VIPoma differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]Parminder Dhingra, M.D. [3]
Overview
VIPoma must be differentiated from ganglioneuroblastoma, ganglioneuroma, factitious diarrhea, bilt salt enteropathy, rectal vilous adenomas, and laxative abuse.[1][2]
Differential Diagnosis
VIPoma must be differentiated from:[1]
- Ganglioneuroblastoma
- Ganglioneuroma
- Enterotoxin production by Vibrio cholera and E.coli
- Rectal vilous adenomas
- Bile salt entropathy
- Factitious diarrhea
- Laxative abuse
The table below summarizes the findings that differentiate watery causes of chronic diarrhea[3][4][5][6]
Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |||
---|---|---|---|---|---|---|---|---|
< 50 mOsm per kg | > 50 mOsm per kg* | |||||||
Watery | Secretory | Crohns | + | - |
|
|
|
|
Hyperthyroidism | + | - |
|
|||||
VIPoma | + | - |
|
|
|
| ||
Osmotic | Lactose intolerance | - | + |
|
||||
Celiac disease | - | + |
|
|
|
|||
Functional | Irritable bowel syndrome | - | - |
Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
History of straining is also common |
|
|
|
VIPoma must be differentiated from diseases that cause abdominal pain and chronic diarrhea. The table below summarizes the findings that differentiate watery causes of chronic diarrhea:[7][3][4][5][6]
Cause | Osmotic gap | History | Physical exam | Gold standard for diagnosis | |
---|---|---|---|---|---|
< 50 mOsm per kg | > 50 mOsm per kg* | ||||
Zollinger-Ellison syndrome | + | - |
|
Gastrin levels | |
Crohn's disease | + | - |
|
|
|
Hyperthyroidism | + | - |
|
||
VIPoma | + | - |
|
|
|
Lactose intolerance | - | + |
| ||
Celiac disease | - | + |
|
|
|
Irritable bowel syndrome | - | - |
Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
History of straining is also common. |
|
|
References
- ↑ 1.0 1.1 Reindl T, Degenhardt P, Luck W, Riebel T, Sarioglu N, Henze G; et al. (2004). "[The VIP-secreting tumor as a differential diagnosis of protracted diarrhea in pediatrics]". Klin Padiatr. 216 (5): 264–9. doi:10.1055/s-2004-44901. PMID 15455292.
- ↑ Elshafie O, Grant C, Al-Hamdani A, Jain R, Woodhouse N (2011). "VIPoma Crisis: Immediate and life saving reduction of massive stool volumes on starting treatment with octreotide". Sultan Qaboos Univ Med J. 11 (1): 104–7. PMC 3074686. PMID 21509215.
- ↑ 3.0 3.1 Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
- ↑ 4.0 4.1 Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
- ↑ 5.0 5.1 Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
- ↑ 6.0 6.1 RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
- ↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.