Neoplastic hypersecretion of the hormone vasoactive intestinal peptide is associated with which of the following features?

Patients characteristically present with intermittent severe diarrhea, typically of a watery nature, averaging 5 liters/day. Malabsorption and steatorrhea are not common. Hypokalemia results from the fecal loss of large amounts of potassium (up to 400 meq/day), and low serum potassium levels may be associated with muscular weakness, lethargy, and nausea. Most patients are hypochlorhydric or achlorhydric. Half of the patients have some degree of hyperglycemia and hypercalcemia, while cutaneous flushing can be observed in a minority of patients. The diagnosis of VIPoma is typically made after excluding other more common causes of diarrhea. The active agent in the VIPoma syndrome is usually vasoactive intestinal polypeptide (VIP), with a minority of patients having elevations of other candidate mediators such as peptide histidine-isoleucine (PHI) or prostaglandins.