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Multiple Endocrine Neoplasia Type 1 via the MEN1 Gene

  • Summary and Pricing
  • Clinical Features and Genetics
  • Citations
  • Methods
  • Ordering/Specimens
Order Kits
TEST METHODS

Sequencing

Test Code TestIndividual Gene PriceCPT Code Copy CPT Codes
715 MEN1$750.00 81405 Add to Order
Targeted Testing

For ordering targeted known variants, please proceed to our Targeted Variants landing page.

Turnaround Time

The great majority of tests are completed within 18 days.

Clinical Sensitivity
This test is predicted to detect a causative mutation in ~50-95% of patients with autosomal dominant MEN1, ~70% of patients with sporadic, or isolated, MEN1, or ~20% of patients with FIHP (Agarwal et al. Hum Mol Genet 6:1169-1175, 1997; Teh et al. J Clin Endo Metab 83:2621-2626, 1998; Warner et al. J Med Genet 41(3): 155-60, 2004).

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Deletion/Duplication Testing via aCGH

Test Code TestIndividual Gene PriceCPT Code Copy CPT Codes
600 MEN1$690.00 81404 Add to Order
Pricing Comment

# of Genes Ordered

Total Price

1

$690

2

$730

3

$770

4-10

$840

11-30

$1,290

31-100

$1,670

Over 100

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Turnaround Time

The great majority of tests are completed within 28 days.

Clinical Sensitivity
Gross deletions of the MEN1 gene have been detected in up to 4% of patients (Falchetti et al. GeneReviews. 2010).

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Clinical Features
Multiple Endocrine Neoplasia Type 1 (MEN1; OMIM 131100) is an autosomal dominant disorder distinguished by tumors of the parathyroid glands, pancreatic islet cells and anterior pituitary gland (reviewed by Pannett and Thakker Endocrine-Related Cancer 6:449-473, 1999). Some patients with MEN1 may also develop adrenal cortical tumors, carcinoid tumors, facial angiofibromas, collagenomas, and/or lipomas. Neoplasia of endocrine glands typically leads to excessive hormone production. As a result, the clinical manifestations of MEN1 are clearly related to the sites of the tumors. For example, ~95% of patients exhibit hypercalcemia, nephrolithiasis, or osteitis fibrosa cystica due to parathyroid tumors; ~40% have recurrent peptic ulcers, hypoglycemia, or hyperglucagonaemia due to pancreatic tumors; and ~30% have hyperprolactinaemia, hypercorticism (i.e. Cushing’s syndrome) or acromegaly due to anterior pituitary tumors.
Genetics
Heterozygous germline mutations in the Menin gene (MEN1) predispose individuals to multiple endocrine neoplasia type 1 (MEN1). For mutant carriers, the penetrance of MEN1 is greater than 75% by the age of 25, and approaches 100% by the age of 60 (Pannett and Thakker. Endocr Relat Cancer 6(4): 449-73,1999). To date, at least 565 distinct causative mutations have been found scattered throughout the MEN1 gene (Lemos and Thakker Hum Mut 29:22-32, 2008). Greater than 80% of these mutations are inactivating (i.e. nonsense, frameshifts, splice-site), consistent with the role of MEN1 as a tumor suppressor gene (Larsson et al. Nature 332:85-87, 1988). Although the precise molecular function of the Menin protein is still not known, data from protein interaction studies suggest it is involved in many vital processes, including transcriptional regulation, DNA replication, and DNA repair (reviewed in Lemos and Thakker, 2008). In addition to familial cases of MEN1, heterozygous mutations have also been found in patients with apparently sporadic cases of MEN1, as well as in patients diagnosed with Familial Isolated Hyperparathyroidism (FIHP; OMIM 145000) (Warner et al. J Med Genet 41:155-160, 2004). Interestingly, ~40% of the causative mutations found in FIHP cases are missense, compared to only ~20% for MEN1 (Lemos and Thakker, 2008). These observations suggest a likely association between weak missense mutations and the mild clinical FIHP variant.
Testing Strategy
This test involves bidirectional DNA sequencing of all 9 coding exons (3-11) of the MEN1 gene, plus ~20 bp of flanking non-coding DNA on either side of each exon. We will also sequence any single exon (Test #100) in family members of patients with a known mutation or to confirm research results.
Indications for Test
Candidates for this test are patients diagnosed with multiple endocrine neoplasia type 1 (MEN1) or familial isolated hyperparathyroidism (FIHP). This test is specifically designed for heritable germline mutations and is not appropriate for the detection of somatic mutations in tumor tissue.

