Screenings for people with multiple endocrine neoplasia
Multiple endocrine neoplasia is a group of inherited disorders that cause tumours in at least two hormone-producing (endocrine) glands; the tumours can be noncancerous or cancerous. Type 1 (MEN1) often involves the parathyroid glands, the pituitary gland and the pancreas. The most common sign of type 2 (MEN2) is medullary thyroid carcinoma, and some people also develop a pheochromocytoma, an adrenal tumour that can cause dangerously high blood pressure. MEN1 affects about 1 in 30,000 people and MEN2 about 1 in 35,000. (MedlinePlus Genetics) This page covers screening checks only, not surgery, medicines or treatment.
The main guidance
For MEN1, the Endocrine Society published clinical practice guidelines in 2012 and recommended that patients and their families be cared for by multidisciplinary teams with experience in endocrine tumours. (Endocrine Society MEN1 guideline, 2012) The American Association of Clinical Endocrinology (AACE) published a consensus statement in 2025 that sets out a screening schedule. (AACE MEN1 consensus, 2025) An international Delphi panel also published 55 recommendations for adults and children with MEN1 in 2025. (International MEN1 recommendations, 2025) For MEN2, the main reference is the 2015 revised American Thyroid Association (ATA) guideline on medullary thyroid carcinoma. (ATA MTC guidelines, 2015)
MEN1: checks the AACE schedule lists
The AACE says its table gives suggested frequencies, and that how often and for how long a person is screened should weigh their values and preferences against the risks and benefits of each test. (AACE MEN1 consensus, 2025)
| Tumour type | Start | Test | How often |
|---|---|---|---|
| Parathyroid | Early childhood (5 to 8) | Blood calcium, phosphorus and parathyroid hormone (PTH) | Yearly |
| Pituitary | 16 | Prolactin and IGF-1 blood tests; contrast-enhanced pituitary MRI | Blood tests yearly; MRI every 1 to 3 years |
| Pancreas and duodenum | 16 | CT or MRI of the abdomen and pelvis, or DOTATATE PET-CT; hormone tests only with symptoms | Every 1 to 3 years |
| Chest (thymus and lungs) | 8 to 15 | CT or MRI of the chest, or DOTATATE PET-CT | Every 1 to 3 years |
| Adrenal | 16 | CT or MRI of the abdomen; hormone tests with symptoms | Every 1 to 3 years |
| Breast (women) | 40 | Breast exam and mammogram | Yearly |
Parathyroid. Overactive parathyroid glands occur in about 95 percent of people with MEN1, often before 30, and are often the first sign. The AACE says people with a confirmed MEN1 gene change, or a close relative with MEN1 who has not had genetic testing, should consider yearly blood tests for it. (AACE MEN1 consensus, 2025)
Pituitary. The AACE recommends pituitary screening for everyone with MEN1, by contrast-enhanced dynamic MRI, with yearly prolactin and IGF-1 blood tests. It notes that some suggest waiting until 16 to screen people without symptoms. (AACE MEN1 consensus, 2025)
Pancreas, chest and adrenal glands. Pancreas and duodenum screening starts at 16 and can be spaced to every 1 to 3 years in people without symptoms. Chest imaging for thymus and lung tumours starts between 8 and 15, and abdominal CT or MRI every 1 to 3 years should be considered for adrenal growths. (AACE MEN1 consensus, 2025)
Breast. MEN1 is linked to a higher risk of early breast cancer, and the AACE says regular screening with mammograms and clinical breast exams may be recommended for women with MEN1 from 40. (AACE MEN1 consensus, 2025) See mammogram: what to expect.
MEN2: checks the ATA guideline lists
The ATA sorts RET gene changes into three risk categories: highest risk (MEN2B and the M918T change), high risk (codon 634 and A883F changes) and moderate risk (the others). (ATA MTC guidelines, 2015)
| Check | High risk | Moderate risk |
|---|---|---|
| Physical exam, neck ultrasound and calcitonin blood test | Yearly from 3 | Yearly from about 5 |
| Pheochromocytoma: plasma free metanephrines or 24-hour urine metanephrines | By 11 (also by 11 for highest risk) | By 16 |
| Hyperparathyroidism: corrected or ionised calcium, with or without PTH | From 11 | From 16 |
Thyroid. Children with codon 634 changes often develop medullary thyroid carcinoma in the first years of life, so the ATA says a yearly physical exam, neck ultrasound and calcitonin test should begin at 3. For the moderate-risk group, the same checks begin at 5, and the ATA notes that 6-monthly or yearly checks may go on for years or decades. Decisions about thyroid surgery are made by the surgeon and paediatrician with the parents; this page does not cover them. (ATA MTC guidelines, 2015) See thyroid cancer screening.
