SHM Converge Scientific Abstract ePoster Gallery-Diarrhea Caused by a Very Important Problem: The Importance of Vipoma in the Differential Diagnosis of Acute Secretory Diarrhea

Diarrhea Caused by a Very Important Problem: The Importance of Vipoma in the Differential Diagnosis of Acute Secretory Diarrhea

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This case highlights VIPoma as an important but rare cause of acute secretory diarrhea in children and adolescents. VIPomas are neuroendocrine tumors that secrete vasoactive intestinal peptide (VIP), leading to WDHA syndrome: watery diarrhea, hypokalemia, and achlorhydria. They may occur alone, with metastases, or as part of multiple endocrine neoplasia type 1 (MEN1).<br /><br />A previously healthy 15-year-old girl presented with fatigue, vomiting, watery diarrhea, and dark urine. Initial labs showed hyponatremia, hypokalemia, metabolic acidosis, and acute kidney injury. Despite aggressive fluid and electrolyte replacement, her diarrhea worsened dramatically, reaching 14 liters per day, and she developed severe oliguria requiring ICU transfer.<br /><br />Because her secretory diarrhea persisted, imaging was pursued to evaluate for an occult tumor. CT scans of the head, neck, chest, abdomen, and pelvis were negative, but abdominal MRI revealed a 6.5 cm mass near the pancreatic tail. Her VIP level returned markedly elevated at 1203 (normal 78), confirming VIPoma. A family history of hyperparathyroidism raised concern for MEN1 syndrome. She improved with octreotide therapy and later underwent surgical resection with close follow-up.<br /><br />The authors emphasize that adolescents hospitalized for presumed gastroenteritis, especially with severe dehydration, should prompt consideration of alternate diagnoses. This is particularly important because fewer than 11% of children admitted for gastroenteritis are older than 10 years. Although VIPomas are extremely rare, they can occur in pediatric patients and should be considered when secretory diarrhea is severe, persistent, and accompanied by electrolyte abnormalities.

Asset Subtitle

Sumedha Medicherla

Meta Tag

Author List Kathryn Mansel, Sumedha Medicherla

Category Clinical Vignettes

Concept VIPoma

Concept WDHA Syndrome

Concept Diarrhea

Concept Hypokalemia

Concept Vasoactive Intestinal Peptide

Distinguished Finalist

Presenter Organization Akron Children's Hospital

Presenting Author Sumedha Medicherla

Track Pediatric

Keywords

VIPoma

secretory diarrhea

WDHA syndrome

vasoactive intestinal peptide

pediatric neuroendocrine tumor

hypokalemia

acute kidney injury

octreotide therapy

MEN1 syndrome

pancreatic tail mass

VIPoma

WDHA Syndrome

Diarrhea

Hypokalemia

Vasoactive Intestinal Peptide