• Watery diarrhoea hypokaleamia and achlorhydria (WDHA)
• Verner - Morrison syndrome (1958)
• 1 in 10 000 000 per year
• 90% arise in the pancreas
• 10% extrapancreatic may come from sympathetic chain or adrenal medulla (may secrete catecholamines)
• 50% are malignant

Clinical Features

• Secretory diarrhoea without steatorrhoea
• 80% have at least 3L /day
• Volume < 700mls excludes the diagnosis
• Severe dehydration and weakness
• Hypokalaemic acidosis
• Hypochlorhydria-inhibition of gastric acid
• Hypercalcaemia in 50% ( PTHrP)
• Glucose intolerance
• Flushing

Diagnosis

• VIP > 60 mol/l
• Clinical features
• Imaging: CT, Octreotide, Angiography

Management

• Surgery
• Hepatic embolisation
• Octreotide or Lanreotide
• Chemotherapy 80% respond to streptozocin and 5 Flurouracil
• Hepatic embolisation
• Excellent response to chemotherapy