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[Vipoma. 9-year observations using currently available therapy methods].

K Zimmermann, T Rapp, J Binder

    Deutsche Medizinische Wochenschrift (1946)
    |February 21, 1986
    PubMed
    Summary
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    A patient with a rare pancreatic tumor causing vasoactive intestinal polypeptide (VIP) hypersecretion experienced a 13-month remission with chemotherapy. Prednisolone effectively managed severe diarrhea, while somatostatin showed dose-dependent effects.

    Area of Science:

    • Oncology
    • Endocrinology
    • Gastroenterology

    Background:

    • Vasoactive intestinal polypeptide (VIP) secreting tumors, often pancreatic carcinomas, cause severe secretory diarrhea.
    • This case involves a 61-year-old man with a VIPoma of the pancreatic tail.

    Observation:

    • The patient underwent a nine-year treatment course for VIP hypersecretion.
    • Initial chemotherapy with lomustine and 5-fluorouracil achieved a 13-month remission.
    • Streptozocin was ineffective and caused neurotoxicity (peroneal paresis).

    Findings:

    • High-dose intravenous somatostatin rapidly reduced stool output, but lower doses were ineffective.
    • Prednisolone provided significant control of massive diarrhea attacks.
    • Indomethacin, lithium, trifluoperazine, nicotinic acid, and clonidine were not effective.

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    Implications:

    • Chemotherapy can induce remission in VIPomas, but treatment strategies need careful consideration due to potential side effects.
    • Somatostatin efficacy is dose-dependent, suggesting potential for targeted therapy.
    • Prednisolone is a valuable option for managing refractory VIPoma-associated diarrhea.
    • Long-acting somatostatin analogues may offer improved long-term management prospects for VIPomas.