Unremitting watery diarrhoea in early childhood period
Palittiya Sintusek1, Thanita Thammarakcharoen2, Shanop Shuangshoti3
1Department of Pediatrics, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand.
Insights
A rare neuroblastic tumor caused intractable diarrhea and hypertension in a child. Prompt diagnosis via vasoactive intestinal peptide (VIP) measurement and imaging led to curative tumor removal and symptom resolution.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Oncology
- Endocrinology
Background:
- Chronic watery diarrhea can indicate gastrointestinal or systemic diseases.
- Early diagnosis of secretory diarrhea is critical for patient outcomes.
Observation:
- A 17-month-old boy presented with intractable diarrhea, failure to gain weight, refractory tachycardia, and severe hypertension.
- Symptoms suggested catecholamine hypersecretion, a known complication of neuroblastic tumors.
Findings:
- Neuroblastic tumors can cause vasoactive intestinal peptide (VIP) overexpression, leading to secretory diarrhea.
- Plasma VIP measurements were crucial for diagnosing VIP-secreting neuroblastic tumors.
- Imaging studies identified and localized the neuroblastic tumor.
Implications:
- Surgical removal of the neuroblastic tumor resulted in complete symptom resolution, demonstrating curative potential.
- Highlights the importance of considering neuroblastic tumors in pediatric cases with refractory diarrhea and hypertension.
- Emphasizes the diagnostic value of plasma VIP levels in identifying VIP-secreting tumors.
Abstract:
Chronic watery diarrhoea can be a presentation of gastrointestinal disease itself or a less-evident systemic disease. A 17-month-old boy presented with intractable diarrhoea, failure to gain weight, refractory tachycardia and severe hypertension. The ability to recognise and make a quick diagnosis of secretory type of diarrhoea dictated the outcome of patients with this ailment. Catecholamine hypersecretion was considered with the additional clues of refractory tachycardia and hypertension, a well-recognised phenomenon of neuroblastic tumours. A neuroblastic tumour can lead to vasoactive intestinal peptide (VIP) overexpression, which may result in secretory diarrhoea. In this situation, measurements of plasma VIP enabled crucial diagnosis. Imaging studies were used to identify and localise a neuroblastic tumour. Subsequent removal of the tumour was curative and led to the resolution of the symptoms.
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