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Incidental detection of multiple endocrine neoplasia and medullary thyroid carcinoma before starting GLP-1 agonist: A

Katie Glasgow1, Victoria Jiminez2, Natalie Garcia3

  • 1Department of Surgery, University of Utah, USA.

Heliyon
|July 17, 2024
PubMed

Insights

A man on weight loss medication was unexpectedly diagnosed with medullary thyroid carcinoma and Multiple Endocrine Neoplasia 2A due to elevated calcitonin levels, prompting family screening.

Area of Science:

  • Endocrinology
  • Oncology
  • Genetics

Background:

  • Glucagon-like peptide-1 (GLP-1) agonists are increasingly used for weight loss.
  • GLP-1 agonists have been associated with C-cell hyperplasia, necessitating pre-treatment evaluation.
  • Routine screening for thyroid abnormalities is crucial in patients with risk factors.

Observation:

  • A patient with obesity and hypothyroidism planned to initiate a GLP-1 agonist.
  • Elevated calcitonin (131 pg/mL) and carcinoembryonic antigen (5.2 ng/mL) levels were detected.
  • Thyroid ultrasound revealed bilateral subcentimeter nodules.

Findings:

  • Total thyroidectomy confirmed bilateral 0.8 cm medullary thyroid carcinoma.
  • Germline RET mutation (NM_020975.6: c.1826G>A; p.Cys609Tyr) confirmed Multiple Endocrine Neoplasia 2A (MEN2A).
  • This case highlights a surprising diagnosis of familial MEN2A discovered prior to GLP-1 agonist initiation.

Implications:

  • Early detection of MEN2A can prevent advanced disease through timely intervention.
  • Genetic testing of first-degree relatives is essential for identifying at-risk individuals.
  • This case underscores the importance of thorough pre-treatment evaluations for GLP-1 agonists in specific patient populations.
Keywords:
GLP-1 agonistMedullary thyroid carcinomaMultiple endocrine neoplasia

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