A 35-year-old woman with epigastric pain, which did not improve on ranitidine, is found to have a nonhealing pyloric channel ulcer on upper endoscopy. Her serum calcium level is 12 mg/dL.

MEN-1, or Werner's syndrome, and autosomal dominant disorder, involves tumors or hyperplasia of two or more glands, most commonly parathyroid, pancreas, and pituitary glands. Hyperparathyroidism is most common, followed by various pancreatic isle cell tumors and pituitary adenomas. MEN-2A (Sipple's syndrome) consist of pheochromocytoma, medullary carcinoma of the thyroid, and often hyperparathyroidism. MEN-2B is characterized by medullary carcinoma of the thyroid, pheochromocytoma, neuromas and marfanoid body habitus. MEN-2A and -2B are also autosomal dominant.