SHM Converge Scientific Abstract ePoster Gallery-Chronic Diarrhea and Hypokalemia: A Case of Vipoma Unveiled After Multiple Hospitalizations

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This case describes a 61-year-old woman with a two-year history of chronic watery, clear, odorless diarrhea associated with weakness, muscle cramps, and recurrent hypokalemia. Her medical history included hypertension, type 2 diabetes, microscopic colitis, hyperlipidemia, and obesity. Over multiple hospitalizations, her symptoms were initially attributed to more common causes such as gastroenteritis, semaglutide (Ozempic) side effects, and microscopic colitis.<br /><br />During the current admission, stool studies were negative for infectious pathogens, prompting further evaluation. Serum vasoactive intestinal polypeptide (VIP) was markedly elevated at 280 pg/mL, raising suspicion for VIPoma. CT imaging showed a fluid-filled colon and pneumobilia. Endoscopic ultrasound (EUS) identified a small 9 mm by 7 mm mass in the uncinate process of the pancreas, and biopsy confirmed a grade 1 VIPoma.<br /><br />VIPomas are rare pancreatic neuroendocrine tumors that secrete VIP and classically cause watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome). Because these tumors are uncommon and symptoms overlap with more frequent gastrointestinal disorders, diagnosis is often delayed. This case underscores how diagnostic bias and common alternative explanations can lead to repeated hospitalizations before the underlying cause is identified.<br /><br />The patient was treated with cryoablation and octreotide, resulting in a favorable clinical outcome. The report emphasizes the importance of maintaining a high index of suspicion for rare endocrine tumors in patients with persistent diarrhea and unexplained electrolyte disturbances, and highlights the value of advanced imaging such as EUS when routine workups are unrevealing.

Asset Subtitle

Ibrahim Shanti

Meta Tag

Author List Abdu Mohammed, Adamsegd Isac Gebremedhen, Ibrahim Shanti, Malik Samardali

Category Clinical Vignettes

Concept VIPoma

Concept WDHA Syndrome

Concept Watery Diarrhea

Concept Hypokalemia

Concept Vasoactive Intestinal Peptide

Distinguished Non-Finalist

Presenter Organization Internal Medicine Resident

Presenting Author Ibrahim Shanti

Track Adult

Keywords

VIPoma

watery diarrhea

hypokalemia

pancreatic neuroendocrine tumor

WDHA syndrome

vasoactive intestinal polypeptide

endoscopic ultrasound

uncinate process

octreotide

cryoablation

VIPoma

WDHA Syndrome

Watery Diarrhea

Hypokalemia

Vasoactive Intestinal Peptide