/ml) S.Calcitonin (At 22 weeks POG): 42.1pg/ml USG Neck: (pre-pregnancy) A TIRADS 5 nodule on right lobe (5.8 x 3.7 mm). Two TIRADS 5 on left lobe of thyroid (8 x 5 mm); USG Neck (At 22 weeks POG, repeated before surgery) Right thyroid nodule (6.5 x 4.8 mm) and left thyroid nodule (6.2 x 5 mm)
Medullary thyroid carcinoma
USG Neck: (At 32 weeks POG): No residual Lesion
Hyper-parathyroidism
S. Calcium (Pre-pregnancy): 12.1mg/dL (Normal- 8.2-10.4 mg/dL iPTH (Pre-pregnancy): 226 pg/ml (Normal < 65 pg/ml) USG Neck: (Pre-pregnancy) A right inferior parathyroid adenoma (9 x 5.2 mm); repeat imaging: 8 x 6 mm USG Abdomen: (Pre-pregnancy) Bilateral nephrocalcinosis, right moderate hydronephrosis
Parathyroid adenoma
S. Calcium: (At 24 weeks POG) 9.1 mg/dL iPTH: (At 24 weeks POG) 8 pg/ml