Images in Clinical Medicine

VIPoma

Stuart M. Lubinski, M.D., and Thomas Hendrix, M.D.

N Engl J Med 2004; 351:808August 19, 2004

Slide

Article

A 50-year-old woman presented with a five-month history of fatigue, weakness, and diarrhea. Her electrocardiogram disclosed prominent U waves and ST-segment depression. The serum potassium level was 1.6 mmol per liter, the blood urea nitrogen value was 55 mg per deciliter (19.6 mmol per liter), and the serum creatinine level was 2.0 mg per deciliter (177 μmol per liter). Other electrolyte values were as follows: serum calcium, 12.1 mg per deciliter (3.0 mmol per liter); serum sodium, 133 mmol per liter; and serum phosphorus, 3.7 mg per deciliter (1.2 mmol per liter). Detailed questioning revealed that the patient had passed approximately 2 liters of stool per day for the past six weeks and that it had had the appearance of “weak tea.” Computed tomographic scanning of the abdomen (Panel A) showed a large mass in the tail of the pancreas (arrow). The vasoactive intestinal peptide (VIP) level was 760 pg per milliliter (normal value, less than 50 pg per milliliter). The tumor was removed surgically, and postoperatively, the VIP level was 35 pg per milliliter. The tumor showed the classic neuroendocrine feature of nested cells (Panel B), with positive staining for chromogranin A (Panel C). Subsequently, the patient did well and had no further diarrhea.

Stuart M. Lubinski, M.D.
Thomas Hendrix, M.D.
Johns Hopkins University, Baltimore, MD 21287

Citing Articles (1)