Gene

Official Gene Symbol OMIM ID
MEN1 613733
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT

Disease

Name Inheritance OMIM ID
Multiple Endocrine Neoplasia, Type 1 131100

Related Tests

Name
CDC73-Related Disorders via the CDC73 Gene
Cancer Sequencing and Deletion/Duplication Panel
Familial Isolated Pituitary Adenoma via the AIP Gene
Primary Macronodular Adrenal Hyperplasia via the ARMC5 Gene

CONTACTS

Genetic Counselors
Geneticist
Citations
  • Agarwal, S. K., et.al. (1997). "Germline mutations of the MEN1 gene in familial multiple endocrine neoplasia type 1 and related states." Hum Mol Genet 6(7): 1169-75. PubMed ID: 9215689
  • Falchetti et al. GeneReviews. 2010
  • Lemos MC, Thakker RV. 2008. Multiple endocrine neoplasia type 1 (MEN1): analysis of 1336 mutations reported in the first decade following identification of the gene. Hum. Mutat. 29: 22–32. PubMed ID: 2894610
  • Pannett, A. A., Thakker, R. V. (1999). "Multiple endocrine neoplasia type 1." Endocr Relat Cancer 6(4): 449-73. PubMed ID: 10730900
  • Teh, B. T., et.al. (1998). "Mutation analysis of the MEN1 gene in multiple endocrine neoplasia type 1, familial acromegaly and familial isolated hyperparathyroidism." J Clin Endocrinol Metab 83(8): 2621-6. PubMed ID: 9709921
  • Warner, J., et.al. (2004). "Genetic testing in familial isolated hyperparathyroidism: unexpected results and their implications." J Med Genet 41(3): 155-60. PubMed ID: 14985373
Order Kits
TEST METHODS

Bi-Directional Sanger Sequencing

Test Procedure

Nomenclature for sequence variants was from the Human Genome Variation Society (http://www.hgvs.org).  As required, DNA is extracted from the patient specimen.  PCR is used to amplify the indicated exons plus additional flanking non-coding sequence.  After cleaning of the PCR products, cycle sequencing is carried out using the ABI Big Dye Terminator v.3.0 kit.  Products are resolved by electrophoresis on an ABI 3730xl capillary sequencer.  In most cases, sequencing is performed in both forward and reverse directions; in some cases, sequencing is performed twice in either the forward or reverse directions.  In nearly all cases, the full coding region of each exon as well as 20 bases of non-coding DNA flanking the exon are sequenced.

Analytical Validity

As of March 2016, we compared 17.37 Mb of Sanger DNA sequence generated at PreventionGenetics to NextGen sequence generated in other labs. We detected only 4 errors in our Sanger sequences, and these were all due to allele dropout during PCR. For Proficiency Testing, both external and internal, in the 12 years of our lab operation we have Sanger sequenced roughly 8,800 PCR amplicons. Only one error has been identified, and this was due to sequence analysis error.

Our Sanger sequencing is capable of detecting virtually all nucleotide substitutions within the PCR amplicons. Similarly, we detect essentially all heterozygous or homozygous deletions within the amplicons. Homozygous deletions which overlap one or more PCR primer annealing sites are detectable as PCR failure. Heterozygous deletions which overlap one or more PCR primer annealing sites are usually not detected (see Analytical Limitations). All heterozygous insertions within the amplicons up to about 100 nucleotides in length appear to be detectable. Larger heterozygous insertions may not be detected. All homozygous insertions within the amplicons up to about 300 nucleotides in length appear to be detectable. Larger homozygous insertions may masquerade as homozygous deletions (PCR failure).

Analytical Limitations

In exons where our sequencing did not reveal any variation between the two alleles, we cannot be certain that we were able to PCR amplify both of the patient’s alleles. Occasionally, a patient may carry an allele which does not amplify, due for example to a deletion or a large insertion. In these cases, the report contains no information about the second allele.

Similarly, our sequencing tests have almost no power to detect duplications, triplications, etc. of the gene sequences.

In most cases, only the indicated exons and roughly 20 bp of flanking non-coding sequence on each side are analyzed. Test reports contain little or no information about other portions of the gene, including many regulatory regions.

In nearly all cases, we are unable to determine the phase of sequence variants. In particular, when we find two likely causative mutations for recessive disorders, we cannot be certain that the mutations are on different alleles.

