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Jon Older, DO; Penny Older, DO; Joel Colker, MD; Robert Brown, MD

Arch Intern Med. 1999;159:879-880.

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.

From the Departments of Medicine (Drs J. Older and Colker) and Pathology (Drs P. Older and Brown), Berkshire Medical Center, Pittsfield, Mass.

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