Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Sergio Ramirez, Meghan Lytle, Enrique Togores, Jorge Parellada, Steve J. Carlan, Mario Madruga, Rodrigo M. Murillo-Alvarez
Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
Am J Case Rep 2019; 20:1723-1727
VIPomas are rare neuroendocrine tumors typically located in the pancreas. The majority of cases autonomously secret vasoactive intestinal polypeptide (VIP), which can result in profuse, refractory, watery diarrhea. The fluid and electrolyte imbalance can progress to dehydration and profound hypokalemia, resulting in the watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome. One previous case of a pancreatic VIPoma progressing to hypokalemic rhabdomyolysis has been described.
CASE REPORT: A 33-year-old woman presented with 3 months of progressive, refractory diarrhea and weakness. Her serum VIP level was elevated and imaging discovered a mass in the region of the pancreatic tail. Laparoscopic partial pancreatic resection was performed and a 3.7-cm diameter, solitary stage T2 N0 M0, well-differentiated carcinoma was removed.
CONCLUSIONS: A high index of suspicion is important when diagnosing chronic diarrhea. Minimally invasive surgery is an option in the surgical treatment of pancreatic VIPoma.
Keywords: neuroendocrine tumors, rhabdomyolysis, Vipoma