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Japanese Journal of Clinical Oncology 19:294-298 (1989)
© 1989 Foundation for Promotion of Cancer Research

case-report

A Case of the Watery Diarrhea-Hypokalemia-Achlorhydria Syndrome: Successful Preoperative Treatment of Watery Diarrhea with a Somatostatin Analogue

Mitsuaki Yoshioka1,*, Minoru Sakazume1, Mitsutoshi Fukagawa1, Tsuyoshi Seki1, Kenji Honma2, Katsuyuki Uchida3, Keisuke Yoshida3, Yoshio Miyake4 and Ken Yamaguchi4

1Department of Internal Medicine Gochi 2-1-1, Jou-etsu City, Niigata 943
2Surgery Jou-etsu General Hospital Gochi 2-1-1, Jou-etsu City, Niigata 943
3The First Department of Surgery, Niigata University School of Medicine lchiban-cho 754, Asahimachidori, Niigata 951
4Growth Factor Division, National Cancer Center Research Institute 1-1, Tsukiji 5-chome, Chuo-ku, Tokyo 104

*For reprints and all correspondence. Present address for correspondence: Department of Internal Medicine, Niigata Prefectural Central Hospital, 3-20, Ootemachi, Jou-etsu City, Niigata 943

Received March 13, 1989; accepted June 28, 1989

A 35-year-old man presenting with severe watery diarrhea was diagnosed as having the watery diarrhea, hypokalemia and achiorhydria (WDHA) syndrome with the elevation of plasma vasoactive intestinal peptide (VIP) level. Imaging diagnostic techniques revealed a hypervascular tumor at the tail of the pancreas as well as a solitary liver metastasis. During the patient's stay in hospital, he developed acute renal failure probably due to persistent dehydration and severe hypokalemia. Although these complications improved with artificial dialyses, severe watery diarrhea continued, which made it difficult to achieve surgical resection of the tumor. A new long-acting and potent somatostatin analogue, SMS 201–995 (Sandoz Ltd, Basel, Switzerland), was tested and was shown to be effective; after a few hours of subcutaneous injection of this agent, the watery diarrhea disappeared, which in turn improved the patient's hypokalemia, hypercalcemia and metabolic acidosis. Three weeks later, distal pancreatectomy with splenectomy and hepatic lobectomy were successfully performed, and the patient resumed his normal life. The somatostatin analogue has been reported to be useful in the long-term treatment of patients with inoperable WDHA syndrome. The present case demonstrated that short-term administration of this agent is also useful for improving the condition of WDHA patients at the preoperative stage.

Key Words: WDHA syndrome • VIPoma • Somatostatin • Watery diarrhea • Hypercalcemia


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