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              <p>We describe for the first time the case of a woman presenting with Tatton-Brown-Rahman syndrome(TBRS) and multiple endocrine neoplasia (MEN). She developed primary hyperparathyroidism at age13, a pituitary cyst at age 14, adrenal tumor at age 21, and metastatic insulinoma at age 34. In addi-tion, she showed intellectual disability, obesity, multiple lipomas, facial dysmorphia, hemihypertrophyand kyphoscoliosis. At age 35, genome analysis revealed a pathogenic de-novo heterozygous germlineDNMT3A variant, while classic MEN syndromes were ruled out by targeted somatic and germline genetictesting. This case highlights not only the importance of genomic analysis in patients with multipleand atypical conditions, but also the need for a multidisciplinary approach for TBRS patients, includ-ing in adulthood, involving endocrinologists to enhance understanding and optimize monitoring of thissyndrome.</p>
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