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if (window.onload && window.onload != null)
	DHTMLNavBarTemponload = window.onload;

function DHTMLFullyLoaded() {
	if (DHTMLNavBarTemponload != null) 
		DHTMLNavBarTemponload();
		DHTML_preloadImages('images/btn_physicians.gif','images/btn_physicians_on.gif','images/btn_hospitals.gif','images/btn_hospitals_on.gif','images/btn_departments.gif','images/btn_departments_on.gif','images/btn_offices.gif','images/btn_offices_on.gif','images/btn_services.gif','images/btn_services_on.gif');
	DHTMLrunMouseOvers = true;
	return true;
}	
function DHTMLNavBarMouseOutTimer() {
	if(DHTMLTimerID) 
		clearTimeout(DHTMLTimerID); 
	DHTMLTimerID = setTimeout("DHTMLNavBarLayerRestore()",5000);
}	
function DHTMLRestoreParent(layername) {
	for(var i=0;i < aryDHTMLLayerNames.length;i++)
	{
		if(!aryDHTMLNavBarLayerInfo[aryDHTMLLayerNames[i]].isDefault)
		{			
			if(!(aryDHTMLLayerNames[i] == layername) && aryDHTMLLayerNames[i].indexOf("grand") == -1) 
				DHTMLNavBarRestoreLayers(aryDHTMLLayerNames[i]);			
		}
	}
}	
function DHTMLRestoreAll() {
	DHTMLNavBarMouseoverRestore();
	DHTMLNavBarLayerRestore();
}	
function DHTMLNavBarMouseoverRestore() {
	var i = 0;
	var o = null;
	if (DHTMLrunMouseOvers)
	{
		for (var i=0; i < DHTMLimageList.length; i++)
		{
			if (aryDHTMLMoImages[imageList[i]].Moused && (o = aryDHTMLMoImages[imageList[i]].ptrImage)) {
				o.src = aryDHTMLMoImages[imageList[i]].OriginalSrc;
				aryDHTMLMoImages[imageList[i]].Moused = false;
			}
		}
	}
	return true;
}	
function DHTMLNavBarLayerRestore() {
	for(var i=0;i < aryDHTMLLayerNames.length;i++)
	{
		if(!aryDHTMLNavBarLayerInfo[aryDHTMLLayerNames[i]].isDefault) 
			DHTMLNavBarRestoreLayers(aryDHTMLLayerNames[i]);		
	}
}	
function DHTMLNavBarArrayPushUnique(aryArray, varNewElement){
	//only pushes if unique value
	var pushIt = true;
	for (var i=0;i < aryArray.length && pushIt;i++) 
	{
		pushIt = (varNewElement!=aryArray[i]);
	}
	if(pushIt) 
		DHTMLNavBarArrayPush(aryArray, varNewElement);	
	
	return pushIt;
}
function DHTMLNavBarArrayPush(aryArray, varNewElement) {
	//Implement Array Push 'cause IE cant handle it
	aryArray[aryArray.length]=varNewElement;
}	
function DHTMLNavBarArrayPop(aryArray) {
	//Implement Array Pop 'cause IE cant handle it before 5.5
	var varItemToPop = null;
	if(aryArray[aryArray.length-1]) {
		varItemToPop = aryArray[aryArray.length-1];
		aryArray[aryArray.length]=null;
	}
	return varItemToPop;
}
	
var registeredObjects = new Array();
//v3.0 name changed to avoid clash with possible other JS in content, this function complements of MM Dreamweaver
function DHTMLNavBarMM_findObj(n, d) {
	x = document.getElementById(n);
	return x;
}
	
var DHTMLNavBarTime         = 100;
var DHTMLNavBarTimes        = 2;
var DHTMLNavBarmoveDistance = 1;
var DHTMLNavBarThisLoc      = 325;
var aryDHTMLLayerNames      = new Array();
var aryDHTMLNavBarLayerInfo = new Array();
var aryDHTMLNavBarLayers    = new Array();
	
function DHTMLNavBarArrayContains()	{
	var a = DHTMLNavBarArrayContains.arguments;
	var foundit = false;
	for(var i=0; i < a[0].length && !foundit; i++) 
	{
		foundit = (a[1]==a[0][i]);
	}
	return foundit;
}
	
