What is the sequence of treatment for MEN-1 with hypercalcemia and a gastrinoma?

In the context of Multiple Endocrine Neoplasia type 1 (MEN-1), the management of hypercalcemia due to primary hyperparathyroidism and gastrinoma requires a careful approach. The cornerstone of treatment for MEN-1 is addressing the causes of hypercalcemia that significantly impact the patient's health, as uncontrolled hypercalcemia can lead to severe complications, including kidney stones, osteoporosis, and various neurological symptoms.

Parathyroid glands are often hyperplastic in MEN-1, leading to increased parathyroid hormone (PTH) secretion and subsequently hypercalcemia. Treatment of hyperparathyroidism, which typically involves surgical resection of the affected parathyroid glands, is often prioritized in the management of these patients. By effectively treating the hyperparathyroidism and normalizing calcium levels, a significant portion of the symptoms associated with hypercalcemia can be alleviated.

On the other hand, gastrinoma, which leads to Zollinger-Ellison syndrome and excess gastrin secretion, is also crucial to manage but may be considered slightly less urgent in the presence of a life-threatening condition such as acute hypercalcemia. Once the calcium levels are stabilized through the treatment of the parathyroids, attention can then shift to managing the