Vasoactive Intestinal Polypeptide (VIP), Plasma

Optimal Result: 0 - 58.8 pg/mL.

Vasoactive intestinal peptide (= VIP) is a neurotransmitter, widely distributed through the central and peripheral nervous system with the highest concentration occurring in the submucosal postganglionic intrinsic nerves of the intestinal tract

Normally VIP has a low blood concentration and does not change with meals.

What are the functions of Vasoactive intestinal peptide?

VIP is considered a hormone and is found in the pancreas, intestine, and central nervous system. It has many functions in the body, such as:

→ functions as a neuromodulator and neurotransmitter

→ helping to control the secretion of water, salts, enzymes, and gastric acid during digestion. 

→ regulates smooth muscle activity, epithelial cell secretion, and blood flow in the gastrointestinal tract 

→ being a potent vasodilator [open (dilate) blood vessels]

→ has effects on the immune system and the central nervous system. 

→ it functions as a neurohormone and paracrine mediator, being released from nerve terminals and acting locally on receptor-bearing cells.

Certain tumors in the pancreas make large amounts of vasoactive intestinal peptide. Vasoactive intestinal polypeptide secreting tumors (VIPomas) are very rare pancreatic neuroendocrine tumors (PNETs) associated with profuse diarrhea. The VIPoma syndrome is also known as Verner-Morrison syndrome, watery diarrhea, hypokalemia, and hypochlorhydria or achlorhydria (WDHA) syndrome, and pancreatic cholera syndrome. VIPomas are functional neuroendocrine tumors that secrete excessive amounts of VIP. VIPoma tumors present as sporadic, solitary pancreatic neoplasias (= abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should).

References:

Sandhu S, Jialal I. ViPoma. 2022 Jun 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29939520.

Iwasaki M, Akiba Y, Kaunitz JD. Recent advances in vasoactive intestinal peptide physiology and pathophysiology: focus on the gastrointestinal system. F1000Res. 2019 Sep 12;8:F1000 Faculty Rev-1629. doi: 10.12688/f1000research.18039.1. PMID: 31559013; PMCID: PMC6743256.

Vu JP, Larauche M, Flores M, Luong L, Norris J, Oh S, Liang LJ, Waschek J, Pisegna JR, Germano PM. Regulation of Appetite, Body Composition, and Metabolic Hormones by Vasoactive Intestinal Polypeptide (VIP). J Mol Neurosci. 2015 Jun;56(2):377-87. doi: 10.1007/s12031-015-0556-z. Epub 2015 Apr 23. PMID: 25904310; PMCID: PMC4458420.

Una Cidon E. Vasoactive intestinal peptide secreting tumour: An overview. World J Gastrointest Oncol. 2022 Apr 15;14(4):808-819. doi: 10.4251/wjgo.v14.i4.808. PMID: 35582098; PMCID: PMC9048535.

Schizas D, Mastoraki A, Bagias G, Patras R, Moris D, Lazaridis II, Arkadopoulos N, Felekouras E. Clinicopathological data and treatment modalities for pancreatic vipomas: a systematic review. J BUON. 2019 Mar-Apr;24(2):415-423. PMID: 31127985.

Ito T, Igarashi H, Jensen RT. Pancreatic neuroendocrine tumors: clinical features, diagnosis and medical treatment: advances. Best Pract Res Clin Gastroenterol. 2012 Dec;26(6):737-53. doi: 10.1016/j.bpg.2012.12.003. PMID: 23582916; PMCID: PMC3627221.

Jensen RT, Cadiot G, Brandi ML, de Herder WW, Kaltsas G, Komminoth P, Scoazec JY, Salazar R, Sauvanet A, Kianmanesh R; Barcelona Consensus Conference participants. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95(2):98-119. doi: 10.1159/000335591. Epub 2012 Feb 15. PMID: 22261919; PMCID: PMC3701449.

Halfdanarson TR, Rubin J, Farnell MB, Grant CS, Petersen GM. Pancreatic endocrine neoplasms: epidemiology and prognosis of pancreatic endocrine tumors. Endocr Relat Cancer. 2008 Jun;15(2):409-27. doi: 10.1677/ERC-07-0221. PMID: 18508996; PMCID: PMC2693313.

Ghaferi AA, Chojnacki KA, Long WD, Cameron JL, Yeo CJ. Pancreatic VIPomas: subject review and one institutional experience. J Gastrointest Surg. 2008 Feb;12(2):382-93. doi: 10.1007/s11605-007-0177-0. PMID: 17510774.

Smith SL, Branton SA, Avino AJ, Martin JK, Klingler PJ, Thompson GB, Grant CS, van Heerden JA. Vasoactive intestinal polypeptide secreting islet cell tumors: a 15-year experience and review of the literature. Surgery. 1998 Dec;124(6):1050-5. doi: 10.1067/msy.1998.92005. PMID: 9854582.

Yao JC, Eisner MP, Leary C, Dagohoy C, Phan A, Rashid A, Hassan M, Evans DB. Population-based study of islet cell carcinoma. Ann Surg Oncol. 2007 Dec;14(12):3492-500. doi: 10.1245/s10434-007-9566-6. Epub 2007 Sep 26. PMID: 17896148; PMCID: PMC2077912.

Thompson R, Landry CS. Multiple endocrine neoplasia 1: a broad overview. Ther Adv Chronic Dis. 2021 Aug 12;12:20406223211035288. doi: 10.1177/20406223211035288. PMID: 34413971; PMCID: PMC8369854.

What does it mean if your Vasoactive Intestinal Polypeptide (VIP), Plasma result is too high?

Values >75 pg/mL may indicate presence of enteropancreatic tumor causing hypersecretion of vasoactive intestinal polypeptide (VIP).

Values >200 pg/mL are strongly suggestive of VIP producing tumors (VIPoma).

Oversecretion of VIP from VIPomas is responsible for the rare Verner-Morrison or WDHA (watery diarrhea, hypokalaemia, achlorhydria) syndrome. It is characterized by profuse watery diarrhea, dehydration, hypotension, flushing, intestinal ileus, hypokalaemia, achlorhydria, hypomagnesaemia and metabolic acidosis. Hyperglycaemia and hypercalcaemia can also occur. While achlorhydria or hypochlorhydria distinguishes this diarrhoeal syndrome from gastrinoma, absence of this feature in some VIPoma patients is possible.

Pancreatic VIPomas (90%) are commonly located in the body and tail of pancreas while extra-pancreatic VIPomas occur in the autonomic nervous system.

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