The McKittrick–Wheelock syndrome: a rare cause of curable diabetes

Abstract

SummaryMcKittrick–Wheelock syndrome (MWS) is a rare consequence of severe dehydration and electrolyte depletion due to mucinous diarrhoea secondary to a rectosigmoid villous adenoma. Reported cases of MWS commonly describe hypersecretion of mucinous diarrhoea in association with dehydration, hypokalaemia, hyponatraemia, hypochloraemia and pre-renal azotemia. Hyperglycaemia and diabetes are rarely reported manifestations of MWS. Herein we describe the case of a 59-year-old woman who presented with new-onset diabetes and severe electrolyte derangement due to a giant rectal villous adenoma. Subsequent endoscopic resection of the tumour cured her diabetes and normalised electrolytes. This case describes a rare cause of ‘curable diabetes’ and indicates hyperaldosteronism and/or whole-body potassium stores as important regulators of insulin secretion and glucose homeostasis.Learning pointsMcKittrick–Wheelock syndrome (MWS) is typically characterised by the triad of pre-renal failure, electrolyte derangement and chronic diarrhoea resulting from a secretory colonic neoplasm.Hyperglycaemia and new-onset diabetes are rare clinical manifestations of MWS.Hyperaldosteronism and/or hypokalaemia may worsen glucose tolerance in MWS.Aggressive replacement of fluid and electrolytes is the mainstay of acute management, with definitive treatment and complete reversal of the metabolic abnormalities being achieved by endoscopic or surgical resection of the neoplasm.

Síndrome de McKittrick-Wheelock. Una causa infrecuente de hipokalemia e injuria renal aguda. Caso clínico

“…Se han comunicado casos en que se ha producido invaginación o prolapso rectal 1,5 . Muy rara vez el adenoma velloso puede asociarse a diabetes mellitus, la que desaparece después de la extirpación del tumor; acompañarse de infección por Clostridium difficile o coexistir junto a un síndrome de Cronkhite-Canada 5,10,11,13 . El tratamiento inmediato del SMKW consiste en la hidratación y reposición de electrolitos, para corregir la hipovolemia y alteraciones metabólicas; y posteriormente la resección del tumor.…”

Chronic Diarrhea with Renal Insufficiency and Electrolyte Disturbances due to a Large Rectal Polyp

“…Untreated MWS can lead to a mortality of 100%. However, if treated correctly and in time, the condition should be completely reversible [2,5].…”

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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.…”

“…Hyperglycemia and new-onset diabetes are very rare complications [5]. Other complications and comorbidities reported in literature include pseudo-obstruction, intussception, rectal prolapse, rhabdomyolysis, Clostridium difficile induced diarrhea and endocarditis [1].…”

“…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.…”