function DHTMLNavBarRegisterLayer()	{
	var a = DHTMLNavBarRegisterLayer.arguments;
	var n = a[0];
	var d = a[1];
	if(a[2] && a[2] == 'MOutLayer')
		var mo = true;
	else 
		var mo = false;	
	
	if(!(DHTMLNavBarArrayContains(aryDHTMLLayerNames,n)))
	{
		if(o = DHTMLNavBarMM_findObj(n))
		{
			aryDHTMLNavBarLayers[n] = o;
			DHTMLNavBarArrayPushUnique(aryDHTMLLayerNames,n);
			aryDHTMLNavBarLayerInfo[n] = new DHTMLNavBarLayer(n,d,mo);
		}
	}
}
	
// v3.0 name changed, this function complements of MM Dreamweaver with customizations
function DHTMLNavBarMM_showHideLayers()	{
	var i,p,v,x,obj,args = DHTMLNavBarMM_showHideLayers.arguments;
	if(args[args.length-1] != "menu") 
		DHTMLNavBarMouseOutTimer(); 
	for (var i=0; i<(args.length-2); i+=3)
	{
		if(!aryDHTMLNavBarLayers[args[i]]) {
			x = (args[i+2]=='show')?'hide':'show';
			DHTMLNavBarRegisterLayer(args[i],x);
		}
	 	if ((obj=aryDHTMLNavBarLayers[args[i]])!=null)
		{
			v = args[i+2];
			aryDHTMLNavBarLayerInfo[args[i]].isDefault = false;
	 		if(args[args.length-1] == "restore") 
				v = (v=='show')?'hide':'show';			
			if (obj.style)
				obj.style.visibility = (v=='show')?'visible':(v='hide')?'hidden':v;
			else 
				obj.visibility = v;			
		}
	}
}
	
// v3.0 name changed, this function complements of MM Dreamweaver with customizations
function DHTMLNavBarMM_showHideGrandLayers() {
	var i,p,v,x,obj,args = DHTMLNavBarMM_showHideGrandLayers.arguments;
	if(args[args.length-1] != "menu") 
		DHTMLNavBarMouseOutTimer();
	for (var i=0; i < (args.length-2); i+=3)
	{
		if(!aryDHTMLNavBarLayers[args[i]]) {
			x = (args[i+2]=='show')?'hide':'show';
			DHTMLNavBarRegisterLayer(args[i],x);
		}
	 	if ((obj=aryDHTMLNavBarLayers[args[i]])!=null)
		{
			v = args[i+2];
			aryDHTMLNavBarLayerInfo[args[i]].isDefault = false;
	 			if(args[args.length-1] == "restore"){
				v = (v=='show')?'hide':'show';		
			}
			if (obj.style)
				obj.style.visibility = (v=='show')?'visible':(v='hide')?'hidden':v;
			else 
	 			obj.visibility = v;			
		}
	}
}
function DHTMLNavBarRestoreLayers()	{
	var i,p,v,obj,args = DHTMLNavBarRestoreLayers.arguments;
	for (var i=0; i < (args.length); i++)
	{		
	 	if (obj = aryDHTMLNavBarLayers[args[i]])
		{
			v = aryDHTMLNavBarLayerInfo[args[i]].defaultVisibility;
			var strobjid = obj.id;
			if (obj.style)
			{
				obj=obj.style;				
				v=(v=='show')?'visible':(v='hide')?'hidden':v;
			}
			obj.visibility = v;
			if (!aryDHTMLNavBarLayerInfo[args[i]].MOutLayer) 
				aryDHTMLNavBarLayerInfo[args[i]].isDefault=true;			
		}
	}
}
function DHTMLNavBarLayer()	{
	var a = DHTMLNavBarLayer.arguments;
	this.defaultVisibility = a[1];
	this.isDefault = true;
	this.MOutLayer = a[2];
}
	
