Previous studies have shown that thermodynamic analysis of protein structure in silico can discriminate between groups of benign and pathogenic missense variants. However, although structures exist for many human disease-associated proteins, such analysis remains largely unexploited in clinical laboratories. Here, we analysed the predicted effect of 338 known missense variants on the structure of Menin, the MEN1 gene product. Results provided strong discrimination between pathogenic and benign variants, with a threshold of >4 kcal/mol for the predicted change in stability providing a strong indicator of pathogenicity. Subsequent analysis of 7 novel missense variants identified during clinical testing of MEN1 patients showed that all 7 were predicted to destabilise Menin by >4 kcal/mol. We conclude that structural analysis provides a useful tool in understanding the impact of missense variants in MEN1, and that integration of proteomic with genomic data could potentially contribute to the classification of novel variants in this disease. collagenomas and meningiomas (11), resulting in a range of clinical symptoms which may overlap with other diseases of different genetic etiology (12)(13)(14). This overlap presents one of the key problems in assessing genetic variants in cases of MEN1. While a large number of pathogenic variants in MEN1 have been reported, genetic testing continues to uncover novel missense substitutions which require assessment of their potential pathogenicity. A further confounding issue is the often later onset of disease, with reported age-related penetrance of 10-43% at 20 years and 81-94% by 50 years (10, 15), which may lead to apparent non-segregation of a variant with disease within a family pedigree.