A 46-year-old woman presents with persistent abdominal pain, watery diarrhea, and flushing. CT reveals a 4 cm pancreatic tail mass with multiple liver metastases. Serum fasting gastrin is normal, but vasoactive intestinal peptide (VIP) is 1,200 pg/mL (normal < 75). What is the classic electrolyte triad associated with this condition?

Answer and explanation

Correct answer: A. Severe hypokalemia, hypochlorhydria, and metabolic acidosis

  1. Step 1: WDHA syndrome (Verner-Morrison syndrome) is caused by a VIP-secreting neuroendocrine tumor (VIPoma).
  2. Step 2: VIP stimulates massive intestinal secretion of water, potassium, and bicarbonate while inhibiting gastric acid.
  3. Step 3: The hallmark clinical features are Watery Diarrhea, Hypokalemia, and Achlorhydria/hypochlorhydria with high stool bicarbonate loss producing normal anion gap metabolic acidosis.
Answer
Severe hypokalemia, hypochlorhydria, and metabolic acidosis.
Why not the others: Secretory diarrhea causes hypokalemia, not hyperkalemia; gastric acid is suppressed, not increased.

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