Hypokalemic rhabdomyolysis due to watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vipoma. 2009

Rizwan Kibria, and Sameer Ahmed, and Syed A Ali, and Christopher J Barde
Department of Gastroenterology, Wright State University School of Medicine, Dayton, OH 45428, USA. rekibria@gmail.com

Mild hypokalemia is common and encountered in a multitude of diseases, but severe hypokalemia leading to rhabdomyolysis is relatively rare. The watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP)-producing tumors, is an extremely rare cause of hypokalemic rhabdomyolysis and the literature is limited to one case report. We report a second case of an adult who presented with rhabdomyolysis due to severe hypokalemia. Further evaluation revealed that he had a VIP-producing pancreatic neuroendocrine tumor (NET), which was the cause of his hypokalemic rhabdomyolysis. Although rare in occurrence, a high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.

UI MeSH Term Description Entries
D007008 Hypokalemia Abnormally low potassium concentration in the blood. It may result from potassium loss by renal secretion or by the gastrointestinal route, as by vomiting or diarrhea. It may be manifested clinically by neuromuscular disorders ranging from weakness to paralysis, by electrocardiographic abnormalities (depression of the T wave and elevation of the U wave), by renal disease, and by gastrointestinal disorders. (Dorland, 27th ed) Hypopotassemia,Hypokalemias,Hypopotassemias
D008297 Male Males
D010190 Pancreatic Neoplasms Tumors or cancer of the PANCREAS. Depending on the types of ISLET CELLS present in the tumors, various hormones can be secreted: GLUCAGON from PANCREATIC ALPHA CELLS; INSULIN from PANCREATIC BETA CELLS; and SOMATOSTATIN from the SOMATOSTATIN-SECRETING CELLS. Most are malignant except the insulin-producing tumors (INSULINOMA). Cancer of Pancreas,Pancreatic Cancer,Cancer of the Pancreas,Neoplasms, Pancreatic,Pancreas Cancer,Pancreas Neoplasms,Pancreatic Acinar Carcinoma,Pancreatic Carcinoma,Acinar Carcinoma, Pancreatic,Acinar Carcinomas, Pancreatic,Cancer, Pancreas,Cancer, Pancreatic,Cancers, Pancreas,Cancers, Pancreatic,Carcinoma, Pancreatic,Carcinoma, Pancreatic Acinar,Carcinomas, Pancreatic,Carcinomas, Pancreatic Acinar,Neoplasm, Pancreas,Neoplasm, Pancreatic,Neoplasms, Pancreas,Pancreas Cancers,Pancreas Neoplasm,Pancreatic Acinar Carcinomas,Pancreatic Cancers,Pancreatic Carcinomas,Pancreatic Neoplasm
D003967 Diarrhea An increased liquidity or decreased consistency of FECES, such as running stool. Fecal consistency is related to the ratio of water-holding capacity of insoluble solids to total water, rather than the amount of water present. Diarrhea is not hyperdefecation or increased fecal weight. Diarrheas
D003969 Vipoma A tumor that secretes VASOACTIVE INTESTINAL PEPTIDE, a neuropeptide that causes VASODILATION; relaxation of smooth muscles; watery DIARRHEA; HYPOKALEMIA; and HYPOCHLORHYDRIA. Vipomas, derived from the pancreatic ISLET CELLS, generally are malignant and can secrete other hormones. In most cases, Vipomas are located in the PANCREAS but can be found in extrapancreatic sites. Diarrheogenic Tumor,Pancreatic Cholera,Verner-Morrison Syndrome,WDHA,WDHH,Watery Diarrhea Syndrome,Watery Diarrhea with Hypokalemic Alkalosis,Diarrheogenic Islet Cell Tumor,Pancreatic VIPoma,VIP-Secreting Tumor (VIPoma),Vasoactive Intestinal Peptide (VIP) Tumor,Vasoactive Intestinal Peptide-Producing Tumor,Vipoma Syndrome,WDHA Syndrome,Watery Diarrhea, Hypokalemia, and Achlorhydria Syndrome,Cholera, Pancreatic,Diarrheogenic Tumors,Pancreatic VIPomas,Syndrome, Verner-Morrison,Syndrome, Vipoma,Tumor, Diarrheogenic,Tumor, VIP-Secreting (VIPoma),Tumors, Diarrheogenic,Tumors, VIP-Secreting (VIPoma),VIP Secreting Tumor (VIPoma),VIP-Secreting Tumors (VIPoma),VIPoma, Pancreatic,VIPomas, Pancreatic,Vasoactive Intestinal Peptide Producing Tumor,Verner Morrison Syndrome,Vipomas,WDHA Syndromes
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000126 Achlorhydria A lack of HYDROCHLORIC ACID in GASTRIC JUICE despite stimulation of gastric secretion. Achylia Gastrica,Hypochlorhydria
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012206 Rhabdomyolysis Necrosis or disintegration of skeletal muscle often followed by myoglobinuria. Rhabdomyolyses
D013577 Syndrome A characteristic symptom complex. Symptom Cluster,Cluster, Symptom,Clusters, Symptom,Symptom Clusters,Syndromes

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