CHRONIC REFRACTORY DIARRHEA - A MANIFESTATION OF ENDOCRINE DISORDERS

Hormonally mediated chronic refractory diarrhoeas constitute a rare bu t important group which often defy precise diagnosis when conventional routine diagnostic methods are used. Hormonal diarrhoea may occur in carcinoid syndrome, medullary carcinoma of the thyroid, thyrotoxicosis , gastrinoma, VIPoma, glucagonoma, somatostatinoma and systemic mastoc ytosis. Diagnosis of these conditions depends upon the awareness of cl inicians, on clinical features and on documentations of high circulati ng hormones, if required, by using provocative tests. Precise localiza tion of the tumours may be accomplished by ultrasonography, computeris ed axial tomography, angiography, percutaneous transhepatic portal and pancreatic venous sampling for the estimation of hormone concentratio ns. Benign tumours are removed surgically. Malignant neoplasms are tre ated either by surgery or chemotherapy depending upon the progress of the disease. Diarrhoea usually ceases when hormone levels are normaliz ed following successful treatment.