Episodic electrolyte disorders and renal failure due to a rare disease: the McKittrick-Wheelock syndrome

Abstract

We describe a patient with intermittent bouts of malaise and muscle weakness due to profound electrolyte disturbances. Colonoscopy showed a giant villous adenoma of the sigmoid. The patient was diagnosed with a McKittrick–Wheelock syndrome with pre-renal disease and electrolyte disorders due to periodic rectal fluid loss. The diagnosis was delayed by the patient’s misinterpretation of the doctor’s questions. In cases where the patient’s history is contrary to what the data reveal, the expected culprit organ should be investigated early in the course of the disease. Extracting relevant and guiding information out of the patient’s history remains an important skill.

Mckittrick-Wheelock Syndrome: A Case Report

“…In the patient described in the present case, there was an episode of atrial fibrillation upon admission due to hypokalemia, which could have otherwise been fatal. Thus, early diagnosis is crucial in order to prevent renal complications as well as rectal carcinoma development [6][7][8]. Colorectal cancer has an annual progression rate of 0.43%.…”

Poorly Differentiated Neuroendocrine Tumor of the Rectum Coexistent with Giant Rectal Villous Adenoma Presenting as McKittrick-Wheelock Syndrome

“…Rectal effluent in a case report demonstrated levels 3 to 6 times higher of PGE2 from a villous adenoma [ 9 ]. Hypersecretion can also result in severe azotemia along with electrolyte imbalances that could lead to cardiac arrhythmias and, in severe cases, rhabdomyolysis or altered mental status may be seen [ 11 , 12 ].…”

Mckittrick–Wheelock syndrome: an often, overlooked complication of rectal adenomas

“…Hypokalemia and hyponatremia are frequently seen. Altered mental status may occur in severe cases of MKWS [5]. Oliguria is usually present.…”