Optimizing guideline-based screening for adults in Southwestern Ontario with multiple endocrine neoplasia type 1 (MEN1) syndrome: a quality improvement (QI) initiative — ASN Events
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Optimizing guideline-based screening for adults in Southwestern Ontario with multiple endocrine neoplasia type 1 (MEN1) syndrome: a quality improvement (QI) initiative (#543)

Jordan C LeSarge 1 , Stan Van Uum 1 , Tayyab S Khan 1
  1. Western University & London Health Sciences Centre, Canada, London, ONTARIO, Canada

MEN1 is a rare autosomal dominant tumour syndrome classically characterized by a predisposition to developing parathyroid tumours, duodenopancreatic neuroendocrine tumours (dp-NETs), and pituitary adenomas. (1) Patients have reduced life expectancy, particularly when tumour screening and surveillance is suboptimal. (1) The recently updated 2025 MEN1 guidelines are comprehensive; however, their complexity can make incorporation into clinical practice challenging.

Through a QI framework, we aim to improve adherence to guideline-based screening in adults with MEN-1 in Southwestern Ontario by at least 20% by 2030.

We conducted a retrospective 5-year chart review of all adults with MEN1 followed London Hospitals (n=26) to assess baseline adherence to guideline-based recommendations, defined as completed investigations relative to those due. Baseline screening adherence varied. For parathyroid hyperplasia, serum calcium was assessed at diagnosis in 57% and annually in 78%. For dp-NETs, serum fasting gastrin was assessed at diagnosis in 62% and annually in 38%; pancreatic imaging was assessed at diagnosis in 69% and follow-up imaging in 100%. For sellar masses, serum prolactin and IGF-1 were assessed at diagnosis in 71% and 59% and annually in 67% and 31%, respectively; sellar imaging was assessed at diagnosis in 47% and follow up imaging in 85%. Screening adherence for thymic, bronchopulmonary, adrenal, and breast tumours had similar variable adherence. Patients had a mean of 9.7 clinical visits over the last 5-years.

QI interventions included sending patient-specific recommendations to their endocrinologist, presenting the guidelines to the division, and placing a guideline summary printout in clinical areas.

In conclusion, despite frequent follow up, adherence to MEN1 guideline-recommended screening is variable. Our targeted QI interventions may improve guideline-concordance and patient outcomes. Future work will evaluate intervention impact and refine strategies within the QI framework.

References: (1) Brandi, M.L. et al. MEN1: recommendations and guidelines for best practice. Lancet. 2025;13:699–721.