A 1-year-old boy with a two-month history of persistent cough, loose stools, and facial flushing accompanied by weight loss. CT shows a tumor in the pancreas. Which pancreatic tumor is most likely?

A 1-year-old boy with a two-month history of persistent cough, loose stools, and facial flushing accompanied by weight loss. CT shows a tumor in the pancreas. Which pancreatic tumor is most likely?

• A. Insulinoma
• B. Gastrinoma
• C. Somatostatinoma
• D. VIPoma

Answer: (D)

A pancreatic tumor that secretes vasoactive intestinal peptide (VIP) explains this mix of symptoms. VIP stimulates water and electrolyte secretion in the intestinal lining, producing large-volume, watery diarrhea. It also causes flushing from vasodilation and can lead to weight loss from persistent diarrhea. VIP also inhibits gastric acid secretion, contributing to a different gastric picture, and can cause bronchodilation, which can contribute to coughing. That combination of watery diarrhea with flushing and weight loss is classic for VIPoma, making it the best match for this presentation. Other pancreatic endocrine tumors don’t fit this symptom cluster: insulinoma causes hypoglycemia symptoms, gastrinoma leads to ulcers from excess acid, and somatostatinoma causes diabetes with fat malabsorption and gallbladder issues.

A pancreatic tumor that secretes vasoactive intestinal peptide (VIP) explains this mix of symptoms. VIP stimulates water and electrolyte secretion in the intestinal lining, producing large-volume, watery diarrhea. It also causes flushing from vasodilation and can lead to weight loss from persistent diarrhea. VIP also inhibits gastric acid secretion, contributing to a different gastric picture, and can cause bronchodilation, which can contribute to coughing.

That combination of watery diarrhea with flushing and weight loss is classic for VIPoma, making it the best match for this presentation. Other pancreatic endocrine tumors don’t fit this symptom cluster: insulinoma causes hypoglycemia symptoms, gastrinoma leads to ulcers from excess acid, and somatostatinoma causes diabetes with fat malabsorption and gallbladder issues.