<prompt> All of the following are features of MEN 1 syndrome except: September 2007Pancreatic tumorPituitary tumorHyperparathyroidismMedullary carcinoma of thyroid  <response>: Ans. D: Medullary carcinoma of thyroid MEN-1Wermer syndrome is characterized by abnormalities involving the parathyroid, pancreas and pituitary gland; thus the mnemonic device, the 3Ps. Parathyroid-Hyperparathyroidism is present in 80-95 of patients. Asymptomatic hypercalcemia is the most common manifestation: about 25 of patients have evidence of nephrolithiasis or nephrocalcinosis. In contrast to sporadic cases of hyperparathyroidism, diffuse hyperplasia or multiple adenomas are more common than solitary adenomas. Pancreas-Pancreatic islet cell tumors occur in 60 to 70 of patients. Tumors are usually multicentric. Multiple adenomas or diffuse islet cell hyperplasia commonly occurs; such tumors may arise from the small bowel rather than the pancreas. About 30 of tumors are malignant and have local or distant metastases. Malignant islet cell tumors due to MEN 1 syndrome often have a more benign course than do sporadically occurring malignant islet cell tumors. About 40 of islet cell tumors originate from a beta cell, secrete insulin insulinoma, and can cause fasting hypoglycemia. Beta-Cell tumors are more common in patients 40. About 60 of islet cell tumors originate from nonbeta-cell elements and tend to occur in patients 40. Non-beta-cell tumors are somewhat more likely to be malignant Pituitary-Pituitary tumors occur in 15 to 42 of MEN 1 patients. From 25 to 90 are prolactinomas. About 25 of pituitary tumors secrete growth hormone or growth hormone and prolactin. Excess prolactin may cause galactorrhea and excess growth hormone causes acromegaly clinically indistinguishable from sporadically occurring acromegaly. About 3 of tumors secrete ACTH, producing Cushings disease. Most of the remainder are nonfunctional. 