Table 6.

Multiple Endocrine Neoplasia Type 4: Recommended Surveillance

System/ConcernEvaluationFrequency 1
  • Serum calcium
  • PTH & vitamin D measurement may also be considered to ensure sufficiency.
Biennially (every 2 yrs) starting at age 25 yrs
Pituitary adenoma Serum IGF-1 & prolactinEvery 3-5 yrs or as symptoms indicate, starting at age 25 yrs
Pituitary MRIImaging every 5 yrs starting at age 25 yrs
If clinical concern for Cushing disease, perform 24-hr urine free cortisol, late night salivary cortisol, &/or 1 mg overnight dexamethasone suppression test.
Neuroendocrine tumors & carcinoids Serum gastrinBiannually starting at age 25 yrs
Abdominal MRI (or CT)Imaging every 5 yrs starting at age 25 yrs, increasing to every 2.5 yrs at age 40 yrs

IGF-1 = insulin-like growth factor 1; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone


Abnormal findings would indicate the need for more frequent follow up (current multiple endocrine neoplasia type 1 treatment guidelines can be used as a guide).

From: Multiple Endocrine Neoplasia Type 4

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