Secretory Villous Adenomas That Cause Depletion Syndrome

Abstract

Secretory villous adenomas of the colon have been known to cause a depleting syndrome characterized by dehydration, prerenal azotemia, hyponatremia, hypokalemia, metabolic acidosis, obtundation, and, in severe cases, death. We describe 1 case of classic depleting syndrome and review the literature on possible mechanisms. Both cyclic adenosine monophosphate and prostaglandin E2 have been implicated as possible secretagogue compounds in the pathogenesis of this syndrome unique to the secretory variant form of villous adenomas. Indomethacin as a prostaglandin inhibitor has been used with apparent benefit in controlling the volume of rectal effluent in patients with secretory villous adenomas.

Mckittrick-Wheelock Syndrome: A Case Report

“…Approximately 2% of patients with rectosigmoidal villous adenoma develop hypersecretory complications [3]. Fluid reabsorption was likely inhibited in the patient in the present case due to the limited remaining amount of normal colonic mucosa as a result of the distal villous adenoma [4]. The abnormal secretary function in this syndrome is thought to be mediated by secretagogues.…”

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“…It is defined by the triad of electrolyte disorders, kidney injury secondary to fluid depletion and chronic secretory diarrhea caused by a large rectal neoplasm [1][2][3][4][5][6][7][8][9][10]. Renal adaption and increased oral intake may initially compensate for the fluid and electrolyte losses.…”

“…Secretory villous adenomas, in contrast to non-secretory villous adenomas, contain multiple goblet cells producing mucus [9]. The mucus production can be mediated by cyclic adenosine monophosphate (cAMP) and stimulated by secreatagogues such as prostaglandins, cytokines and neuropeptides [13].…”

“…Proportional to the size, these secretory polyps can produce an abundant amount of rectal discharge and consequentially can cause hypovolemia, renal insufficiency and profound electrolyte disturbances. This rare disorder is known as the McKittrick-Wheelock syndrome (MWS) [1][2][3][4][5][6][7][8][9][10]. Treatment is initially based on volume resuscitation and on correction of the electrolyte disturbances.…”

The McKittrick-Wheelock Syndrome: A Case of Acute Renal Failure Due to Neoplastic Cholera

“…[3] Cases of mucus hypersecretion from villous adenomas causing dehydration, hyponatremia, hypokalemia, and hypochloremia have been reported. [3][4][5][6][7][8] The majority of these describe a concomitant metabolic acidosis, secondary to pre-renal failure. [4,5,7] More unusually, metabolic alkalosis, presumed secondary to hypokalemia, has been described in one case report.…”