Islet tumours of the pancreas with intractable diarrhoea

Vasoactive Intestinal Peptide-Secreting Tumors: A Review

Vasoactive intestinal peptide-secreting tumors (VIPomas) are a group of rare neuroendocrine tumors, which cause a typical syndrome of watery diarrhea. Most of these tumors are found in the pancreas and are usually detected at a later stage. Although curative resection is not possible in most of these tumors, both symptom and tumor control can be achieved by a multidimensional approach, to enable a long survival of most patients. There are no clear-cut guidelines for the management of VIPomas because of the rarity of this neoplasm and lack of prospective data. In this review, we discuss the available evidence on the clinical features and management of these rare tumors.

WDHA syndrome caused by pheochromocytoma: report of a case

A case in which a pheochromocytoma secreted vasoactive intestinal peptide, causing WDHA syndrome, is reported. The patient, a 43-year-old woman, was seen because of intractable watery diarrhea, hypokalemia and weight loss. She was found to have a mass in the right adrenal area. Preoperatively, vasoactive intestinal peptide levels were elevated, and the diagnosis of WDHA syndrome was entertained. Exploratory laparotomy revealed a tumor of the right adrenal gland, measuring 15 x 15 cm, which was resected. Histologic examination revealed it to be a pheochromocytoma. Postoperatively, vasoactive intestinal peptide returned to normal. The patient had complete remission of symptoms, and has remained well since.

Pancreatic islet cell tumour with watery diarrhoea and hypokalaemia

A further patient with watery diarrhoea and hypokalaemia in association with a non-beta islet cell tumour of the pancreas is reported. The mechanism by which fluid and electrolyte losses are produced is discussed and cases previously reported are reviewed.

Spontaneous achlorhydria with atrophic gastritis in the Zollinger-Ellison syndrome

This case report describes the occurrence of spontaneous, persistent achlorhydria in a patient with markedly raised basal acid secretion and diarrhoea for over two years (Zollinger-Ellison syndrome). Achlorhydria was due to the rapid development of severe atrophic gastritis in a gastric mucosa that had previously shown markedly increased numbers of parietal cells.

Identification of the diarrheogenic hormone associated with non-beta islet cell tumors of the pancreas

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Syndromes of water and electrolyte depletion of intestinal origin

Because of the important part played by the intestine in maintaining the constancy of the internal environment, any disturbance in the orderly sequence of secretion and reabsorption of water and electrolytes can quickly lead to severe fluid depletion. Malabsorption of water and electrolytes may occur in diseases of the intestinal mucosa or following massive resection of bowel or as a result of disordered intestinal motility. The handling of fluids by the bowel may be altered by the action of hormones or of bacterial toxins, or in the presence of neoplasms. Electrolyte disorders may result from the introduction of abnormal solutions into the intestinal lumen.

Management of the clinical problems requires a clear understanding of the abnormal mechanisms and urgent attention to the re-institution of water and salt balance, restoration of acid-base status and replacement of lost potassium.

WATERY DIARRHOEA AND AN ISLET CELL TUMOUR

It is suggested that there are two hormonal syndromes associated with noninsulin-secreting islet cell tumours and this case is an example of the non-gastrin-secreting type with watery diarrhoea and hypokalaemia. The patient had histamine-fast achlorhydria and a normal gastric biopsy and no gastrin was recovered from the tumour tissue. The watery diarrhoea was isosmotic with plasma and was increased by an intravenous saline load. There was a dramatic response to steroids.

GASTRIC EPITHELIUM IN THE DUODENUM

It has been found that a ;gastric' type of epithelium tends to develop in the first part of the duodenum in patients with duodenal ulceration and is found in the second part of the duodenum in a patient with the Zollinger-Ellison syndrome. It is likely that ;gastric' epithelium appears when the duodenal acidity is high and it is resistant to ulceration.

Diarrhea caused by pancreatic islet cell tumours

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