var viz = "hide";
function DHTMLNavBarNavMove() {
	if(thisl==DHTMLNavBarMM_findObj("DHTMLNavBarScrollLayer"))	
	{
		if(thisl.style)
		{
			thisl=thisl.style;
			viz="hidden";
		}
		thisl.top = DHTMLNavBarThisLoc -= 3;
		if(DHTMLNavBarThisLoc < -750)
		{
			DHTMLNavBarThisLoc=325;
			DHTMLNavBarTimes--;
		}
	}
	if (DHTMLNavBarTimes<=0)
	{
		otherl=DHTMLNavBarMM_findObj("DHTMLNavBarLayer");
		otherl.visibility=viz;
	}
	else setTimeout("DHTMLNavBarNavMove()",DHTMLNavBarTime);	
}
function DHTML_swapImgRestore()	{ 	
 	var i,x,a=document.Sliding_sr;
 	for(var i=0; a && i < a.length && (x=a[i]) && x.oSrc; i++) 
	{			
		x.src = x.oSrc;
	}
}
function DHTML_preloadImages() { 
 	var d=document;
 	if(d.images)
 	{
 		if(!d.Sliding_p) 
			d.Sliding_p=new Array();	
		var i,j=d.Sliding_p.length,a=DHTML_preloadImages.arguments;
		for(var i=0; i < a.length; i++)
		{
	 		if (a[i].indexOf("#")!=0)
			{
				d.Sliding_p[j]=new Image;
				d.Sliding_p[j++].src=a[i];
			}
		}
	}
}
function DHTML_findObj(n, d) { 
	var p,i,x;
	if(!d) 
		d=document;	
	if((p=n.indexOf("?")) > 0 && parent.frames.length)
	{
	 	d=parent.frames[n.substring(p+1)].document;
		n=n.substring(0,p);
	}
	if(!(x=d[n]) && d.all) 
		x=d.all[n];
	for (var i=0; !x && i < d.forms.length; i++) 
	{
		x = d.forms[i][n];	
	}
	for(var i=0; !x && d.layers && i < d.layers.length; i++) 
	{
		x = DHTML_findObj(n,d.layers[i].document);
	}
	 if(!x && d.getElementById) 
		x=d.getElementById(n);	
		
	return x;
}
function DHTML_swapImage() { 
	var i,j=0,x,a=DHTML_swapImage.arguments;
	document.Sliding_sr=new Array;
	for(var i=0; i < (a.length-2); i+=3)
	{
		if ((x=DHTML_findObj(a[i]))!=null)
		{
			document.Sliding_sr[j++] = x;
			if(!x.oSrc)
				x.oSrc=x.src;			
			x.src = a[i+2];
		}
	}
}
function DHTMLNavBarSwapRollover(swapimage,defaultimage,imageID) {
	if(imageID.length > 0 && document.getElementById(imageID))
	{
		if(swapimage.length > 0) 
			document.getElementById(imageID).src = "images/" + swapimage;
		else
			document.getElementById(imageID).src = "images/" + defaultimage;		
	}
}
window.onload = DHTMLFullyLoaded;
			