Adrenal (pheochromocytoma). Screening is by plasma free metanephrines and normetanephrines or 24-hour urine metanephrines and normetanephrines, with CT or MRI of the adrenal glands only after a positive blood or urine result. The ATA notes pheochromocytomas usually appear in the third or fourth decade of life in MEN2A, but have been seen as early as 8 to 12 in the higher-risk groups and 19 in the moderate-risk group. (ATA MTC guidelines, 2015)
Parathyroid. The ATA says people in the high and moderate risk groups should be screened for hyperparathyroidism at the same time as for pheochromocytoma, with a calcium blood test with or without PTH. (ATA MTC guidelines, 2015)
Checks for relatives
MedlinePlus Genetics says MEN1 and MEN2 are inherited in an autosomal dominant pattern, so one altered copy of the gene is enough to cause the disorder. (MedlinePlus Genetics) The 2012 MEN1 guideline says first-degree relatives have a 50 percent risk and can often be identified by genetic testing. (Endocrine Society MEN1 guideline, 2012) The AACE recommends genetic testing of at-risk relatives between 5 and 10, when tumour screening should also begin, and promptly for at-risk relatives older than 10; relatives who test negative do not need MEN1 follow-up. (AACE MEN1 consensus, 2025) For MEN2, the ATA says genetic counselling and RET testing should be offered to first-degree relatives of people with proven hereditary medullary thyroid carcinoma. (ATA MTC guidelines, 2015) See family history and screening and how to collect your family health history.
When to contact a provider
MedlinePlus, MEN I, when to contact a medical professional: (MedlinePlus, MEN I)
Contact your provider if you notice symptoms of MEN I or have a family history of this condition.
MedlinePlus, MEN II, when to contact a medical professional: (MedlinePlus, MEN II)
Contact your provider if you notice symptoms of MEN II or if someone in your family receives such a diagnosis.
Routine age-based screening
MEN checks are added to, not instead of, the routine screenings for your age and sex; see screenings by age and gender.
Where they differ:
- When MEN1 pituitary screening starts. The AACE table starts pituitary blood tests and MRI at 16 and notes some suggest waiting until then to save cost and burden, while it says earlier guidelines start tumour screening at age 5. (AACE MEN1 consensus, 2025)
- MEN1 relatives with no gene change found. The AACE says current guidelines advise the same screening for every MEN1 group, including yearly checks for close relatives of people whose gene change was not found, but that most evidence suggests less screening may be appropriate for them; the data are not yet enough to change it. (AACE MEN1 consensus, 2025)
- MEN2 start ages depend on the gene change. The ATA starts thyroid checks at 3 or about 5, and adrenal and calcium tests at 11 or 16, depending on the risk category. (ATA MTC guidelines, 2015)
- No single MEN1 consensus. The 2025 international Delphi panel says no consensus existed on the best assessment and management of MEN1, which it set out to address. (International MEN1 recommendations, 2025)
Your doctor decides what your result means for you.
Questions people ask
What checks do people with MEN1 have?
The 2025 AACE consensus suggests a yearly calcium, phosphorus and parathyroid hormone blood test from early childhood (5 to 8); from 16, yearly prolactin and IGF-1 tests with a pituitary MRI every 1 to 3 years, and abdominal CT or MRI every 1 to 3 years; chest CT or MRI every 1 to 3 years from 8 to 15; and for women, a yearly mammogram and breast exam from 40. (AACE MEN1 consensus, 2025)
What checks do people with MEN2 have?
The American Thyroid Association guidelines describe a yearly physical exam, neck ultrasound and calcitonin blood test from age 3 for people with high-risk RET changes and from about 5 for moderate-risk changes, plus blood or urine metanephrine tests for pheochromocytoma and a calcium test for hyperparathyroidism, starting by 11 or 16 depending on the risk group. (ATA MTC guidelines, 2015)
Why does the RET gene change matter?
The ATA groups RET changes into highest, high and moderate risk categories. The category sets how early thyroid checks and adrenal and calcium tests begin. (ATA MTC guidelines, 2015)
Are hormone tests for the pancreas done every year in MEN1?
No. The AACE consensus says hormone tests for pancreas and duodenum tumours are advised only when symptoms suggest hormone excess, because they rarely find anything without symptoms. Imaging every 1 to 3 years is used instead. (AACE MEN1 consensus, 2025)
Should relatives be tested?
Yes. Both types are inherited in an autosomal dominant pattern, and the 2012 Endocrine Society guideline says first-degree relatives of someone with MEN1 have a 50 percent risk. The AACE consensus recommends genetic testing of at-risk relatives between 5 and 10, and the ATA recommends genetic counselling and RET testing for first-degree relatives of people with hereditary medullary thyroid cancer. (MedlinePlus Genetics) (Endocrine Society MEN1 guideline, 2012) (AACE MEN1 consensus, 2025) (ATA MTC guidelines, 2015)
Related
- Screenings for people with familial adenomatous polyposis
- Screenings for people with von Hippel-Lindau disease
- Screenings for people with Cowden syndrome
- Screenings for people with Li-Fraumeni syndrome
- Thyroid cancer screening
- Thyroid test results
- Family history: when screening starts earlier
- Screenings by age and gender
- Questions to ask your doctor