Our ability to detect minor sequence variants, due for example to somatic mosaicism is limited. Sequence variants that are present in less than 50% of the patient’s nucleated cells may not be detected.

Runs of mononucleotide repeats (eg (A)n or (T)n) with n >8 in the reference sequence are generally not analyzed because of strand slippage during PCR and cycle sequencing.

Unless otherwise indicated, the sequence data that we report are based on DNA isolated from a specific tissue (usually leukocytes). Test reports contain no information about gene sequences in other tissues.

Deletion/Duplication Testing Via Array Comparative Genomic Hybridization

Test Procedure

Equal amounts of genomic DNA from the patient and a gender matched reference sample are amplified and labeled with Cy3 and Cy5 dyes, respectively. To prevent any sample cross contamination, a unique sample tracking control is added into each patient sample. Each labeled patient product is then purified, quantified, and combined with the same amount of reference product. The combined sample is loaded onto the designed array and hybridized for at least 22-42 hours at 65°C. Arrays are then washed and scanned immediately with 2.5 µM resolution. Only data for the gene(s) of interest for each patient are extracted and analyzed.

Analytical Validity

PreventionGenetics' high density gene-centric custom designed aCGH enables the detection of relatively small deletions and duplications within a single exon of a given gene or deletions and duplications encompassing the entire gene. PreventionGenetics has established and verified this test's accuracy and precision.

Analytical Limitations

Our dense probe coverage may allow detection of deletions/duplications down to 100 bp; however due to limitations and probe spacing this cannot be guaranteed across all exons of all genes. Therefore, some copy number changes smaller than 100-300 bp within a targeted large exon may not be detected by our array.

This array may not detect deletions and duplications present at low levels of mosaicism or those present in genes that have pseudogene copies or repeats elsewhere in the genome.

aCGH will not detect balanced translocations, inversions, or point mutations that may be responsible for the clinical phenotype.

Breakpoints, if occurring outside the targeted gene, may be hard to define.

The sensitivity of this assay may be reduced when DNA is extracted by an outside laboratory.

Order Kits

Ordering Options


myPrevent - Online Ordering
  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
REQUISITION FORM
  • The first four pages of the requisition form must accompany all specimens.
  • Billing information is on the third and fourth pages.
  • Specimen and shipping instructions are listed on the fifth and sixth pages.
  • All testing must be ordered by a qualified healthcare provider.

SPECIMEN TYPES
WHOLE BLOOD

(Delivery accepted Monday - Saturday)

  • Collect 3-5 ml (5 ml preferred) of whole blood in EDTA (purple top tube) or ACD (yellow top tube). For Test #500-DNA Banking only, collect 10-20 ml of whole blood.
  • For small babies, we require a minimum of 1 ml of blood.
  • Only one blood tube is required for multiple tests.
  • Ship blood tubes at room temperature in an insulated container. Do not freeze blood.
  • During hot weather, include a frozen ice pack in the shipping container. Place a paper towel or other thin material between the ice pack and the blood tube.
  • In cold weather, include an unfrozen ice pack in the shipping container as insulation.
  • At room temperature, blood specimen is good for up to 48 hours.
  • If refrigerated, blood specimen is good for up to one week.
  • Label the tube with the patient name, date of birth and/or ID number.

DNA

(Delivery accepted Monday - Saturday)

  • NextGen Sequencing Tests: Send in screw cap tube at least 10 µg of purified DNA at a concentration of at least 50 µg/ml
  • Sanger Sequencing Tests: Send in a screw cap tube at least 15 µg of purified DNA at a concentration of at least 20 µg/ml. For tests involving the sequencing of more than three genes, send an additional 5 µg DNA per gene. DNA may be shipped at room temperature.
  • Deletion/Duplication via aCGH: Send in screw cap tube at least 1 µg of purified DNA at a concentration of at least 100 µg/ml.
  • Whole-Genome Chromosomal Microarray: Collect at least 5 µg of DNA in TE (10 mM Tris-cl pH 8.0, 1mM EDTA), dissolved in 200 µl at a concentration of at least 100 ng/ul (indicate concentration on tube label). DNA extracted using a column-based method (Qiagen) or bead-based technology is preferred.

CELL CULTURE

(Delivery accepted Monday - Thursday)

  • PreventionGenetics should be notified in advance of arrival of a cell culture.
  • Ship at least two T25 flasks of confluent cells.
  • Label the flasks with the patient name, date of birth, and/or ID number.
  • We do not culture cells.