VIP and WDHA

Abstract

Watery diarrhea with hypokalemia and achlorhydria (WDHA) often complicates the clinical course of nonbetacell adenomas of the pancreas and occasionally of other hormone-secreting tumors. This serious and frequently fatal complication is sometimes referred to as pancreatic cholera or Verner-Morrison syndrome. 1 Neither the eponymic nor the descriptive term, however, provides clues to the hormone or hormones responsible for the increased intestinal secretion of fluid and electrolytes and for other metabolic derangements—achlorhydria, hypercalcemia, hyperglycemia—associated with WDHA. Barbezat and Grossman 2 suggested that gastrin and glucagon are the responsible hormones. Sanzenbacher and his associates 3 sought to incriminate secretin or secretin-like substances. Elias et al 4 reported a patient in whom gastrininhibitory-peptide appeared to be the culprit. None of these hypotheses, however, gained much credence. More substantial is the evidence implicating VIP, the vasoactive intestinal polypeptide that was discovered and purified by Said and Mutt 5 in 1970. This polypeptide, which is