{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T23:26:28Z","timestamp":1772148388676,"version":"3.50.1"},"reference-count":14,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Multiple endocrine neoplasia type-4 (MEN4) is a rare form of multiple endocrine neoplasia due to a pathogenic variation in the cyclin-dependent kinase inhibitor 1B (CDKN1B) gene. It has a similar presentation to patients with multiple endocrine neoplasia type-1 (MEN1), with primary hyperparathyroidism and pituitary adenomas being the most common features. In this case, we describe a 54-year-old woman presenting with a pituitary macroadenoma cosecreting growth hormone and prolactin and primary hyperparathyroidism. She was initially managed with cabergoline without satisfactory response. Eventually she proceeded to transsphenoidal pituitary resection of the adenoma, and histology revealed appearances consistent with a mixed somatotroph-lactotroph adenoma. Subsequently genetic analysis confirmed the presence of a pathogenic variant in the CDKN1B gene (CDKN1B c.410del), in keeping with a diagnosis of MEN4. This is the first case of a cosecreting pituitary macroadenoma to be described in a patient with MEN4.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf124","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T06:34:31Z","timestamp":1748500471000},"source":"Crossref","is-referenced-by-count":1,"title":["A Pituitary Macroadenoma Cosecreting Prolactin and Growth Hormone in a Patient With Multiple Endocrine Neoplasia Type 4"],"prefix":"10.1210","volume":"3","author":[{"given":"Leah","family":"Green","sequence":"first","affiliation":[{"name":"Department of Medicine, Dunedin School of Medicine, University of Otago , Dunedin 9016 ,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Millie","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dunedin School of Medicine, University of Otago , Dunedin 9016 ,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aufar","family":"Bahri","sequence":"additional","affiliation":[{"name":"Department of Pathology, Dunedin School of Medicine, University of Otago , Dunedin 9016 ,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Radiology, Dunedin School of Medicine, University of Otago , Dunedin 9016 ,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7514-6717","authenticated-orcid":false,"given":"Patrick","family":"Manning","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dunedin School of Medicine, University of Otago , Dunedin 9016 ,","place":["New Zealand"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"issue":"42","key":"2025052902342864100_luaf124-B1","doi-asserted-by":"crossref","first-page":"15558","DOI":"10.1073\/pnas.0603877103","article-title":"Germ-line mutations in p27Kip1 cause a multiple endocrine neoplasia syndrome in rats and humans","volume":"103","author":"Pellegata","year":"2006","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"2025052902342864100_luaf124-B2","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1002\/humu.21170","article-title":"Diagnostic challenges due to phenocopies: lessons from multiple endocrine neoplasia type1 (MEN1)","volume":"31","author":"Turner","year":"2010","journal-title":"Hum Mutat"},{"issue":"7","key":"2025052902342864100_luaf124-B3","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1210\/clinem\/dgae055","article-title":"Beyond MEN1, when to think about MEN4? Retrospective study on 5600 patients in the French population and literature review","volume":"109","author":"Chevalier","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2025052902342864100_luaf124-B4","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s12020-023-03497-2","article-title":"Multiple endocrine neoplasia type 4 (MEN4): a thorough update on the latest and least known men syndrome","volume":"82","author":"Ruggeri","year":"2023","journal-title":"Endocrine"},{"issue":"9","key":"2025052902342864100_luaf124-B5","doi-asserted-by":"crossref","first-page":"3637","DOI":"10.1210\/jc.2019-00082","article-title":"Clinical features of multiple endocrine neoplasia type 4: novel pathogenic variant and review of published cases","volume":"104","author":"Frederiksen","year":"2019","journal-title":"J Clin Endocrinol 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