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Target exams

Red flags

• Hypertensive crisis from unrecognised pheochromocytoma in MEN2 — must be biochemically excluded before any surgery or thyroidectomy
• Severe hypercalcaemia with end-organ effects in MEN1 primary hyperparathyroidism — risk of acute kidney injury, pancreatitis and arrhythmia
• Medullary thyroid carcinoma with local invasion, airway compromise or bulky nodal disease — surgical urgency and lifelong calcitonin surveillance
• Recurrent hypoglycaemia from insulinoma — Whipple triad demands supervised 72-hour fast with insulin, C-peptide and proinsulin
• Metastatic or locally advanced pancreatic neuroendocrine tumour — leading cause of MEN1 mortality
• Pituitary apoplexy in a large MEN1 macroadenoma — sudden headache, visual loss and cranial nerve palsy