title: Indomethacin therapy effective in a patient with depletion syndrome from secretory villous adenoma.
abstract: This paper details the case of a 26-year-old woman with depletion syndrome and the effectiveness of her treatment with indomethacin. Villous adenomas are benign neoplasms with a high incidence of becoming malignant. A small percentage of villous adenomas are known to cause depletion syndrome, also referred to as the McKittrick-Wheelock syndrome, a condition characterised by secretory diarrhoea, dehydration, hyponatremia, hypokalaemia, hypochloraemia, metabolic acidosis and acute renal failure. Prostaglandin-E2 mediates the hypersecretion mechanism observed in depletion syndrome, and can be inhibited by cyclo-oxygenase inhibitors. This case study measured the effectiveness of prostaglandin inhibition on a patient with oral and parenteral electrolyte replacement refractory depletion syndrome. Fluid loss and prostaglandin levels were measured before and after pharmacological treatment. This case demonstrates a 49% decrease in rectal effluent and a marked commensurate decrease in daily replenishment requirements within 48 hours of indomethacin treatment initiation, resulting in subsequent electrolyte stabilisation.
authors.affiliation: Department of Psychiatry, Kern Medical, Bakersfield, California, USA.
authors.forename: Matthew David
authors.identifier: http://orcid.org/0000-0002-1052-4874
authors.initials: MD
authors.lastname: Kagan
authors.affiliation: Department of Internal Medicine, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA.
authors.forename: Kara
authors.identifier: http://orcid.org/0000-0001-7563-2844
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Ross University School of Medicine, North Brunswick, New Jersey, USA.
authors.forename: Gurtej
authors.initials: G
authors.lastname: Sangha
mesh_terms: D018253:Adenoma, Villous / Q000150:complications*; D000328:Adult; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000188:drug therapy* / Q000209:etiology; D007010:Hyponatremia / Q000188:drug therapy* / Q000209:etiology; D007213:Indomethacin / Q000627:therapeutic use*; D011188:Potassium / Q000627:therapeutic use; D011453:Prostaglandins / Q000032:analysis; D012004:Rectal Neoplasms / Q000150:complications*; D012007:Rectum / Q000737:chemistry; D013148:Spironolactone / Q000627:therapeutic use; D013577:Syndrome
chemical_list: D016861:Cyclooxygenase Inhibitors; D004232:Diuretics; D011453:Prostaglandins; D013148:Spironolactone; D011188:Potassium; D007213:Indomethacin