Hypercalcemia as the Presenting Finding in VIPoma

Hypercalcemia is typically associated with primary hyperparathyroidism, malignancy, vitamin D intoxication, and granulomatous disease; however, it can also be associated with a neuroendocrine tumor that secretes vasoactive intestinal polypeptide (VIP). A 74-year-old woman with a history of hypothyroidism and nephrolithiasis presented to her primary care physician with a chief complaint of diarrhea and was found to have mild hypercalcemia. A Hypercalcemia workup was initiated, and the patient was ultimately found to have elevated VIP. Although a discrete pancreatic mass was not identified, an endoscopic ultrasound with fine needle aspiration revealed a VIPoma. She was then referred to hepatobiliary surgery for the removal of the tumor. As VIPoma has a poor prognosis, early recognition and treatment are essential for improving patient outcomes.