Vasoactive Intestinal Peptide—Secreting Tumor Appearing as Growth Failure

Abstract

Neural crest tumors are a known cause of intractable watery diarrhea in children. Although high levels of catecholamines and their metabolites were previously thought to be the causative agents, vasoactive intestinal peptide (VIP) has recently been implicated as the mediator of such diarrhea. In adults, high levels of VIP were found in association with the syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA), with the majority suffering from pancreatic islet cell tumors.1 We report a case of VIP-secreting ganglioneuroma in a 7-year-old boy in whom the predominant clinical picture was growth failure with intermittent secretory diarrhea and soiling. In previously reported pediatric cases, diarrhea, failure to thrive, wasting, and anorexia were the predominant symptoms.2-5Our patient is unique in that short stature with severe growth failure was a dominant feature in the absence of weight loss, malabsorption, or ill health. A growth spurt of 10 cm in the