//-->
</script>
			
	
<table border="0" cellpadding="0" cellspacing="0">
	<tr>
		<td valign="top">
		<div id="lryParentmain54" class="Parentmain1"  onmouseover="DHTMLRestoreAll();DHTML_swapImage('btn_physicians_1_54','','images/btn_physicians_on.gif',54);DHTMLNavBarMM_showHideLayers('lyr54','','show','lyrTopMO1','','show','lyrLeftMO1','','show','menu');" onmouseout="DHTML_swapImgRestore();" onclick="DHTMLNavBar_configureCookie('54');">
			<table border="0" class="ParentNav1" width="100%" cellpadding="0" cellspacing="0">
				<tr id="pRow54" style="vertical-align: top; background-color: transparent;" >
					<td valign="top" style="" id="pLink54"><a href="body.cfm?id=54" target="" class="clMain1"><img src="images/btn_physicians.gif" border="0" id="btn_physicians_1_54" alt="UCLA Physicians" ></a></td>
				</tr>
			</table>
			<div id="lyr54" class="clLeft1" onMouseOut="DHTMLRestoreAll();">
				<table cellpadding="0" cellspacing="0" class="ChildNav1" border="0">
					<tr id="cRow54_1" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_1"><a href="body.cfm?id=479" target="" class="clSubb1">Physician Directory</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_2" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_2"><a href="body.cfm?id=308" target="" class="clSubb1">Physician Referral Service</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_3" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_3"><a href="body.cfm?id=1087" target="" class="clSubb1">Cancer Specialists</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_4" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_4"><a href="http://www.uclahealth.org/body_mattel.cfm?id=956&amp;oTopID=956" target="" class="clSubb1">Pediatric Physicians</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_5" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_5"><a href="body.cfm?xyzpdqabc=0&amp;id=479&amp;action=list&amp;subaction=specialty&amp;searchaction=simple&amp;specialtygroups=family%20medicine,internal%20medicine,pediatrics,obstetrics%20&amp;%20gynecology" target="" class="clSubb1">Primary Care Physicians by Specialty</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_6" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_6"><a href="body.cfm?xyzpdqabc=0&amp;id=479&amp;action=list&amp;subaction=location&amp;searchaction=simple" target="" class="clSubb1">Primary Care Physicians by Location</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_7" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_7"><a href="body.cfm?id=932" target="" class="clSubb1">Voted Best Doctors</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_8" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_8"><a href="body.cfm?id=1162" target="" class="clSubb1">Voted Super Doctors</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
				</table>
				<!--[if lte IE 6.5]>
				<div id="endTablelyr54" style="height:1px;overflow:hidden;"></div><iframe id="Framelyr54" frameborder="0" style="background-color:transparent;left:0px;position:absolute;top:0px;width:100%;height:120;z-index:-1;filter:mask();"></iframe>
				<![endif]-->
			</div>
		</div>
		</td>
		<td valign="top">
		<div id="lryParentmain56" class="Parentmain1"  onmouseover="DHTMLRestoreAll();DHTML_swapImage('btn_hospitals_1_56','','images/btn_hospitals_on.gif',56);DHTMLNavBarMM_showHideLayers('lyr56','','show','lyrTopMO1','','show','lyrLeftMO1','','show','menu');" onmouseout="DHTML_swapImgRestore();" onclick="DHTMLNavBar_configureCookie('56');">
			<table border="0" class="ParentNav1" width="100%" cellpadding="0" cellspacing="0">
				<tr id="pRow56" style="vertical-align: top; background-color: transparent;" >
					<td valign="top" style="" id="pLink56"><a href="body.cfm?id=56" target="" class="clMain1"><img src="images/btn_hospitals.gif" border="0" id="btn_hospitals_1_56" alt="UCLA Hospitals" ></a></td>
				</tr>
			</table>
			<div id="lyr56" class="clLeft1" onMouseOut="DHTMLRestoreAll();">
				<table cellpadding="0" cellspacing="0" class="ChildNav1" border="0">
					<tr id="cRow56_1" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_1"><a href="homepage_med.cfm?id=264" target="" class="clSubb1">Ronald Reagan UCLA Medical Center</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow56_2" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_2"><a href="homepage_sanmon.cfm?id=265" target="" class="clSubb1">Santa Monica UCLA Medical Center and Orthopaedic Hospital</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow56_3" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_3"><a href="homepage_mattel.cfm?id=266" target="" class="clSubb1">Mattel Children's Hospital UCLA</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow56_4" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_4"><a href="homepage_neuro.cfm?id=267" target="" class="clSubb1">Resnick Neuropsychiatric Hospital at UCLA</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
				</table>
				<!--[if lte IE 6.5]>
				<div id="endTablelyr56" style="height:1px;overflow:hidden;"></div><iframe id="Framelyr56" frameborder="0" style="background-color:transparent;left:0px;position:absolute;top:0px;width:100%;height:60;z-index:-1;filter:mask();"></iframe>
				<![endif]-->
			</div>
		</div>
		</td>
		<td valign="top">
		<div id="lryParentmain977" class="Parentmain1"  onmouseover="DHTMLRestoreAll();DHTML_swapImage('btn_departments_1_977','','images/btn_departments_on.gif',977);DHTMLNavBarMM_showHideLayers('lyr977','','show','lyrTopMO1','','show','lyrLeftMO1','','show','menu');" onmouseout="DHTML_swapImgRestore();" onclick="DHTMLNavBar_configureCookie('977');">
			<table border="0" class="ParentNav1" width="100%" cellpadding="0" cellspacing="0">
				<tr id="pRow977" style="vertical-align: top; background-color: transparent;" >
					<td valign="top" style="" id="pLink977"><a href="body.cfm?id=977" target="" class="clMain1"><img src="images/btn_departments.gif" border="0" id="btn_departments_1_977" alt="Departments" ></a></td>
				</tr>
			</table>
			<div id="lyr977" class="clLeft1" onMouseOut="DHTMLRestoreAll();">
				<table cellpadding="0" cellspacing="0" class="ChildNav1" border="0">
