Zollenger Ellison - MEM 1- Hyperparathryoidism

My 44 year old son was diagnosed 1 week ago with a kidney stone and the CT Scan revealed a 2 cm lesion on his pancreas and an osteolytic lesion on the right iliac. I am age 66 and was diagnosed with ZE - MEN 1 at age 50 with tumors on my pancreas and parathryoids. Both of us have prolonged histories of high serum calcium.
It would appear that my son also has the ZE gene and the symptoms are now emergeing. As yet he has not been tested for serum gastrin or pth levels. I am fairly conversant as a lay person with the ZE Men 1 condition but I want to know about the "osteolytic lesion".
1. Is this consistent with the hyperparathyroidism characteristic of MEN 1 ?
2. Does removal of the diseased parathroid(s) allivate the osteolic lesion?
3. Apart form a parathryoidectomy and possible sub total pancreodectomy what other traetment would be required for the ostelytic lesion?
4. Are osteolytic lesions arising from hyperparathroidism usually malignant?
4. As regards the parathyroidectomy, are you familiar with MIRP (minimum invasive radio guided parathryroidectomy) developed by Dr. Norman of South Florida University, Tampa? Do you think this method is better than the traditional method?
5. Finally, if pancreatic surgery is required- can you indicate a medical center and Physicians (gastroenteroligist and endocrinoligist) experianced in treating MEN 1, preferably in Florida.

[Kevin Pho, MD]

Surgeon has kindly answer the major questions in his comment below.  

Regarding finding gastroenterologists and endocrinologists in your area, you may want to try the American Board of Internal Medicine website:
http://www.abim.org/dp/apps/physdir1.htm

The best chance of finding the right doctors would likely be at the nearest academic medical center.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

osteolytic lesions can be due to many things, including hyperparathyroidism. In that instance, they are usually multiple. When due to hyperparathyroidism, they are not malignant. Malignancy can cause them; but it's not related, typically , to MEN. If due to hyper-pth, removal of the gland would take care of it. If due to something else, then other treatment would be needed. Since parathyroid tumors are more likely to be multiple in MEN, I'm not sure the minimally invasive technique is as useful as it is when there's only one tumor which has been localized preoperatively. I don't know specific places or docs to recommend on the east coast; maybe Dr. Pho does. Subtotal pancreatectomy is not as daunting an operation as some other forms of pancreatectomy (eg, the Whipple procedure.) I'd imagine a hospital associated with one of the medical schools would have several experienced surgeons.

[fluvus]

A related discussion, what is the MEN1 gene which affects parathyroid and pancrease my brother has is as he has the symtoms (symptoms)( tumors). Is there a test for it? was started.