[Metastasizing pancreatic vipoma. Its diagnosis and therapy with the somatostatin analog octreotide].
METHODS
An 82-year-old woman was hospitalized for anaemia of 4.8 g/dl after having suffered for about one year from watery treatment-resistant diarrhoea, causing a weight loss of ca. 10 kg.


RESULTS
Computed tomography, magnetic resonance imaging and endosonography revealed a 2.5 x 2.0 cm space-occupying mass in the body of the pancreas. Taking into account electrolyte abnormalities (potassium 2.7 mmol/l), marked metabolic acidosis (pH 7.16, base excess -20.3 mmol/l) and achlorhydria, an increased serum concentration of vasoactive peptide (VIP) of 548.5 pmol/l confirmed a VIPoma. Somatostatin-receptor scintigraphy also demonstrated a metastasis, 1.8 cm in diameter, in the region of the right ovary.


METHODS
Under administration of somatostatin analogue octreotide (150 micrograms three times daily subcutaneously) the symptoms quickly disappeared and the stools as well as electrolyte and acid-base balances became normalized. After 5 months of treatment the levels of VIP, pancreatic enzymes and gastrin were within normal limits or clearly suppressed. There has been no recent evidence of tumour progression.


CONCLUSIONS
This case demonstrates so far successful suppression of a metastasizing VIPoma with the somatostatin analogue octreotide, the metastasis having been revealed first by somatostatin-receptor scintigraphy.
Scheffold
N
N
Medizinische Klinik I, Städtisches Krankenhaus Heilbronn.
Arnold
R
R
Cyran
J
J
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002908:Chronic Disease; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D010051:Ovarian Neoplasms / Q000556:secondary*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D012074:Remission Induction; D003969:Vipoma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide
Metastasierendes Pankreas-VIPom. Diagnostik und Therapie mit dem Somatostatin-Analogon Octreotid.