					<tr id="cRow977_1" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_1"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=10" target="" class="clSubb1">Anesthesiology</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_2" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_2"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=12" target="" class="clSubb1">Dental Services</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_3" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_3"><a href="http://clinicaltrials.ucla.edu" target="" class="clSubb1">Clinical Trials</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_4" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_4"><a href="http://www.donatedbodyprogram.ucla.edu" target="" class="clSubb1">Donated Body Program</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_5" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_5"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=31" target="" class="clSubb1">Emergency Medicine</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_6" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_6"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=14" target="" class="clSubb1">Family Medicine</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_7" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_7"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=15" target="" class="clSubb1">Medicine</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_8" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_8"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=16" target="" class="clSubb1">Neurology</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_9" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_9"><a href="http://neurosurgery.ucla.edu/default.cfm" target="" class="clSubb1">Neurosurgery</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
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		<table width="100%" border="0" cellspacing="0" cellpadding="0" class="adam_01"><tr class="adam_01"><td class="adam_01"><table width="100%" height="800" border="0" cellpadding="0" cellspacing="0" class="adam_01"><tr class="adam_01"><td valign="top" align="left" width="80%" class="adam_01"><table width="100%" border="0" class="adam_01"><tr class="adam_01"><td width="100%" valign="top" align="left" class="adam_01"><table width="100%" border="0" class="adam_01"><tr align="left" valign="top" class="adam_01"><td valign="top" height="15" class="adam_01"></td></tr><tr class="adam_01"><td align="left" class="adam_01"><TABLE width="100%" border="0" class="adam_01"><tr class="adam_01"></tr><tr class="adam_01"><td align="left" class="adam_01"><table width="100%" align="left" border="0" class="adam_01"><tr align="center" class="adam_01"><td valign="top" align="center" width="105" class="adam_01"><table cellpadding="2" cellspacing="3" class="adam_01"><tr class="adam_01"><td align="center" valign="top" class="adam_01"></td></tr><tr class="adam_01"><td align="center" valign="top" class="adam_01"><br><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=1093&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_2" > <img border="0" class="" src="http://www.uclahealth.org/ae_images/adam04/graphics/tnail/1093t.jpg" alt="Endocrine glands" title ="Endocrine glands" border="0"><br>Endocrine glands</a><br></td></tr></table></td></tr></table></td></tr></table></td></tr><tr class="adam_01"><td class="adam_01"><hr class="adam_01"><h2 class="adam_01">Multiple endocrine neoplasia (MEN) II</h2><b class="adam_01">Definition:</b> <p>Multiple endocrine neoplasia II (MEN II) is an uncommon condition passed down through families (inherited), in which the thyroid, adrenal, and parathyroid glands are overactive.</p><p>See also: <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000398&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">MEN I</a> </p><BR><BR><div id="AEAdamdiv1" class="adam_01"><b class="adam_01">Alternative Names:</b> Sipple's syndrome<BR><BR></div><div id="AEAdamdiv2" class="adam_01"><b class="adam_01">Causes, incidence, and risk factors:</b> <p>The cause of MEN II is a defect in a gene called RET. This defect causes many tumors to appear in the same person, but not necessarily at the same time. The adrenal tumor is called a <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000340&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">pheochromocytoma</a> , and the thyroid tumor is a <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000374&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">medullary carcinoma of the thyroid</a> .</p><p>The disorder may occur at any age, and affects men and women equally. The main risk factor is a family history of MEN II.</p><p>There are two similar subtypes of MEN II -- MEN IIa and IIb. MEN IIb is less common.</p><BR><BR></div><div id="AEAdamdiv3" class="adam_01"><b class="adam_01">Symptoms:</b> <ul><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003120&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Abdominal pain</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003108&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Back pain</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003079&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Chest pain</a> </li><li>Cough</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003073&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Cough with blood</a> </li><li>Depression</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003126&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Diarrhea</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003088&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Fatigue</a> </li><li>Heart <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003081&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">palpitations</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003085&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Increased thirst</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003146&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Increased urine output</a> </li><li>Irritability</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003121&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Loss of appetite</a> </li><li>Muscle weakness</li><li>Nausea</li><li>Nervousness</li><li>Personality