WATERY DIARRHOEA AND AN ISLET CELL TUMOUR

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.

[The Verner-Morrison syndrome. The clinical picture and pathologic anatomy]

The Verner-Morrison Syndrome is a clinically defined entity caused by an islet cell tumor of the pancreas. More than 60 cases have been described so long. The syndrome is characterized by diarrhea, hypokalemia and hypochlorhydria. In addition to a diabetic disposition, raised calcium levels and skin alterations may be present. The diagnosis is a clinical one. A pancreatic tumor should be searched for and removed. Morphologically a benign and a maligne islet cell tumor or a diffuse hyperplasia of the islets of Langerhans can be found. Until now identification of the tumor cells has not been possible. There seems no doubt that the tumor cells produce a peptide hormone. Secretin, gastric inhibitory polypeptide, vasoactive intestinal polypeptide and combinations of hormones are discussed. The results are contradictory. Theories concerning the formal and causal pathogenesis are only incomplete and unproved up to now.

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.

Two cases of "pancreatic cholera" with features of peptide-secreting adenomatosis of the pancreas

The clinical data are presented of two women with profound metabolic upset from exceptional water and electrolyte losses in diarrhoea. One had an islet-cell adenoma of the pancreas and the other abnormal islets. Gastric and pancreatic function were abnormal in both, consistent with the subsequent demonstration of a pancreatic and choleretic secretagogue in the tumour tissue and pancreatic and gastric secretagogues in circulating blood (Cleator, Thomson, Sircus, and Coombes, 1970).

Spontaneous decrease in gastric secretory response to humoral stimuli

The gastric response to pentagastrin was studied over a period of seven months in a healthy 25-year-old man without symptoms or history of gastrointestinal disease. An abrupt impairment of the gastric response to several stimulants was observed one month after starting the tests. Periodic testing since that time has shown no reversion to the type of response seen during the initial period of testing. A second subject with proved chronic duodenal ulceration presented an identical change in pattern of gastric response to stimulants.This study suggests that such a variation in the response to gastric stimulation in a subject with a normal stomach should be borne in mind when interpreting results of gastric secretory studies.

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.