- 期刊
VIPoma／水狀腹瀉症候群：一病例報告
VIPoma/Watery Diarrhea Syndrome: Report of a Case
摘要
VIPoma，臨床上是以水狀、分泌性腹瀉、低血鉀症、低血氣症為特徵來表現。有時被稱之為”WDHA syndrome”即watery diarrhea, hypokalemia, achlorhydria症候群。我們報告一個76歲男性病人，原患有肺癌，曾接受放射線治療，病程穩定。約二年後病人有嚴重的腹瀉，經他院診斷為躁激性大腸症給予治療，但病情仍逐漸惡化，而有脱水現象。當病人來本院門診時，有姿勢性低血壓及低血鉀症，加上外院已作的影像檢查有胰臟部位腫瘤及檢驗數據，我們即高度懷疑為VIPoma。經病理穿刺切片診斷為胰島細胞瘤，使用octreotide後有緩解腹瀉的效果。經與病人討論後作腫瘤之切除，術後病人症狀完全緩解。以後血清經美國杜克大學測量VIP值及本院隨後之特殊免疫染色，約證實為VIPoma。病人已追蹤二年了無任何復發的跡象。
並列摘要
VIPoma, also named ”WDHA” is characterized by watery diarrhea, hypokalemia, achlorhydria. We report a 76 years old man with previous history of lung cancer which was stable with radiotherapy. The patient developed severe diarrhea two years after the diagnosis of lung cancer. He was initially managed as having irritable bowel syndrome. However, the disease progressed to the extent that he passed up to three liters of stool a day. The illness made him dehydrated and frequent emergency room visits were needed. When he was first seen in the clinic of our cancer center he had postural hypotension and hypokalemia. Based on the pancreatic mass on CT-imaging study and other laboratory tests done at an outside hospital, we suspected that he had VIPoma. The fine needle aspiration from the pancreatic mass confirmed an islet cell adenoma. The diarrhea responded to the administration of subcutaneous octreotide initially. After the discussion with patient and his family, they agreed to proceed with resection of the pancreatic mass. The patient completely recovered from his diarrhea soon after the operation. Subsequently, the serum VIP assay performed at Duke University Medical Center and special immunohistochemical stain done at our institution confirmed the diagnosis of VIPoma. The patient has been followed far two years without any sign of recurrence.