title: Large cell carcinoma with calcitonin and vasoactive intestinal polypeptide-associated Verner-Morrison syndrome.
abstract: Verner-Morrison syndrome, characterized by diarrhea, hypokalemia, and hypochlorhydria, is caused most commonly by vasoactive intestinal polypeptide-secreting islet cell tumors of the pancreas. Verner-Morrison syndrome has not been described as a paraneoplastic syndrome in non-small cell lung cancer. We describe a 38-year-old man with metastatic non-small cell lung cancer of large cell carcinoma with neuroendocrine differentiation who presented with bone metastasis and intractable secretory diarrhea that was unresponsive to pharmacological treatment, including octreotide. Laboratory evaluation indicated elevated serum calcitonin and vasoactive intestinal polypeptide levels. Chemotherapy resulted in a transient response in the patient's diarrhea and neuroendocrine markers. The patient did not respond to further therapy and died 5 months after onset of back pain. To our knowledge, this is the first published case of large cell carcinoma with neuroendocrine differentiation associated with treatment-responsive paraneoplastic Verner-Morrison syndrome.
authors.affiliation: Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. pratz.keith@mayo.edu
authors.forename: Keith W
authors.initials: KW
authors.lastname: Pratz
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ma
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Aubry
authors.forename: Terri J
authors.initials: TJ
authors.lastname: Vrtiska
authors.forename: Charles
authors.initials: C
authors.lastname: Erlichman
mesh_terms: D000328:Adult; D002116:Calcitonin / Q000378:metabolism*; D018287:Carcinoma, Large Cell / Q000378:metabolism*; D006801:Humans; D008175:Lung Neoplasms / Q000378:metabolism*; D008297:Male; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000209:etiology*; D009384:Paraneoplastic Endocrine Syndromes / Q000209:etiology*; D014660:Vasoactive Intestinal Peptide / Q000378:metabolism*; D003969:Vipoma / Q000188:drug therapy / Q000209:etiology*
chemical_list: D014660:Vasoactive Intestinal Peptide; D002116:Calcitonin; D015282:Octreotide