changes</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003077&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Rapid heart rate</a> </li><li>Severe headache</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003218&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Sweating</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003107&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Weight loss</a> </li></ul><p>The symptoms may vary. However, they are similar to those of:</p><ul><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=001215&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Hyperparathyroidism</a> </li><li>Medullary carcinoma of the thyroid </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000340&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Pheochromocytoma</a> </li></ul><BR><BR></div><div id="AEAdamdiv4" class="adam_01"><b class="adam_01">Signs and tests:</b> <p>To diagnose this condition, the health care provider looks for a mutation in the RET gene. This can be done with a blood test.</p><p>A physical examination may reveal:</p><ul><li>Enlarged lymph nodes in the neck</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003090&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Fever</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000468&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">High blood pressure</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003077&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Rapid heart rate</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=007265&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Thyroid nodules</a> </li></ul><p>Diagnostic tests are used to evaluate the function of each <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=002351&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">endocrine</a>  gland. The following tests may be performed:</p><ul><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003789&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Abdominal CT scan</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003900&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Adrenal biopsy</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003699&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Calcitonin</a> </li><li>Electrocardiogram (<a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003868&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">ECG</a> )</li><li>Imaging of the kidneys or ureters</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003830&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">MIBG scintiscan</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003796&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">MRI of abdomen</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003898&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Parathyroid biopsy</a> </li><li>Radioimmune assay of <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003690&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">parathyroid hormone</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003470&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Serum alkaline phosphatase</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003477&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Serum calcium</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003478&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Serum phosphorus</a> </li><li>Thyroid biopsy</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003829&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Thyroid scan</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003776&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Ultrasound of the thyroid</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003613&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Urine catecholamines</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003613&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Urine metanephrine</a> </li></ul><BR><BR></div><div id="AEAdamdiv5" class="adam_01"><b class="adam_01">Treatment:</b> <p>Surgery is needed to remove both the medullary carcinoma of the thyroid and the pheochromocytoma. For medullary carcinoma of the thyroid, the thyroid gland and surrounding lymph nodes must be totally removed. Thyroid hormone replacement therapy is given after surgery.</p><p>Surgery to remove the thyroid before it becomes cancerous is often being performed at an early age (before age 5) in people with known MEN IIa, and before age 6 months in people with MEN IIb.</p><p>Family members should be screened for the RET gene mutation.</p><BR><BR></div><div id="AEAdamdiv6" class="adam_01"><b class="adam_01">Support Groups:</b> <p /><BR><BR></div><div id="AEAdamdiv7" class="adam_01"><b class="adam_01">Expectations (prognosis):</b> <p>Pheochromocytoma is usually not cancerous (benign). Medullary carcinoma of the thyroid is a very aggressive and potentially fatal cancer. However, early diagnosis and surgery can often lead to a cure.</p><BR><BR></div><div id="AEAdamdiv8" class="adam_01"><b class="adam_01">Complications:</b> <p>The spread of cancerous cells is a complication.</p><BR><BR></div><div id="AEAdamdiv9" class="adam_01"><b class="adam_01">Calling your health care provider:</b> <p>Call your health care provider if you notice symptoms of MEN II.</p><BR><BR></div><div id="AEAdamdiv10" class="adam_01"><b class="adam_01">Prevention:</b> <p>Screening close relatives of people with MEN II may lead to early detection of the syndrome and related cancers.</p><BR><BR></div><div id="AEAdamdiv12" class="adam_01"><b class="adam_01">References:</b> <p>Kronenberg HM. Plyglandular disorders. In: Goldman L, Ausiello D, eds. <em>Cecil Medicine</em>. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 250.</p><BR><BR></div></td></tr><tr class="adam_01"><td class="adam_01"><hr class="adam_01"></td></tr><tr class="adam_01"><td class="adam_01">Review Date: 9/4/2008<br class="adam_01">Reviewed By: Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, Washington; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.<br class="adam_01"></td></tr><tr class="adam_01"><td align="left" valign="top" width="470" class="adam_01"><br class="adam_01"><font size="1" class="adam_01">
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