A case of VIPoma

Published:September 28, 2022DOI:


      • VIPoma is a rare neuroendocrine tumour with multisystem effects.
      • A multidisciplinary approach to management in a specialist centre is vital.
      • Management of electrolytes and avoidance of triggers for VIP secretion are key.
      • Reduce large changes in sympathetic tone during labour with epidural analgesia.
      • Administration of a somatostatin analogue inhibits VIP secretion.


      This case report addresses the management of a pregnant woman in the peripartum period with a VIPoma. This rare and highly malignant neuroendocrine tumour secretes vasoactive intestinal peptide (VIP), a substance that may cause potentially life-threatening disruption to physiology.
      A 36-year-old woman presented for induction of labour with a three-year history of chronic diarrhoea, hypophosphataemia, palpitations and skin flushing. Raised VIP levels indicated presence of a VIPoma, however despite extensive investigation prior to pregnancy by neuroendocrine specialists, the tumour location remained unidentified.
      The patient delivered a healthy boy with the aid of forceps in theatre following an epidural top-up. Key features of management were a multidisciplinary approach, avoidance of triggers for VIP secretion, strict management of electrolytes and avoidance of severe changes in sympathetic tone during labour with epidural analgesia.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yu R.
        Neuroendocrine tumour syndromes.
        in: Larry Jameson J. de Kretser D.M. Grossman A.B. Potts J.T. De Groot L.J. Giudice L.C. Melmed S. Weir G.C. Endocrinology: Adult and Pediatric. Saunders, Philadelphia2016: 2612
      1. BMJ Best Practice. VIPoma. Available at:;%202022. Accessed March 23, 2022.

        • Holdcroft A.
        Hormones and the gut.
        Br J Anaesth. 2000; 85: 58-68
        • Wang X.S.
        • Lau H.Y.A.
        Prostaglandin E2 potentiates the immunologically stimulated histamine release from human peripheral blood-derived mast cells through EP1/EP3 receptors.
        Allergy. 2006; 61: 503-506
      2. National Institute for Health and Care Excellence. British National Formulary. Octreotide. Available at: Accessed April 2, 2022.

        • Predescu D.
        Pancreatic neuroendocrine tumour in pregnancy - diagnosis and treatment management.
        Chir (Rom). 2019; 114: 550-563
        • Sherf S.
        • Yu R.
        Gut and pancreatic neuroendocrine tumors in pregnancy and lactation.
        in: Kovacs C.S. Deal C.L. Maternal-Fetal and Neonatal Endocrinology. Elsevier Inc, Canada2020: 411-416
        • Ramage J.K.
        • Ahmed A.
        • Ardill J.
        • et al.
        Guidelines for the management of gastro-enteropancreatic neuroendocrine (including carcinoid) tumours (NETs).
        Gut. 2012; 61: 6-32
        • Acosta-Gualandri A.
        • Kao K.T.
        • Wong T.
        • et al.
        Perioperative hypotensive crisis in an adolescent with a pancreatic VIPoma and MEN1-gene variant.
        Horm Res Paediatr. 2019; 9: 285-289
        • Ryder S.A.
        • Waldmann C.
        BJA Educ. 2004; 4: 111-113