American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the role of secretory diarrhea in the context of malignancy?

1. Always indicates ischemia

2. Can result from hormone-producing tumors

3. Is typically associated with inflammatory conditions

4. Always requires immediate hospitalization

The correct answer is: Can result from hormone-producing tumors

Secretory diarrhea can occur in the context of malignancy and is particularly relevant when considering hormone-producing tumors. These types of tumors can secrete various hormones or biologically active peptides that influence gastrointestinal function, leading to increased secretion of electrolytes and fluids directly into the intestinal lumen. This results in persistent diarrhea that is not related to dietary intake or absorption issues. For instance, vasoactive intestinal peptide (VIP) secreting tumors, such as VIPomas, can cause a specific form of secretory diarrhea characterized by copious watery stools. Similarly, other neuroendocrine tumors can produce substances that stimulate the gut and lead to increased secretion. While secretory diarrhea may accompany inflammatory conditions or instances requiring hospitalization, the important distinction with malignancy is the underlying hormonal influence that can manifest as persistent diarrhea independent of other factors. Understanding this relationship helps in the recognition and management of gastrointestinal symptoms in patients with cancer, guiding further diagnostics and treatment approaches tailored to the tumor type and its effects on the gastrointestinal system.