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Belei O, Basaca DG, Heredea ER, Iacob ER, Olariu L, Folescu R, Motoc AGM, Nanu AM, Mărginean O. Chronic Diarrhea Caused by Vasoactive Intestinal Peptide-Secreting Tumor. Life (Basel) 2023; 13:1974. [PMID: 37895355 PMCID: PMC10608053 DOI: 10.3390/life13101974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
VIPomas are a type of neuroendocrine tumor that independently produces vasoactive intestinal peptide (VIP). VIPomas causing watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome are not frequently observed in adult patients without pancreatic ailments. However, in children, the occurrence of a VIPoma originating in the pancreas is exceedingly uncommon. Instead, WDHA syndrome is more commonly associated with neurogenic tumors that secrete VIP, often located in the retroperitoneum or mediastinum. Among infants, chronic diarrhea is a prevalent issue that often necessitates the attention of pediatric gastroenterologists. The underlying causes are diverse, and delays in arriving at a definitive diagnosis can give rise to complications affecting the overall well-being of the child. The authors present the case of an infant with chronic watery diarrhea, subocclusion manifestations, mild hypokalemia, and metabolic hyperchloremic acidosis secondary to a VIPoma in the retroperitoneum that was diagnosed via abdominal ultrasound and tomography. The laboratory results revealed lowered potassium levels and an excessive secretion of VIP. Following the surgical removal of the tumor, the diarrhea resolved, and both electrolyte levels and the imbalanced hormone levels returned to normal. Immunohistochemical examination confirmed the diagnosis of ganglioneuroblastoma, with N-MYC negative on molecular biology tests. We present the clinical and histo-genetic aspects of this rare clinical entity, with a literature review.
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Affiliation(s)
- Oana Belei
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
| | - Diana-Georgiana Basaca
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
| | - Elena Rodica Heredea
- Department of Pathology, “Louis Ţurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania;
- Department of Clinical Practical Skills, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Laura Olariu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
- First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Roxana Folescu
- Department of Balneology, Medical Recovery, and Rheumatology, Family Medicine Discipline, Center for Preventive Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Andrei Gheorghe Marius Motoc
- Department of Anatomy and Embryology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Anda-Maria Nanu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
| | - Otilia Mărginean
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Hospital for Children, 300011 Timișoara, Romania; (L.O.); (A.-M.N.)
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Lo K, Sridhar S, Ali S. Chronic Diarrhea and Weight Loss in an 18-month-old Boy. Pediatr Rev 2021; 42:514-518. [PMID: 34470872 DOI: 10.1542/pir.2020-000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Sabina Ali
- Department of Pediatric Gastroenterology, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA
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Sintusek P, Thammarakcharoen T, Shuangshoti S, Vivatvakin B. Unremitting watery diarrhoea in early childhood period. BMJ Case Rep 2017; 2017:bcr-2016-217532. [PMID: 28751427 DOI: 10.1136/bcr-2016-217532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic watery diarrhoea can be a presentation of gastrointestinal disease itself or a less-evident systemic disease. A 17-month-old boy presented with intractable diarrhoea, failure to gain weight, refractory tachycardia and severe hypertension. The ability to recognise and make a quick diagnosis of secretory type of diarrhoea dictated the outcome of patients with this ailment. Catecholamine hypersecretion was considered with the additional clues of refractory tachycardia and hypertension, a well-recognised phenomenon of neuroblastic tumours. A neuroblastic tumour can lead to vasoactive intestinal peptide (VIP) overexpression, which may result in secretory diarrhoea. In this situation, measurements of plasma VIP enabled crucial diagnosis. Imaging studies were used to identify and localise a neuroblastic tumour. Subsequent removal of the tumour was curative and led to the resolution of the symptoms.
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Affiliation(s)
- Palittiya Sintusek
- Department of Pediatrics, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
| | | | | | - Boosba Vivatvakin
- Department of Pediatrics, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
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Ganglioneuroblastoma secretor de péptido intestinal vasoactivo en niño de 20 meses. An Pediatr (Barc) 2014; 80:e76-8. [DOI: 10.1016/j.anpedi.2013.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/22/2013] [Accepted: 06/26/2013] [Indexed: 11/21/2022] Open
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