Multifactorial Approach for Depression in Multiple Endocrine Neoplasia 2A (MEN2A): A Case Report.

BACKGROUND: Multiple endocrine neoplasia 2A (MEN2A) is an uncommon autosomal dominant disorder characterized by medullary thyroid cancer (MTC), parathyroid adenoma or hyperplasia, and pheochromocytoma with associated hypothyroidism, hyperparathyroidism, hypercalcemia, and catecholamine excess. Existing literature elucidates the correlation of depression with each endocrine condition. To our knowledge, this is the first case report emphasizing the multifaceted association of MEN2A and depression with contributory intergenerational psychosocial factors. CASE PRESENTATION: We present a 21-year-old male patient with past medical history of MEN2A and family history of coexisting MEN2A and depression, who presented with depression, psychosis, and suicidality. After exclusion of plausible MEN2A-associated endocrine causes, depression was identified to be psychiatric in etiology, subsequently responsive to sertraline and risperidone with adjunctive psychotherapy. DISCUSSION: Prophylactic thyroidectomy for MTC in MEN2A may result in thyroid derangement due to inappropriate replacement. Parathyroid adenoma can cause hyperparathyroidism with hypercalcemia. Pheochromocytoma is a benign adrenal tumor secreting excess catecholamines. These endocrine conditions in MEN2A can potentially contribute to depression. This report discusses attributing endocrine, genetic, and social factors for depression and suicidal ideation in MEN2A. Highlighted is the holistic treatment approach, including hormonal imbalance correction and psychopharmacological and psychosocial interventions necessary for symptom abatement. CONCLUSION: The importance of a multidisciplinary investigation of plausible etiologic factors of depression in MEN2A before committing to psychiatric interventions is emphasized. This perspective optimally addresses diagnosis, differential diagnoses, and treatment options. Awareness of familial depression in MEN2A is reinforced with potential for future research regarding genetic anticipation and holistic management strategies.