Definition	pancreatic NET (80-90 %) with excessively elevated secretion of VIP (vasoactive intestinal peptide) original lit.:Verner et al. 1958 (Am J Med), Bloom et al. 1973 (Lancet)
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Incidence	Incidence: 0.05 - 0.2 - 0.5 per 1 Mill./year
Pathology - Pathophysiology	mostly large and solitary tumors located in the pancreatic tail ( 50 % ) , frequently malignant ( 80 % ) extrapancreatic vipomas: carcinoids, lung cancer, pheochromo---cytoma, ganglioneuroma Diarrhea: VIP effect upon transport of elektrolytes and water - secondary hypokalemia Hypochlorhydria: inhibition of gastric acid secretion; flush: vasodilation
Clinical	Typical clinical syndrome Verner-Morrison-Syn. - WDHA-Syn. - pancreatic "cholera" 1. watery diarrhea (WD) - 100 %; loss of 3 - 5 liters / day 2. hypokalemia (H) - 100 %; < 3 mmol/l 3. achlorhydria (A) - 100 % other symptoms: weight loss, abdominal pain, colics, flush (urticaria)
Diagnosis	Laboatory: elevated plasma conc. of VIP > 200 pg/ml, often 500 - 1000 pg/ml hypokalemia ( < 2.5 mmol/l), hypochlorhydria with normal pentagastrin stimulation, sometimes hypercalcemia, hyperglycemia frequent cosecretion of PP, calcitonin, GIP, secretin, prostaglandins
Therapy- Strategies	Surgical resection - surgery of liver (metastases) - chemoperfusion and -embolisation - chemotherapy symptoms : fluid supplementation (5 liters/day)- potassium substitution ( > 350 mval/day), somatostatin analogs, diarrhea: corticosteroids, clonidin, lithium, indomethacin, metoclopramid, loperamid
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