Answer is B (Secretory Diarrhoea) The principle feature of VIPOMA is large volume secretory Diarrhoea. Diarrhoea is secretory in nature, persists during fasting and is almost always greater than > I Litre per day (>3 Litres per day in 70 percent). A stool volume less than 700 ml per day is proposed to exclude the diagnosis. Most patients do not have accompanying Steatorrhea. VIPOMAS (Verner-Morrison Syndrome/ Pancreatic Cholera/WDHA Syndrome) VIPomas are tumours that secrete large amounts of Vasoactive Intestinal Peptide (VIP) VIP is an impoant neurotransmitter ubiquitously present in the CNS and GIT The most common location of VlPomas is the Pancreas Most common site within the pancreas is the pancreatic tail Usually Solitary Usually Malignant (37-68 % have hepatic metastasis at diagnosis VIP Stimulates Small Intestinal chloride secretion Stimulates smooth muscle contractility Inhibits acid secretion Has vasodilatory effects Typical Features (WDHA) Watery Diarrhoea (Large Volume Secretory Diarrhoea leading to dehydration) Hypokalemia (Diarrhoea severe enough to cause hypokalemia) Achlorhydria (Hypochlorhydria from increased small intestinal chloride secretion) The principle Symptoms are large volume diarrhoea (100 %) severe enough to cause hypokalemia (80-100%), dehydration (83%), hypochlorhydria (54-76%) and flushing (20%) Most patients do not have accompanying Steatorrhea Other Features Increased stool Volume due to increased secretion of sodium and potassium which with the anion account for osmolality of the stool Hyperglycemia (25-50% Hypercalcemia (25-50%) The diagnosis requires demonstration of an elevated plasma VIP level and the presence of large volume secretory diarrhea.