Abstract.We report monozygotic twins who showed different MEN1 phenotypes. The proband (28 y.o., female) had both primary hyperparathyroidism (PHP) and insulinoma, and genetic analysis revealed a point mutation (569de11, exon 3) of the MEN] gene. This mutation causes a frameshift and produces a stop codon at codon 184. Restriction digestion (HinfI) analysis confirmed the same mutation of the MEN1 gene in six of the affected members including her two sisters, the monozygotic twins, and no such mutation in two unaffected members. In two generations of this family, eight of eleven family members had PHP and four of them were found to have other MEN1-related lesions. Both of the monozygotic twins had PHP. Interestingly, one had pancreatic tumor but the other had no evidence of it. Pituitary MRI showed no pituitary lesion in either of them. This is the first Japanese case of monozygotic twins with different MEN1 phenotypes.Key words: MEN1, Monozygotic, Twin, Japanese, Mutation (Endocrine Journal 47: 37-43, 2000) MULTIPLE endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder, the classical spectrum of which includes tumors of the parathyroid gland, anterior pituitary, and enteropancreatic region. Less frequently observed associations include foregut carcinoids, lipomas, adrenal tumors, and thyroid diseases. Parathyoid tumors are known to occur in more than 95% of MEN1 patients and primary hyperparathyroidism (PHP) is usually expressed at an early age [1 , 2] . The incidence of other MEN1-related lesions differs in various reports.